- Experts say there are a number of reasons they prefer organ transplant recipients receive vaccinations against COVID-19 as well as other diseases before surgery.
- They say a vaccinated person has a better chance of surviving the transplant if they are vaccinated beforehand.
- They also note that organ transplant recipients are also at higher risk of hospitalization and death from COVID-19 than the general public.
When a Colorado woman in need of a kidney transplant was denied the procedure last fall because she refused to get vaccinated against COVID-19, a firestorm ensued on social media about that medical decision.
The situation has come up again this week as a man who needs a heart transplant says he is being denied the surgery by a Boston hospital because he has refused to get a COVID-19 vaccination.
Organ transplant doctors, however, say health decisions around transplants – as well as vaccination and lifestyle change requirements – are nothing new.
The doctors say evidence shows that COVID-19 impacts people living with a transplanted organ on a much larger scale, so they understand why a COVID-19 vaccine could be a crucial part of a transplant procedure.
“We have a fair amount of data showing the negative consequences of COVID following a transplant,” Dr. Kapil Saharia, MPH, an assistant professor at the Institute of Human Virology and the chief of Solid Organ Transplant Infectious Diseases Service at the University of Maryland School of Medicine, told Healthline.
“Patients who have received a transplanted organ are at significant risk from COVID-19,” said Dan Weaver, a spokesperson for the University of Colorado Hospital, the organ transplant center that denied the woman’s surgery. “Should they become infected, they are at particularly high risk of severe illness, hospitalization, and death.”
They are also, he told Healthline, at higher risk for organ rejection if unvaccinated.
That means, when you look at what’s been asked of recipients in the past and what is being asked now, experts say there are several reasons, new and old, to attach requirements to a potential transplant.
Experts say the organ transplant process has long involved a partnership between the medical team and the recipient for one simple, overriding reason.
Donated organs are rare, valuable commodities, and there aren’t nearly enough of them for the people who need them.
“Transplant centers across the nation, including the UCHealth Transplant Center, have specific requirements in place to protect patients both during and after surgery,” Weaver explained.
For example, he said, potential recipients may be required to receive several vaccinations, including hepatitis, measles, mumps, and others before being approved for a transplant.
There are social requirements as well, such as avoiding alcohol, quitting tobacco, and even, Weaver said, proof that recipients “will be able to continue taking their anti-rejection medications long after their transplant surgery.”
Why?
“These requirements increase the likelihood that a transplant will be successful and the patient will avoid rejection,” Weaver said.
Saharia said that while the University of Maryland has not mandated any of those actions, they do work hard to guide potential recipients to those choices. They will sometimes make a yes or no decision based on the candidate’s choices.
“[This] happens with all vaccinations,” he said. “This is nothing new.”
Doctors may also require cardiac screenings and for recipients to cease smoking and, in the case of a liver transplant, drinking alcohol.
“These are very scarce resources,” Saharia said. “Every time we do this, we do it with the hope that we don’t just help the patient live then, but that we help the organ last.”
He added that behavior such as a vaccine refusal could hint at other potential problems going forward.
“If the situation around a candidate is such that we don’t think they can keep up with their needs post-surgery (such as taking the long-term medications required), we go slowly (in deciding on approval),” Saharia said.
COVID-19 has added a new hoop to jump through for what doctors feel is the best chance for an organ transplant.
Studies show that transplant recipients fare worse than the general population when they develop COVID-19.
Specifically, one
“This is why it is essential that both the recipient and the living donor be vaccinated and take other precautions prior to undergoing transplant surgery,” Weaver said.
Also, Saharia said, transplant doctors “believe the chances of a good response to the vaccine is much higher before a transplant operation than after. You’re going to respond far better before.”
Despite the widespread coverage of the Colorado woman, he said, the medical community is not seeing a lot of pushback on the issue.
“By and large, most candidates are getting vaccinated,” he said.
Doctors say people facing possible immune system transplants to fight diseases such as cancer are being told to wait if they aren’t vaccinated.
“I would say people should be vaccinated (against COVID-19) prior unless they are less than 3 months from (the transplant),” said Dr. Stephen J. Forman, the leader of the City of Hope’s Hematologic Malignancies and Stem Cell Transplantation Institute and the Francis & Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation in California.
If they aren’t vaccinated when they receive the transplant, they’re advised to do so afterward.
“[There’s] a lot to do to get ready and make sure all the organs are working as they should” before a transplant is approved.
Protection against COVID-19 can help that process, Forman told Healthline.
He also points out that for now, with more learning to do, all transplant patients – vaccinated or not – should take extra precautions to lower their risk of contracting the coronavirus.
“There can be a false sense of security [for an organ recipient who has been vaccinated],” he said.
He said all recipients should be reminded that while the vaccine cuts down on risk, they are still more at risk than others.