As someone who has sat through hundreds of meetings during which decisions are made about who should or should not be on transplant waiting lists, the policy did not strike me as controversial. In fact, rare in the world of organ transplants where there are so many clinical and ethical gray areas, this decision should be considered a “no brainer.”
During the course of my career, I have been closely involved in carefully considering the hundreds of factors that go into making good decisions when it comes to who among our patients — often people we knew and cared about — is listed for a life-saving transplant. It was never lost on me the awesome responsibility that we had during these selection meetings (yes, they are really called that).
And what was my overriding guiding principle? What kind of person the patient was, perhaps? Did I like them, maybe? Did they share my values?
No, none of these.
The main concerns were: Would this person do well with their transplant? And would we be using the donor’s gift effectively by giving it to this patient? In a world where 107,000 people are waiting for an organ transplant — of which 17 die every day — and where I am forced to tell family members that their loved one’s time had run out before an organ could be found, this last question was not a theoretical one.
Transplant teams are success-oriented, to put it mildly. At times, we perform transplants for people who don’t share our values, politics or life experiences. To be even more frank, we transplant people we probably wouldn’t be friends with in real life. No matter, because we have a sole purpose in mind: to save their lives.
So when it comes time to picking candidates, we do everything to stack the deck in the patient’s favor. We do a heart catheterization to rule our coronary artery disease, because we don’t want a patient to have a heart attack during the transplant operation. We check to see if the patient has hepatitis, because patients with liver problems can run into all sorts of postoperative problems. We do imaging scans and blood tests to determine if a patient has an occult cancer that could rear its ugly head after the transplant due to the pro-cancer growth effects of immunosuppressive drugs.
And we require vaccinations, including for hepatitis B and measles, mumps and rubella, because transplant doctors don’t want to take on any more risk than absolutely necessary.
Which brings us back to the coronavirus vaccine. It is indisputable that immunosuppressed transplant recipients who develop covid-19 face a significantly higher risk of death than their immunocompetent counterparts. Once infected, mortality in transplant patients ranges from 20 to 30 percent, versus less than 1 percent in age-matched people who have not had a transplant. These data in the transplant population, still emerging, are supported by the experience seen in the general population, where unvaccinated people are nearly 11 times more likely to die from covid-19, according to the Centers for Disease Control and Prevention. The verdict is in on vaccines, at least in medical and scientific circles.
So why not transplant patients who are unvaccinated? Simple. Because doing so adds risk to the transplant recipient and — this is important — we have something that can effectively mitigate that risk: vaccines.
Some may say that turning down unvaccinated patients for transplant are making “value judgments,” “trampling on personal liberties,” or worse, “making a political statement.” Nonsense.
We in the transplant community are doing what we have always done: everything we can to honor the selfless gift that a family has made to donate their loved one’s organs at a time of unimaginable grief. This unassailable mission is about doing what medicine and science tell us to do to ensure the transplant is a success. It’s not about anything other than that. And shouldn’t be.
The Colorado health system is not the only transplant program receiving criticism for its vaccination policy. Because of that, it is time for professional societies to endorse coronavirus vaccination for all potential transplant recipients and to speak with one voice so that there is consistent messaging from transplant professionals about what is the best medical practice.
Consistent messaging — isn’t that what we have been missing throughout the pandemic in so many aspects? At least in regard to organ transplantation, let’s get it right this time.