POST 232. January 28, 2022. CORONAVIRUS. “A Boston hospital’s denial of a heart transplant to a man who is unvaccinated for Covid-19 has generated national attention, but experts say mandating vaccines is in keeping with other long-standing requirements that patients have to meet to receive an organ — including getting other shots…”

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JANUARY 25, 2022

“A hospital patient in Boston is now ineligible to receive a heart transplant because he is unvaccinated, according to the patient’s family… 

The hospital said in a statement that the COVID-19 vaccine is only one of several other vaccinations required for transplants. 

“And like many other transplant programs in the United States – the COVID-19 vaccine is one of several vaccines and lifestyle behaviors required for transplant candidates in the Mass General Brigham system in order to create both the best chance for a successful operation and also the patient’s survival after transplantation.”

The hospital stated on its website that transplant candidates “must also receive the seasonal influenza and hepatitis B vaccines, follow other healthy behaviors, and demonstrate they can commit to taking the required medications” following the procedure…

“Our Mass General Brigham healthcare system requires several CDC-recommended vaccines, including the COVID-19 vaccine, and lifestyle behaviors for transplant candidates to create both the best chance for a successful operation and to optimize the patient’s survival after transplantation, given that their immune system is drastically suppressed,” the spokesperson said. 

“Patients are not active on the waitlist without this,” they added.“ (A)

JANUARY 25, 2022

“Dr. Arthur Caplan, head of Medical Ethics at NYU’s Grossman School of Medicine also told Newsweek on Tuesday that vaccination against any disease has long been recommended to patients in need of transplant surgery, as the operation makes individuals immunosuppressed and at high risk of infection.

“It is recommended that all vaccines be tried in people who are eligible for transplant – flu vaccine, measles, tetanus, etc. The idea behind that is trying to boost your immunity if possible before you get completely immunosuppressed as a result of a transplant,” said Caplan, who also specializes in transplant research.

“Any infection after a transplant could potentially kill you, from athletes foot to COVID-19. I am firmly behind the decision to say that all patients should be vaccinated in order to receive a transplant.”

Transplant patients are at such high risk of infection that even “relatives of patients should be vaccinated too,” as they pose a high risk of transmitting the disease, he added.

Caplan also noted that the issue should not be viewed as a means of discriminating against unvaccinated populations, but rather, as a way to ensure that individuals who require a transplant are receiving the best possible care.

“It has to do with trying to make sure that very scarce hearts are used in a way that maximizes the chance that recipients live. The political ideology that you are discriminating is getting confused with basic biology,” he said.

Research has suggested that transplant patients who become sick with the coronavirus have a 20 to 30 percent chance of dying, a rate that is considerably higher than the rest of the population, which sits at 1.6 percent, The Guardian reported.

A study published last summer by researchers at the University of California San Diego also found that organ transplant recipients who are vaccinated before receiving surgery were 80 percent less likely to become infected with COVID-19, as compared to their unvaccinated counterparts.” (B)

“A man seeking a kidney that could save his life is claiming that he has been denied a place on the active transplant list because of his COVID-19 vaccination status…

“Art said you’re not interested in the COVID vaccine,” UVA Hospital’s Dr. Karen Warburton said to Connors, according to a recording of the call obtained by Fox News Digital. “So, it is a requirement for you to be active.”..

“I just had COVID, so I don’t — so why would I get the vaccine?” Connors responded on the phone. However, the hospital did not budge, according to Connors.

“You may have had delta, and that may not protect you against the omicron variant, which is what we’re seeing now,” Dr. Warburton continued on the recording from Jan. 6. “So, our policy is that in order to have people active on the transplant list and get a transplant, you need to be fully vaccinated.”…

“So you’re on the list, you’re just not in an active status right now as we tie up all these other loose ends. So in order to be activated on the list, you will need to get the vaccine,” the Dr. Warburton warned Connors in the recording of the call.

“Are you willing to do it?” she asked on the phone, followed by a pause. When Connors didn’t respond, Dr. Warburton continued, “OK, so you don’t want to move forward?”..

According to the recording, Dr. Warburton went on to give Connors two options – either stay inactive on the transplant list and pray that something changes, or close out the evaluation and live with his failing kidney.

“So, what is your wish at this point? Do you want to stay inactive on the list, and see what shakes out?” Dr. Warburton asked. “Or do you want to just have us close your evaluation, or what’s your preference?””  (H)

OCTOBER 20, 2021

As vaccine mandates spur debate and anger in workplaces across the country, some on social media claim vaccines are also being cited to deny organ transplants to some patients.

“Unvaccinated organ transplant patients in Colorado removed from waitlist,” reads a graphic shared in an Oct. 6 Instagram post. 

The post, citing another Instagram post and the New York Post, claims the policy is being enforced by UCHealth, a large, nonprofit health care system based in Colorado, on all its patients and their live donors.

In an email to USA TODAY, UCHealth spokesperson Kelly Tracer confirmed that “in almost all situations, transplant recipients and living donors,” within the health system “are now required to be vaccinated against COVID-19 in addition to meeting other health requirements.”..

But that’s not quite the whole story. Immunization requirements for transplant patients are not a new policy, experts say. And UCHealth is not alone in its COVID-19 vaccine mandate: health systems nationwide are requiring or recommending the shots to ensure transplant patients – an already vulnerable group – don’t die from the virus.

Patients undergoing an organ transplant must meet certain requirements to protect them before and after surgery, said Tracer and Dr. Deepali Kumar, president-elect of the American Society of Transplantation.

People on waitlists typically already are vaccinated to protect against infectious hepatitis A and B, pneumonia, shingles and the flu, Kumar told USA TODAY…

Experts say it’s important to be vaccinated before a transplant because the vaccine is less effective if administered after a transplant due to anti-rejection medications.

UCHealth is not the only health system imposing a COVID-19 vaccine mandate for its transplant patients.

Cleveland Clinic recently announced it would also require the shot for both transplant recipients and living donors, the Associated Press reported. Existing patients need to be vaccinated before Nov. 1 or risk being placed on the inactive list.

University Hospitals of Ohio has also issued a COVID-19 vaccine requirement for its patients and their living donors, NBC News reported.

Hospital systems like the University of San Franciso Health, the University of Alabama at Birmingham Medicine, Virginia Commonwealth University Health and Massachusetts General Hospital in Boston are strongly recommending live donors and transplant patients get vaccinated before surgery.”  (C)

OCTOBER 12, 2021

The Centers for Disease Control and Prevention (CDC) currently notes that people who have had a solid organ transplant are at a higher risk for developing severe COVID-19. The CDC also warns that people who are in an immunocompromised state are more likely to get severely ill from the virus, including people who take immune-weakening medications—and transplant recipients need to take immunosuppressive medications so that their bodies don’t reject the new organ, William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, tells Health.

Infectious disease experts say the policy is fair. “To protect the recipient, you would certainly want them to be vaccinated,” Dr. Schaffner says. “The vaccine would reduce the risk they will acquire an infection, threaten their life, and make the whole organ transplant effort futile.”

It’s important that transplant patients work with physicians to get the COVID-19 vaccine the recommended amount of time before their surgery, says Richard Watkins, MD, an infectious disease physician and professor of internal medicine at the Northeast Ohio Medical University. “Being on immunosuppressive therapy can reduce the immune response after the vaccine,” he tells Health. Basically, getting the COVID-19 vaccine while you’re taking immunosuppressive medication in the time leading up to a transplant may lessen your body’s ability to build up antibodies to SARS-CoV-2, the virus that causes COVID-19, from the vaccine.

Dr. Watkins also points out that in general, organ transplant recipients are more likely to stay healthy during a pandemic if they’ve been fully vaccinated against COVID-19. “Organs are a very precious resource that must be allocated in the most fair and equitable way,” he says. “If someone chooses to not get vaccinated, they are potentially going to do less well than someone who got the vaccine.”

Overall, Dr. Schaffner says, “these policies sure do make a whole lot of sense.”” (D)

NOVEMBER 28, 2021

About one in 10 lung transplants in the United States now go to COVID-19 patients, according to data from the United Network for Organ Sharing, or UNOS.

The trend is raising questions about the ethics of allocating a scarce resource to people who have chosen not to be vaccinated against the coronavirus.

“They are accumulating on a steady basis. So it’s very much a real thing,” says David Klassen, chief medical officer for UNOS.

“If there were more lungs available for transplants, I believe the numbers would be greater than they are,” he says.

In all, 238 people across the country have received lung transplants due to COVID-19 since the first such operations were tracked in August of 2020, according to the latest UNOS figures from October of this year.

Lung transplants for COVID patients rose tenfold between the first year of the pandemic and 2021, according to UNOS data, which also shows transplants for other top lung diseases, like emphysema, cystic fibrosis and pulmonary fibrosis, are down compared to prior years.

“It’s happening in the U.S. It’s also happening in Canada. There was just a paper out from Western Canada about this causing a huge surge in the number of lung transplants there. It’s a big problem,” says David Mulligan, chair of the Yale-New Haven Health Transplantation Center…

“When somebody contracts such severe COVID that they need a lung transplant, and they got it refusing to get a vaccine, it’s a really ethical dilemma,” says Mulligan. “How can they just jump in and take a lung away from somebody who’s sick, but has been doing the best they can to take care of themselves and avoid getting COVID?”

Transplant centers weigh a lot of different factors when listing people who need an organ. But social and behavioral factors — such as how people came to be sick — are not usually among them.

People who smoked can be eligible for a lung transplant, just like people who drank alcohol in excess can also be listed for a new liver if they’ve stayed smoke-free or sober for six months.

Not judging people’s past behavior is fairly standard in medicine. But future behavior, when it comes to transplants, is fair game, according to Olivia Kates, an assistant professor of medicine at Johns Hopkins.

“I think [COVID-19 patients] should be subject to the same expectation, that they should either be vaccinated or be able to demonstrate immunity to COVID-19 going forward, so that their next set of lungs is not subject to the same risk,” Kates says.

Some transplant centers have said patients will lose their spot on the list if they are not vaccinated against coronavirus.

But some say eliminating anyone who hasn’t had a COVID vaccine from even being considered for an organ may be unfair because it could exclude racial, religious or ethnic groups that have lower vaccination rates.

The current system of waitlisting people for transplant strives for equity and prioritizes “people who can’t wait much longer for their organ, but if they get one, they have a good chance of being able to benefit and keep that organ,” says Govind Persad, who teaches bioethics and health law at the University of Denver.” (E)

JANUARY 20, 2022

More Americans are now hospitalized with COVID-19 than ever before. Their sheer numbers are overwhelming health-care workers, whose ranks have been diminished by resignations and breakthrough infections. In many parts of the country, patients with all kinds of medical emergencies now face long waits and worse care. After writing about this crisis earlier this month, I heard from a number of readers who said that the solution was obvious: Deny medical care to unvaccinated adults. Such arguments were aired last year, as the Delta variant crested, and they’re emerging again as Omicron spreads. Their rationale often goes something like this:

Every adult in the U.S. has been eligible for vaccines since April. At this point, the unvaccinated have made their choice. That choice is hurting everyone else, by perpetuating the pandemic and, now, by crushing the health-care system. Most of the people hospitalized with COVID are unvaccinated. It’s unethical that health-care workers should sacrifice for people who won’t take care of themselves. And it’s especially unethical that even vaccinated people, who did everything right, might be unable to get care for heart attacks or strokes because emergency rooms are choked with unvaccinated COVID patients.

To be clear, this debate is theoretical: Health-care workers are not denying care to unvaccinated patients, even though, ironically, many told me they’ve been accused of doing so by not prescribing ivermectin or hydroxychloroquine, which are ineffective against COVID but are often wrongly billed as lifesavers. Still, I ran this argument past several ethicists, clinicians, and public-health practitioners. Many of them sympathized with the exasperation and fear behind the sentiment. But all of them said that it was an awful idea—unethical, impractical, and founded on a shallow understanding of why some people remain unvaccinated.

“It’s an understandable response out of frustration and anger, and it is completely contrary to the tenets of medical ethics, which have stood pretty firm since the Second World War,” Matt Wynia, a doctor and ethicist at the University of Colorado, told me. “We don’t use the medical-care system as a way of meting out justice. We don’t use it to punish people for their social choices.” The matter “is pretty cut-and-dry,” Sara Murray, a hospitalist at UC San Francisco, added. “We have an ethical obligation to provide care for people regardless of the choices they made, and that stands true for our unvaccinated patients.” (F)

JANUARY 26, 2022

“A Boston hospital’s denial of a heart transplant to a man who is unvaccinated for Covid-19 has generated national attention, but experts say mandating vaccines is in keeping with other long-standing requirements that patients have to meet to receive an organ — including getting other shots.

In this case, Brigham and Women’s Hospital dropped a 31-year-old man named DJ Ferguson from its transplant waitlist, his family said. Ferguson was concerned about side effects and the speed with which the vaccines were developed, his mother told WCVB.

This is not the first such case to make headlines. Last year, both the Cleveland Clinic and University of Colorado Hospital refused to perform organ transplants for recipients who hadn’t been vaccinated.

Perhaps because of the politicization of Covid-19 vaccines more broadly, the reaction to such decisions is sometimes greeted with outrage. But ethicists and transplant physicians stress that organ allocation has to be partially determined by who can survive and thrive with a scarce resource. With so many people waiting for an organ, clinicians try to maximize the chances of a successful transplant. Hospitals don’t want to allocate an organ to people who are putting themselves at higher risk of dying after a transplant — especially since that organ can’t then go to someone else.

“The entire transplant evaluation process, which can be very long and very demanding, is about making sure patients are in the best physical, mental, and social condition to endure a transplant, and then all the downstream effects of transplantation,” said Olivia Kates, a Johns Hopkins infectious diseases physician who specializes in transplant patients…

“We strongly recommend that all eligible children and adult transplant candidates and recipients be vaccinated” against Covid-19, the American Society of Transplant Surgeons, the American Society of Transplantation, and the International Society for Heart & Lung Transplantation said in a joint statement in November.

The U.S. government outlines guidelines for how transplant centers should consider candidates, and notes that “predicted years of life added” is one factor that can be weighed. Individual centers establish their own policies, but there are some common practices. Hospitals will typically require transplant candidates to abstain from smoking, for example. Recipients generally have to go through psychosocial evaluations, and often have to be vaccinated against hepatitis B, commit to getting annual flu shots, and show they’re immune to measles.

Kates, who is also a bioethicist who studies vaccine policies, said there wasn’t a good estimate for the percentage of transplant centers that had already instituted a Covid-19 vaccination requirement, but that the number was growing as more centers implement policies.

It’s possible for patients to try to seek care at another center if they’re denied at one hospital.”  (G)

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