There appears to be growing consensus among Canadian organ transplant specialists about requiring COVID-19 vaccination for patients looking to be placed on the wait-list for an organ donation.
Why?
It’s all about trying to ensure the “best possible outcome” for the patients receiving a scarce and precious organ, experts say.
“We strongly support transplant program requirements for transplant candidates to receive COVID-19 vaccine prior to transplantation,” the Canadian Society of Transplantation said in updated guidance provided to the provincial organ donation organizations and regional transplant programs.
That guidance, issued on Jan. 9 following months of debate among Canadian transplant organizations, urged any provincial and regional programs to be transparent if they choose to implement the rule.
Among those that have done so over recent months is the Ajmera Transplant Centre at University Health Network (UHN).
The Ajmera Transplant Centre in Toronto is the country’s largest organ transplant program and performs more than 500 transplants each year. It also requires patients to have at least two doses of a COVID-19 vaccine.
“After transplant surgery, patients are severely immunocompromised because of the life-long treatment to prevent rejection of the new organ. This means, transplant recipients are at much greater risk of complications and of dying if they get COVID-19,” said Ana Fernandes, spokesperson for the UHN.
“Vaccination reduces these risks for the individual transplant recipient. It is ethically wrong to knowingly immunosuppress a patient without first taking all necessary precautions including vaccination.”
Fernandes said there are cases where exemptions may apply: if the patient has a medical reason for not getting vaccinated, or “in cases of urgent need for a transplant.”
“Life-saving organs are scarce and all transplant programs follow strict criteria to ensure they are offered to patients with the highest need, but also with highest chance of a positive outcome,” Fernandes added.
“In general, if measures to ensure the patient’s safety are not taken, alternative treatments (such as dialysis for kidney failure) are often associated with better patient outcomes.”
Ontario’s Trillium Gift of Life Network noted that it “strongly recommends” that transplant recipients be vaccinated beforehand, and be fully informed of the risks of not doing so.
“The clinical decision to proceed in transplanting unvaccinated potential recipients rests with the transplant programs, on a case by case basis, and is based on the spectrum of illness severity, degree of immunosuppression, community virus activity, and each individual case detail,” a spokesperson for the network said.
“Patient prioritization on the waitlist is unchanged and based on medical urgency (i.e. the sickest person is given priority) and other factors such as blood type and size match are considered when an organ becomes available.”
Following publication, the Saskatchewan Health Authority also confirmed its transplant program is taking similar steps.
“Our provincial organ transplant program has moved forward with aligning with the national/international recommendations,” said a spokesperson in an email.
“Our program policy, which is in the final review stages before approval, will allow patients with at least two doses of COVID vaccination to be added to the active wait list, but patients will require three doses for organ transplant to occur. Acceptable exemptions for medical or religious reasons will be considered within the policy.”
The topic of vaccine requirements for organ transplant patients had made headlines over recent months but most recently this week, after the family of a Boston-area man said he was denied a heart transplant because he was not vaccinated against COVID-19.
In October 2021, a Colorado woman was also in the news after she said she was denied an organ transplant because she refused to get the vaccine.
“A donor heart is a precious and scarce gift which must be cared for well,” Dr. Howard Eisen, medical director for the advanced heart failure program at Penn State University in Hershey, Penn., told The Associated Press at the time.
“Our goal is to preserve patient survival and good outcomes post-transplant.”
The Canadian Society of Transplantation is the professional organization for health-care workers specializing in the transplant field. It comprises more than 500 doctors, surgeons, physicians, scientists and other health workers from across the country.
The organization says it based its recommendation in support of vaccine requirements for transplant recipients on advice received from its own members as well as from the Canadian Blood Services’ advisory committees, Health Canada and the Public Health Agency of Canada.
That advice also included the recommendations from the World Health Organization, provincial agencies and international partners, including the United Kingdom and Spain, which both have robust organ transplant systems, the organization said.
“Any policy that makes the COVID-19 vaccine mandatory should be transparent and be announced with enough time for transplant candidates and healthcare staff to adhere to the mandate,” the organization recommended this month. “Candidates should have time to obtain their vaccines before the policy is
implemented, as is done for healthcare professionals.
“The healthcare system has a duty to maximize efforts at education and reassurance of vaccine hesitant candidates. Transplant programs should endeavour to address any uncertainties, concerns, or misperceptions candidates may have through evidence-based patient education.
“The vaccine policy should be reassessed on a regular basis.”
Similar requirements are also recommended by the American Society on Transplantation.
Organ transplant patients are already required to follow a range of recommendations, ranging from guidance to get vaccines for things like hepatitis B, pneumococcal disease and influenza, to a requirement in many jurisdictions to be at least six months sober before receiving a liver transplant.
All are billed as important measures to reduce the risks of contracting an infection following transplant, when a person’s immune system is suppressed and highly vulnerable, as well as to make sure the organ is going to someone who will have a good outcome after receiving it.
The COVID-19 pandemic has exacerbated wait times for organ donations, with many provinces forced to delay procedures as hospital systems came under the strain of successive waves of the virus.
According to the Canadian Institute for Health Information, there were a total of 2,594 organ transplants in Canada in 2020 — down by 14 per cent from 2019, which CIHI says is likely due to the pandemic.
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