Avis Favaro, Elizabeth St. Philip, Nicole Bogart
Published:October 8, 2021
TORONTO — Canada’s largest transplant centre has enacted a precedent-setting policy requiring that patients be fully vaccinated against COVID-19 in order to be considered for a life-saving organ transplant.
The decision – one carefully debated by doctors at Toronto’s University Health Network (UHN) – affects some 4,300 Canadians waiting for a donor organ to become available, as well as those who come after them.
“From a medical point of view, we all felt quite strongly that this was needed. So, we’ve been having a lot of discussion on how best to formulate this policy,” Dr. Atul Humar, director of UHN’s Ajmera Transplant Centre, told CTV National News.
“It was actually a very complex discussion. We had ethical input; we had input from medical leaders and experts in the field.”
Organ transplant recipients face unique risks posed by COVID-19.
While any type of surgery puts stress on a patient’s immune system, leaving them more vulnerable to contracting a virus like COVID-19, organ transplant recipients have an even greater risk thanks to the powerful regime of anti-rejection drugs they need to take in to suppress their immune system to keep their body from rejecting the new organ.
Not only are these patients’ immune systems compromised, they face greater risks of complications and death from COVID-19.
“There is ample research to support that the best course of action is to vaccinate individuals prior to transplant, whenever possible,” reads a statement from UHN regarding the decision.
“Just as with other medical requirements, the COVID-19 vaccination helps ensure best possible outcome for our patients.”
According to statistics provided by UHN, unvaccinated patients face a 12-per-cent higher risk of organ rejection and a 30 per cent greater chance of dying from COVID-19 – risks Humar says is far too great to risk squandering a precious resource.
“Remember, the organ is really a scarce resource. It’s something donated by another human being. And really, we have to go to all efforts to try to make sure the patient does well, but also that the organ is well cared for,” he said.
The policy is not far-fetched when you consider the rigorous requirements patients already have to meet in order to be listed for a transplant.
“You can’t be actively drinking and be listed for a liver transplant you can’t actively be smoking and be listed for a lung transplant and this is the same kind of thing really,” Humar explained.
And while it may be the first of its kind in Canada, the requirement has already stirred up a life or death debate in the U.S.
Colorado woman Leilani Lutali, a born-again Christian with stage 5 kidney disease, was denied a life-saving kidney transplant because she says she cannot agree to be vaccinated on religious grounds.
Lutali, who had lined up her own donor, says both she and the donor were removed from the transplant list.
“It feels a little bit like my transplant is being held hostage and there’s only one decision that I’m being left with,” she told CTV National News.
While UHN’s policy only came into effect Friday, Humar says the hospital has given careful consideration to those who may be vaccine hesitant, including an educational process to help people understand vaccines.
“The good news is that there are very, very few patients who refuse vaccination,” he said. “Once they have proper education, once they understand what a transplant involves and the risks related to immunosuppression, then most of them actually agree to get vaccinated.
Maude Laberge, a health equity and policy analysis expert at Laval University, says policies like these are not about making a judgment on people’s decision, but ensuring health-care resources, which are already overstretched, are used effectively.
“From a perspective of wanting to use our healthcare resources… to allocate them to the patients that are most likely going to benefit from them, it makes sense to require the vaccine,” she told CTV National News.
“This is not about making a value judgment on people’s lifestyle or habits or whatever, but more about their capacity to benefit from the intervention.”
It’s unclear just how many hospitals in North America have enacted transplant vaccination policies.
The American Hospital Association, which represents nearly 5,000 hospitals, health care systems and networks in the United States, told The Associated Press it did not have data to share on the issue. But it said many transplant programs insist that patients get vaccinated for COVID-19 because of the weakened state of their immune system.
Humar admits that this is new territory for health care providers; that it would be up to each individual transplant program to decide what is best for their patients.
“Certainly, many other programs are very seriously looking at this,” he said.