Hospital system says it will deny transplants to the unvaccinated in ‘almost all situations’

A Colorado-based health system says it is denying organ transplants to patients not vaccinated against the coronavirus in “almost all situations,” citing studies that show these patients are much more likely to die if they get covid-19.

The policy illustrates the growing costs of being unvaccinated and wades into deeply controversial territory - the use of immunization status to decide who gets limited medical care. The mere idea of prioritizing the vaccinated for rationed health resources has drawn intense backlash, as overwhelmingly unvaccinated covid-19 patients push some hospitals to adopt “crisis standards of care,” in which health systems can prioritize patients for scarce resources based largely on their likelihood of survival.

UCHealth’s rules for transplants entered the spotlight Tuesday when Colorado state Rep. Tim Geitner, a Republican, said it denied a kidney transplant to a Colorado Springs woman because she was not vaccinated against the coronavirus. Calling the decision “disgusting” and discriminatory, Geitner shared a letter that he said the patient got last week from UCHealth’s transplant centre at the University of Colorado’s Anschutz Medical Campus in the city of Aurora.

The letter said the woman would be “inactivated” on a kidney transplant waiting list and had 30 days to start coronavirus vaccination. If she refused the shots, it said, she would be removed.

UCHealth declined to discuss particular patients due to federal privacy laws, and The Washington Post could not independently verify the woman’s story. But the health system confirmed Tuesday that nearly all of its transplant recipients and organ donors must get vaccinated against the coronavirus - on top of other vaccinations and health requirements. A spokesman, Dan Weaver, said that other transplant centres in the United States have similar policies or are transitioning to them.

Conditions on organ transplants are not new. Weaver noted that transplant centres around the country may require patients to get other vaccinations, stop smoking, avoid alcohol or demonstrate that they will take crucial medications, in an effort to ensure that people do well post-surgery and do not “reject” organs for which there is fierce competition.

More than 100,000 people are on the transplant waiting list and only a fraction of those seeking a kidney got one in 2020, according to the federal government. An estimated 17 people die every day waiting for an organ.

Geitner did not immediately respond to inquiries Tuesday.

Multiples studies show that covid-19 is especially deadly to recipients of kidney transplants. Weaver said that the mortality rate observed for transplant patients who contract covid-19 ranges from roughly 20 per cent to more than 30 per cent - far higher than the 1.6 per cent fatality rate observed generally in the United States.

“An organ transplant is a unique surgery that leads to a lifetime of specialized management to ensure an organ is not rejected, which can lead to serious complications, the need for a subsequent transplant surgery, or even death,” Weaver wrote in an email. “Physicians must consider the short- and long-term health risks for patients as they consider whether to recommend an organ transplant.”

Living donors could also pass a coronavirus infection to an organ recipient, threatening the patient’s life, Weaver said.

Organ donations in the United States are coordinated through a national network run by the nonprofit United Network for Organ Sharing (UNOS). UNOS does not set requirements or listing or removing someone as a transplant candidate, said spokeswoman Anne Paschke, so transplant centers such as UCHealth’s “make such decisions according to [their] individual medical judgment.”

Weaver did not clarify Tuesday what might qualify someone for an exception to the coronavirus vaccination rule.

Geitner said in a Facebook Live video that he has spoken with UCHealth and that there is “very little” it would do to accommodate those without shots.

The patient reportedly denied a transplant, whom Geitner did not identify, has about “12 percent of her kidney function left,” the state lawmaker said Tuesday. Geitner said the patient has found a possible donor and that she already has antibodies that fight covid-19 infection.

Geitner also criticized UCHealth for firing unvaccinated staff, who represent less than 1 percent of the health system’s workforce, according to the Denver Post. Hospitals with mandates have said they appear to be successful, with almost all employees staying on despite fears the rules could deepen staffing strains.

As more than a third of Americans have yet to get a first shot, leaders and companies have increasingly embraced mandates over intense opposition from Republicans who champion personal choice. The unvaccinated may face unemployment or more expensive health insurance and in some places are barred from parts of public life such as indoor dining.

Then there are the risks of covid-19. Cases, hospitalizations and deaths have spiked around the country this summer and fall as the highly contagious delta variant dominates, though Colorado has seen less of a surge. The state’s current covid-19 hospitalizations remain well below a peak from winter of 2020.

A recent report from the Centers for Disease Control and Prevention found that people who were not fully vaccinated this spring and summer were 10 times more likely to be hospitalized and 11 times more likely to die of covid-19.

As covid-19 cases stretch medical resources, being vaccinated can also count against patients in some cases. Faced with a recent federal push to conserve monoclonal antibodies, a highly effective covid-19 treatment, some officials have urged healthcare providers to give them first to people who are not vaccinated.

Putting the unvaccinated first can “rub people the wrong way,” Karen Bloch, medical director of the antibody infusion clinic at Vanderbilt University Medical Center, told The Post last month.

But the reality is clear, she said: Those without shots are far more likely to die.