Evidence continues to mount that vaccination against COVID-19, most notably the Pfizer and Moderna vaccines, produces robust, durable protection in the vast majority of recipients.
But questions remain for some at greatest risk of a severe outcome from a COVID-19 infection: Recipients of donor organs and bone marrow whose immune systems are necessarily suppressed to ensure their transplants are successful and lasting.
Some studies have found that vaccinated transplant recipients produce a weak immune response, and severe cases of COVID-19 have been reported in transplant recipients who had received two doses of vaccine.
Researchers at UC San Diego Health have launched a pair of clinical trials to study vaccinated transplant recipients of bone marrow (to treat and cure multiple diseases and types of cancer) and solid organs, such as the heart, lung, liver and kidney.
“Our goal is to quantify the immunogenicity (immune response) of COVID vaccines in immunocompromised populations,” said Jennifer Dan, MD, PhD, an infectious disease specialist at UC San Diego Health. “We want to gain an understanding of how differing degrees of immunosuppression may impact the COVID vaccine immune response and use that knowledge to optimize vaccine regimens for these patients.”
Under current guidelines, both solid organ and bone marrow transplant (BMT) recipients are eligible for COVID-19 vaccination. BMT recipients can begin receiving COVID-19 vaccinations three months after transplant, provided the transplanted cells have engrafted or begun growing within bone marrow. Solid organ recipients can be vaccinated as early as one month after transplantation, although a strong immunosuppression drug regimen to prevent organ rejection may cause a few months’ delay.
In both cases, the patients’ transplant physicians determine when the vaccination process can begin.
But what happens when a transplant patient doesn’t want the Covid vaccine?
The University of Colorado medical center denied a kidney transplant because patient has not been vaccinated.
A Colorado Springs woman who is waiting on a life-saving kidney transplant is being taken off the transplant list at UCHealth.
Leilani Lutali has a willing donor, but both she and her potential donor are being taken off the list because they are both unvaccinated.
Lutali has stage five kidney disease and is in desperate need of a transplant. She claims she has already had covid, but won’t be getting vaccinated for religious reasons.
“I was the one that had to break the news to Leilani and we were just devastated that somebody could take her life away from her because of a vaccine,” potential donor Jaimee Fougner told KRDO.
Fougner and Lutali met at a bible study in January. They immediately hit it off, with Fougner planning on saving Lutali’s life with a kidney donation. But then, they got a letter in the mail from UCHealth on Sept. 28 telling them they were going to be taken off the 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,” Lutali shared. “And there are other options that we could do, but there’s just been a hard-line drawn.”
Both Lutali and Fougner are passing on the shot because they don’t approve of the way they believe the vaccines were developed.
Dan Weaver, a spokesperson with UCHealth, shared a statement with KRDO saying he couldn’t comment on the specific case. Weaver did say transplant patients who contract COVID-19 face higher mortality rates.
“For those who test positive for COVID-19, the mortality death rate is about 1.6%. It’s even less if you consider the people who are infected but who don’t get tested or who are asymptomatic,” Weaver said. “For transplant patients who contract COVID-19, the mortality rate ranges from about 20% to more than 30%.”
As specific as this case got, Weaver linked to a study in the National Library of Medicine that found kidney transplants who contracted COVID-19 had a 21% mortality rate.
“This is why it is essential that both the recipient and the living donor be vaccinated and take other precautions prior to undergoing transplant surgery,” Weaver said. “Surgeries may be postponed until patients take all required precautions in order to give them the best chance at positive outcomes.”
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Colorado State Rep. Tim Geitner shared the letter on social media, prompting a debate about transplant eligibility and vaccines. He posted a Facebook Live video Tuesday morning supporting them and questioning the policy since Lutali already has COVID antibodies after testing positive.
“It’s frustrating when someone finds themselves in what could be an end-of-life situation, and this is the requirement,” Geitner, a Republican from El Paso County representing House District 19 told KRDO. “Comply with this covid vaccine or best of luck. I don’t think that that’s a place where we want to be in the United States.”
UCHealth denies life saving treatment – kidney transplant – to El Paso County resident. See my FB live post @timgeitnercolorado pic.twitter.com/Z2r8D2VY4m
— Tim Geitner (@tgeitner) October 5, 2021
