ABSTRACT
Purpose: The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented challenges and there are practice differences for solid organ transplant programs worldwide. We sought to assess an international perspective on COVID-19 vaccine mandates and rationales for or against a mandate policy. Method(s): We administered an electronic survey instrument to staff at transplant programs outside the United States (October-November 2021) that comprised of 23 questions addressing the reasons cited by centers for or against implementing a vaccine mandate. Each responding transplant program was represented once in the analysis. Result(s): Respondents (n=63) represented 19 countries on 5 continents. More than half (52.6%) of centers reported implementing a vaccine mandate, however 37.2% reported that their center has not considered (27.1%) or unsure (10.2%) on vaccination requirement. The main rationale for centers not implementing a vaccine mandate were concerns for undue pressure to transplant candidates, equity and legal considerations. (Fig. 1) The main rationale for centers with a vaccine mandate were efficacy of pre-transplant vaccination then post-transplant, importance for public health and minimizing exposure of other patients. (Fig. 2) The majority (79%) of the centers mandate vaccine regardless of prior SARS-CoV-2 infection status, and regardless of pre-vaccination spike-protein antibody titer or other markers or prior infection. Only 24.4% of centers with a vaccine mandate for transplant candidates also extended a vaccine requirement to potential living donors. Conclusion(s): The approach to pre-transplant COVID-19 vaccination mandate is heterogeneous across different countries and centers. More than one third of centers are reluctant to consider vaccine mandates for a varies of reasons including ethical, legal and equity concerns. (Figure Presented).
ABSTRACT
Purpose: We surveyed current policies of transplant centers regarding a COVID-19 vaccine mandate, and rationales for or against a mandate policy. Method(s): An electronic survey was distributed to clinicians at U.S. solid organ transplant programs from 2020-2021. Result(s): 56.4% of transplant programs representing 78.5% of all kidney transplant volume and 82.4% of liver transplant volume in the US from 9/1/20-9/1/21 responded to the survey. 35.7% of centers reported implementing a vaccine mandate, while 60.7% reported not that vaccination was not required and 3.6% were uncertain. Centers without a vaccine mandate policy cited administrative, equity, and legal considerations (Figure A). Centers with a vaccine mandate cited clinical evidence supporting the efficacy of pre-transplant vaccination (82.0%) and stewardship obligations to ensure organs were transplanted into the lowest risk patients (64.0%) (Figure B). Among centers with a mandate, few required confirmation of vaccine responsiveness through antibody testing (2.6%), required a support person (10.0%) or co-habitants (5.0%) to be vaccinated. 42.5% of centers with a mandate also required living donor candidates to be vaccinated. There was no correlation between the presence or absence of a vaccine mandate and the point prevalence rate of COVID-19 vaccination by the home State of the transplant center. Conclusion(s): Solid organ transplant centers in the US exhibit significant heterogeneity in the requirement for a COVID-19 vaccination prior to receiving an organ. While all centers encourage vaccination, most programs do not require all candidates and living donors to receive the COVID-19 vaccine prior to surgery, citing administrative opposition, legal prohibitions, and concern about equity in access to transplants. Among the minority of centers mandating COVID-19 vaccination for candidates, few centers also mandate vaccination for support persons or co-habitants, require additional testing to demonstrate adequate vaccine responsiveness, and less than half of these centers also mandate vaccination for living donor candidates. (Figure Presented).