Mandatory Vaccine Requirements in Waitlisted Transplant Patients: A Transplant Center's Perspective - A Call to Action

ABSTRACT

Purpose: The global pandemic caused by the SARS Cov-2 virus has caused unprecedented, previously unthinkable changes. COVID-19 infection in transplanted patients carries an ~ 30% risk of mortality in the unvaccinated. We made a decision across our Transplant Institute (including all organs - heart, liver, lung, kidney, pancreas) to mandate completed vaccination in patients waitlisted for organ transplant. To our knowledge, we are one of only 9 transplant centers around the country to implement this mandatory vaccination policy at that time for patients on the organ transplant waiting list. Method(s) All patients were directly contacted by the organ transplant coordinators and also received a letter detailing the requirement for completed vaccination. Patients who were not vaccinated by the deadline (October 15, 2021) were inactivated on the waiting list, with the option to be reactivated once completion of vaccination was documented. Result(s) Of 598 patients on the waitlist at our center, there were 465 kidney, 104 liver, 10 kidney/pancreas, 11 heart and 8 lung patients (Table 1). The total number of vaccinated patients were 395 kidney, 88 liver, 5 kidney/pancreas, 11 heart and 8 lung patients. When the policy was instituted, there were 99 unvaccinated patients on the waitlist at our center. Overall, we have seen a 25% increase in vaccination rates in our patients after institution of this policy. Conclusion(s) Vaccination against COVID-19 has proven to be safe and effective in preventing severe disease, along with social distancing and masking. With the ever increasing imbalance between organ supply and demand, it behooves the transplant community to be responsible stewards of a scarce resource i.e. organs available for transplant. In addition, the increase in mortality seen in post-transplant patients infected with COVID-19 certainly poses a risk to transplant centers who are being monitored for patient and graft survival. At the current time, there are no exceptions being made in the risk adjustment modeling to exclude patient deaths post-transplant due to COVID-19. We were able to help patients overcome vaccinehesitancy with our policy mandate and education and achieved higher vaccination rates in our waitlisted patients. Given the safety and effectiveness of the currently approved vaccines available, mandatory vaccination for waitlisted patients seems to be the most responsible and prudent course of action. (Table Presented).