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In solid-organ transplant recipients, the immune response to COVID-19 vaccination is much lower than in immunocompetent individuals (including those with end-stage organ disease); therefore, COVID-19 vaccination is encouraged prior to transplantation. Mandating COVID-19 vaccination is controversial, however, and the proportion of transplant centers requiring vaccination for listing has not been reported.
Researchers received responses from 141 U.S. transplant centers (56%) to a standardized survey. While 88% of respondents had considered a pretransplant COVID-19 vaccine mandate, only 36% required COVID-19 vaccination for recipient listing and 14% required it for living organ donors. Religious objection was not permitted in 45% of centers with a mandate. Justifications for a mandate included stewardship (64%) or public health obligation (53%) and desire to reduce transmission risk (40%). Centers without mandates cited concerns about exacerbating access inequities (41%), fear of placing undue pressure on recipients (34%), or legal consequences (34%).
Hippen BE et al. Survey of current transplant center practices regarding COVID-19 vaccine mandates in the United States. Am J Transplant 2022 Feb 10; [e-pub]. (https://doi.org/10.1111/AJT.16995)
Comment
Candidates for solid-organ transplantation are asked to undergo many medical procedures (e.g., standard cancer screening) and sometimes to adhere to behavioral changes (e.g., smoking cessation) to optimize posttransplant outcomes and support efficient allocation of the limited supply of donated organs. While the issue is highly politicized, I feel that requiring COVID-19 vaccination prior to organ transplantation (exempting those with a medical contraindication or urgent need for transplantation) is medically justified, particularly given the attenuated posttransplant vaccine response.