Transplant programs reviewing policy on recipients being vaccinated against COVID-19

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Transplant centres in Western Canada have stopped short of requiring organ recipients to be fully vaccinated against COVID-19, but they say conversations about such a policy are ongoing.

Some centres in other parts of the country, including Ontario, are requiring proof of vaccination before a patient is approved for the life-saving surgery.

BC Transplant, located in Vancouver, said COVID-19 vaccination is not required to be eligible for a transplant, but programs in the province are actively reviewing it.

"The transplant programs are strongly encouraging all pre-transplant patients to be vaccinated against COVID-19, as they do with many other vaccine-preventable infections," the agency said in a statement.

Similarly, Alberta Health Services told The Canadian Press it has long been a requirement that patients preparing for transplant have all vaccines to help maximize their chances of success post-transplant. It notes, however, it's only a practice guideline at this point.

Saskatchewan has also not made any changes.

"Saskatchewan's organ transplant teams are strongly supportive of all recipients and donors having COVID vaccinations, and the issue of requiring these vaccinations in recipients is actively being discussed," Lisa Thomson, a spokeswoman for the Saskatchewan Health Authority, said in a statement.

The Ajmera Transplant Centre at Toronto's University Health Network recently announced its decision to implement a policy that requires patients who may benefit from receiving a transplant be fully vaccinated against COVID-19 before they are listed for solid organ transplant.

However, there may be exemptions for medical reasons or in cases of urgent need of a transplant.

"We all recognize that (COVID-19) is a massive, massive risk factor. The prudent and ethical thing to do to protect patients and to protect each other, and show fidelity and respect to those organ donors, is to require this (policy) to be a price of pass and go," UHN president and chief executive officer Kevin Smith said in an interview.

The decision to enact the policy is based on a few factors, according to the organization.

It said transplant patients are severely immunocompromised because of lifelong treatment to prevent rejection of a new organ. If someone who is immunocompromised gets COVID-19, they are at a very high risk of being hospitalized or placed on ventilation.

Unvaccinated recipients could also pose a risk to other patients post-surgery. Transplant recipients have high health needs after their transplants and require frequent visits to a hospital. These individuals may pose a greater risk of spreading illness, should they get infected, to other immunocompromised patients in an inpatient or outpatient setting.

"Thinking about an outbreak in an environment like that would be just a massacre," Smith said.

Infectious disease experts noted this type of policy isn't new.

"There's just requirements pre-transplant in order to be eligible for listing. Some of it is complying with some of the medical measures to see if patients would be eligible," said Dr. Dima Kabbani, an assistant professor in the division of infectious diseases at the University of Alberta.

Kabbani added pre-transplant vaccine recommendations are already in place for hepatitis B, pneumococcal disease and influenza.

Manitoba's Shared Health said there is no requirement for Manitobans awaiting a transplant to be vaccinated for COVID-19, but noted patients may be required to show proof of vaccinationif there are requirements elsewhere.Kidney transplants are performed in the province while all other organ transplants take place in other provinces.

Jessica Bailey, 35, is living with stage five kidney disease and awaiting a transplant in Saskatoon.

The government has postponed surgeries as the province deals with a devastating fourth wave of COVID-19.

Bailey said she is not in favour of requiring recipients to be vaccinated against COVID-19. She said she is double vaccinated but believes recipients should still have the choice on whether they want the vaccine.

She does encourage patients who may be on the fence to look at the bigger picture.

"If you can get a transplant just by getting the vaccine, go and do it. Pick and choose your battles," Bailey said.

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This report by The Canadian Press was first published on Oct. 15, 2021.

This story was produced with the financial assistance of the Facebook and Canadian Press News Fellowship.