Disclosures: Hippen reports he is an employee of Fresenius Medical Care. Please see the study for all other authors’ relevant financial disclosures.
March 10, 2022
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Survey: Most transplant centers not requiring COVID-19 vaccinations before surgery

Disclosures: Hippen reports he is an employee of Fresenius Medical Care. Please see the study for all other authors’ relevant financial disclosures.
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About 60% of transplant centers in a recent survey reported that patients are not required to have COVID-19 vaccinations prior to surgery.

“Only 35.7% of centers reported implementing a vaccine mandate, while 60.7% reported that vaccination was not required,” Benjamin E. Hippen, MD, and colleagues wrote in a recent issue of the American Journal of Transplantation. “A minority (42%) of responding centers with a vaccine mandate for transplant candidates also mandated vaccination for living organ donors.”

Infographic showing vaccine mandates
Data derived from Hippen BE, et al. AmJTrans. 2022;doi:0.1111/ajt.16995.

Researchers conducted the survey “to better inform clinicians, policy makers and the public about the prevalence, rationale and scope of vaccine mandate policies instituted (or not) by solid organ transplant centers in the United States ... For centers with a mandate as a condition of active transplant candidacy, we queried whether or to what extent the mandate extended to medical contraindications to the vaccine (eg, anaphylaxis), religious objections, pediatric candidates, support persons, co-habitants and living donor candidates,” the authors wrote.

The survey was distributed to staff at solid organ transplant centers performing transplants from Oct. 14, 2021 to Nov. 15, 2021. A total of 141 transplant centers responded to the survey, representing 56.4% of centers in the United States. “Those centers performed 78.5% of kidney transplants and 82.4% of liver transplants in the year prior to survey administration,” the researchers wrote.

Vaccine mandates

In 82% of cases, centers with a vaccine mandate indicated in the survey that clinical evidence supported the value of having patients vaccinated prior to transplant surgery.

Among 64% of respondents, a belief in ensuring organs were transplanted into the lowest risk patients was cited as justification for a vaccine mandate.

The survey follows a case in October 2021 in which transplant center staff at University of Colorado Health declined to perform surgery because neither the candidate nor her kidney donor had been vaccinated, citing religious reasons. In justifying its decision to not perform the transplant, the center said data showed transplant candidates who are unvaccinated have a higher mortality risk along with higher graft failure rates compared with transplant candidates who are vaccinated.

Researchers said transplant centers in the survey cited several reasons for not requiring vaccinations for candidates, including “administrative opposition, legal prohibitions and concern about equity in access to transplants.”

Specifically, the most frequently cited reasons included concerns that “a mandate may exacerbate inequities in access to transplantation (41%), would result in undue pressure on transplant candidates (32%), and could result in legal consequences for the center (34%),” the authors wrote.

Among centers that did mandate vaccination, “the most frequent justification included public health-based obligations (52%), stewardship obligations to ensure organs are transplanted into patients at the lowest risk for SARS-CoV-2 infection (64%), and the need to reduce transmission risks to health care personnel (40%), other patients and family members (40%),” the authors wrote.

Religious objections

“In the case of religious objections to the vaccine, 45% of centers with a mandate reported they would decline these patients for active candidacy, while the remainder would either agree to an exemption (17%) or some version of a case-by-case consideration (38%),” they wrote.

Hippen told Healio Nephrology it would be hard to predict how centers would answer the survey today – now 5 months after the original was sent to transplant centers. “The free-text responses to several of our survey questions suggested many respondents were still working through the details of a mandate policy but did suggest the total number of centers with some sort of mandate policy likely increased after the completion of the survey,” Hippen said. “Future trends regarding vaccine mandates are difficult to predict, as this will be influenced by the future incidence of new infections in the context of both future total rates of vaccination/boosters, native immunity from infection, the smaller possibility of novel variants against which current vaccines are less efficacious and the evolving political and policy environment surrounding this issue.”

Hippen said the researchers looked at whether transplant centers requiring vaccinations were in states where government officials took a similar stance against vaccinating the general public.

“We specifically looked to see if there was any correlation between whether a transplant center in a given geography was more or less likely to have a vaccine mandate policy depending on whether the center was located in a state with higher or lower rate of point prevalent vaccination rates.

“We found no correlation between the two,” he said.