COVID-19 vaccination for transplant candidates

At Brigham and Women’s Hospital, we are committed to providing the most appropriate care for our patients with advanced heart disease and do everything possible to effectively improve heart function without a heart transplant. The journey to transplantation is often long because of the shortage of available organs compared to recipients in need, but we work with patients and their families to make each step of the transplant process as comfortable as possible.

There are currently more than 100,000 candidates on waitlists for organ transplantation and a shortage of available organs — around half of people on waiting lists will not receive an organ within five years. There is no candidate who is “first on the list” since there are varying levels of priority for allocation of organs. Waitlists are everchanging and are based on many patient and donor factors. Patient criteria includes immunologic and blood factors, psychological and social factors, medical and surgical factors, and clinical condition. When an organ does become available, it must be carefully matched among a regional and national pool of candidates based on many factors, including blood type, height, weight, medical factors, distance to the recipient and organ size.

Given the shortage of available organs, we do everything we can to ensure that a patient who receives a transplanted organ has the greatest chance of survival. Our Mass General Brigham healthcare system requires several CDC-recommended vaccines, including the COVID-19 vaccine, and lifestyle behaviors for transplant candidates to create both the best chance for a successful operation and to optimize the patient’s survival after transplantation, given that their immune system is drastically suppressed. Patients are not active on the waitlist without this. Research has shown that transplant recipients are at a much higher risk of dying from COVID-19 when compared to non-transplant patients. This guidance is in alignment with recommendations from the American Society of Transplantation, American Society of Transplant Surgeons and International Society for Heart and Lung Transplantation.

• Like most other transplant programs across the country, the COVID-19 vaccine is one of several vaccines and lifestyle behaviors that are required for patients awaiting solid organ transplant.
• Transplant candidates must also receive the seasonal influenza and hepatitis B vaccines, follow other healthy behaviors, and demonstrate they can commit to taking the required medications following transplant.
• At the Brigham and across our system, we have transplant guidelines that we follow in alignment with recommendations from the American Society of Transplantation, the American Society of Transplant Surgeons and the International Society for Heart and Lung Transplantation. More information is available here.
• We follow this guidance in order to create both the best chance for a successful operation and also the patient’s disease-free survival, given that their immune system is suppressed after transplant.
• Research has shown that transplant recipients are at a higher risk of dying from COVID-19 when compared to non-transplant patients. Transplant recipients must take immunosuppressive medications after receiving a transplanted organ. This means that after a transplant, recipients will develop less of an antibody response to a vaccine and are especially vulnerable to severe illness if they contract the virus.
• For this reason, experts recommend COVID-19 vaccination before organ transplantation to lower the chance of severe disease and death if a recipient becomes infected.
• Exceptions to these requirements are reviewed by a multidisciplinary group of experts in transplantation.