Hospital Denies Transplant Because Woman Didn't get the COVID Vaccine - A Bad Policy

Vinay Prasad, MD MPH; Physician & Professor Hematologist/ Oncologist: Hospital Denies Transplant Because Woman Didn't get the COVID Vaccine - A Bad Policy
"There's a letter out there from the Mayo Clinic that denies someone's mother a lung transplant because they weren't fully compliant with the COVID-19 vaccination. It's the talk of the town. A lot of doctors have weighed in to say that this is a good policy, it makes sense, it makes sure that those scarce resource lungs are used most wisely to people who have the best chance of doing well with them. But I think that's completely off the mark. They completely missed the point. And mandating the COVID-19 vaccine in 2024, for someone getting a solid organ transplant doesn't make a lot of sense, so let's review the facts. One. Obviously, people who get a organ transplant are immunosuppressed with a bunch of drugs to prevent them from rejecting that organ, and they're susceptible to a number of infections. One doctor said, I've even seen severe COVID in somebody who had a solid organ transplant. So that's the reason why you gotta get the vaccine. But the problem with that argument is that the person they saw the severe COVID in was someone who was actually fully vaccinated because the standard has already been to be fully vaccinated with COVID-19 before you can get an organ. They couldn't have seen it in somebody who wasn't fully vaccinated. You see, that's the problem with their argument. They saw severe COVID in somebody fully vaccinated. The question with the medical therapy isn't, what's the baseline risk? What's the risk to somebody who walks out without that therapy? It's what does the therapy do to change the risk? Okay, fast forward, it's 2024 now against currently circulating strains in a population that has a huge amount of natural COVID-19 immunity from prior infection, there's just no credible evidence that getting the shot now for such a person, getting up to date now, is going to have a risk reduction and the risk of a bad outcome after a solid organ transplant. So the argument against this policy is that there's simply no evidence. This policy means you're more likely to live long or do better with the organ you're given. That's the problem.
And sure, there's some baseline risk. I suspect that baseline risk has fallen precipitously with natural immunity. But the question is, does getting this additional dose of vaccine lower it further? And they don't have any evidence for that. Next up. There's another alternative to vaccination they could look for. They could look for antibody titers to COVID-19 and say, you know, above a certain threshold, whether that's naturally derived antibody titers or whether that's through vaccination above a certain threshold. I still think that policy is not, strictly speaking, evidence-based, it doesn't discriminate against people who had COVID and recovered and may not want the vaccine. Now here's why it's really problematic. It's problematic because it is a type of discrimination. You know, somebody said to me that hospitals and lung transplant centers, they can create all sorts of obstacles to getting the transplanted organ, whatever they want. It doesn't have to be medically necessary or evidence-based. They can create whatever obstacles they want. Well, they can as long as those obstacles are not discriminatory.
And I would contend that this is a discriminatory policy. Why? Because the rates of COVID-19 vaccination are lower in some races. The rates of COVID-19 vaccination are lower depending on who you vote for. So this policy, which doesn't have a medical basis, is a proxy for race, to some degree, and voting patterns, to some degree. It's a way to punish blacks. It's a way to punish Republicans. And as such, I think it's a problematic policy. It's set by one of these, you know warrior type people, advocate type people, activist type people who went to medical school who's not putting on their medical hat and they just want to make policy based on their activist hat. They want to force people to do something.
I also think it's just another one of these things, virtue signaling things people want to do in medicine where they want to continue to disparage people who didn't get the vaccine as the bad people and they continue wanna pat themselves on the back. The one thing that everyone who got the vaccine and who didn't get the vaccine have in common is they've mostly all had COVID-19. That's the one thing they've got in common. They all ended up getting COVID-19 anyway."