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October 19, 2021

Pennsylvania woman denied kidney transplant over COVID-19 vaccine refusal

Health systems are increasingly weighing policies and priorities for high-risk organ recipients

A Pennsylvania mother who has waited nearly seven years for a kidney transplant was denied the potentially life-saving surgery due to her decision not to get vaccinated against COVID-19.

The 40-year-old Lycoming County woman's ineligibility for a transplant highlights a divide among U.S. health care providers, many of which have begun requiring the vaccine to move forward with an operation.

Sherry Breen, a realtor from Muncy, said she received a letter from Geisinger Health System's transplant program explaining that her refusal of the vaccine means she'll be placed on an "inactive" list in the queue for kidney recipients. Her time accrued on the wait list will be honored, but won't return to an active status unless she gets vaccinated.

"If you choose not to be vaccinated, you will need to wait until after the spread of COVID goes down to a safer level before being made 'active' on the list again," the letter said, according to The Daily Item, a newspaper in Sunbury.

Breen does not consider herself anti-vaccine, but said a previous bout with COVID-19 last November, prior to the availability of the vaccines, has made her leery of how her body may respond to immunization.

"For three or four days I wasn't sure if I would live. I got septic arthritis and even lost all my long red hair," Breen told the newspaper. "I've waited years to get to the top of the transplant list but I know my body and I'm afraid of what the vaccine will do to me. I'm worried I'll end up in worse condition and I just don't want to rock the boat and make my body sicker."

There are more than 250 organ transplant centers in the United States and more than 107,000 people in need of new organs, according to Kaiser Health News. Some centers require vaccination while others simply encourage it, creating an uneven playing field among hopeful recipients.

At issue for transplant centers that require the vaccine is whether those who undergo these operations will ultimately place themselves at greater risk of serious illness, since transplants necessitate immunosuppressant drugs that make patients more vulnerable to serious infections, including severe cases of COVID-19. Many in need of transplants may already have weakened immune systems due to their underlying conditions.

With waiting lists as extensive as they are across the United States, transplant centers are faced with the question of whether providing such a limited number of organs to unvaccinated, high-risk patients is an appropriate use of resources.

Breen has been on peritoneal dialysis for nearly seven years, a painstaking daily treatment that patients can only continue for a period of six to eight years before a transplant becomes necessary.

"A kidney transplant is life-saving surgery and I'm being disqualified because I'm scared," Breen said.

Geisinger, a health system that covers much of south-central and northeastern Pennsylvania, has cited "overwhelming data and recommendations from countless experts" in reaching its decision about vaccine requirements.

Elsewhere in Pennsylvania, UPMC and Highmark's Allegheny Health Network are not requiring COVID-19 vaccination to move forward with organ transplants, but both health systems strongly recommend it. Most AHN patients have heeded these recommendations, a spokesperson told the Tribune-Review.

In Philadelphia, the transplant programs at Penn Medicine and Jefferson Health did not immediately respond to requests for comment about their vaccine policies.

Research published earlier this year found that vaccinated transplant patients from around the world have shown higher rates of COVID-19 breakthrough infections, and that just 54% of transplant recipients produced antibodies to protect them from the virus after receiving two doses of the Pfizer or Moderna vaccines. A third vaccine dose has shown improved effectiveness in raising antibody levels among this population, making the question of boosters more urgent for transplant recipients.

Despite questions about efficacy, many experts still believe that transplant recipients should get vaccinated to receive even limited protection from more serious disease if exposed to COVID-19.

Breen, whose future is in serious question without a kidney transplant, plans to explore whether another transplant center will evaluate her case and accept her into a different program before her kidney disease progresses too far for her to survive.

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