Colorado health system to woman waiting for kidney transplant: Get vaxxed or you're ineligible

I don’t get this. I do get wanting to take vaccination status into account when rationing hospital care since whether you end up needing a nurse after getting COVID is now largely a matter of your own choice. If you choose to expose yourself to a higher risk of a severe case by refusing to get a free and ubiquitous shot then that should be weighed when deciding whether you deserve a bed more than some other desperately needy patient does.

But as you’ll see, the Colorado case isn’t a matter of rationing care. The health system is telling her that they refuse to help save her life because she won’t mitigate her risk from COVID, even though she’s likely to survive an infection post-op even if she’s unvaccinated.

“You might die if you don’t get the shots, so we’ll guarantee that you die by not doing the surgery.” Is that about the size of it?

UCHealth is defending its decision by reminding the media that conditions are routinely imposed on transplant recipients. Organs are scarce, after all. If you’re lucky enough to receive a new pair of lungs, doctors want to know that you won’t immediately start smoking two packs a day. The point of a transplant is to extend life as much as possible; if they think you’re a bad bet to cooperate in that, they’ll find someone who’s a better bet.

Weaver noted that transplant centers around the country may require patients to get other vaccinations, stop smoking, avoid alcohol or demonstrate that they will take crucial medications in an effort to ensure that people do well post-surgery and do not “reject” organs for which there is fierce competition.

Multiples studies show that covid-19 is especially deadly for recipients of kidney transplants. Weaver said the mortality rate observed for transplant patients who develop covid-19 ranges from about 20 percent to more than 30 percent — far higher than the 1.6 percent fatality rate observed generally in the United States

The patient reportedly denied a transplant, whom Geitner did not identify, has about “12 percent of her kidney function left,” the state lawmaker said Tuesday.

If this were a case where multiple people were competing for a kidney from the national organ donor stockpile, you can see why doctors might consider their relative susceptibility to COVID in deciding who gets it. The virus is highly contagious now thanks to Delta, to the point where some experts believe everyone will be infected by it eventually. Imagine telling someone who’s vaccinated that they’ll have to keep waiting for a kidney because you’ve decided to give the one that’s available to an unvaccinated person instead — and then that person promptly gets infected and dies within a month. You gave the gift of life, and it was squandered.

But even in that scenario, where organs are being rationed, there’s no reason to declare someone flatly ineligible because they’re unvaccinated. Their vaccination status should be considered as one factor among many. Who’s more likely to survive after receiving a kidney, after all? An unvaccinated 25-year-old or a vaccinated 85-year-old?

Again, though, this Colorado case isn’t about rationing care. That’s because the woman who was told she’s ineligible for a transplant has a direct donor lined up. She’s not taking a kidney that would have gone to someone else. She’s getting it from a friend who’s willing to donate it to her. Watch the two of them speak to local media in the interview below. Neither can understand why a willing donor and willing recipient should be denied the surgery on account of the fact that they’re unvaccinated. I can’t either. Even if mortality from COVID is 20-30 percent for transplant patients, as UCHealth claims, the odds of survival would still be in the recipient’s favor.

It gets worse. According to the Colorado state rep who publicized their case, the recipient has “tested positive for the immunity, she already has those COVID antibodies on board.” If it’s true that she’s recovered from COVID and has natural immunity, the argument for denying her a transplant gets even weaker. Granted, natural immunity can wane over time, but vaccine immunity can too. At least one study from Israel shows that natural immunity is more durable than vaccine immunity. Whether the transplant recipient has a robust number of antibodies could be ascertained by giving her an antibody test. Why won’t they consider that as an alternative to rendering her ineligible?

I’m all for “soft” vaccine mandates to twist people’s arms to get their shots but denying a direct organ donation to someone who’s dying to pressure them is more like tearing their arm off.

In lieu of an exit question, go read about a state that *is* having to ration care right now because there are too many COVID patients for its hospitals to handle. That’s not Colorado, it’s Alaska, which is finally coming down from a ferocious surge that forced some hospitals to invoke “crisis standards of care” in which doctors prioritize treatment according to who’s most likely to survive. This NYT story opens with an account of a rural patient who needed emergency surgery and asked to be flown into Anchorage for it, but the main hospital in Anchorage was overwhelmed with COVID patients. Doctors huddled and concluded that a patient in their own ER had a better chance of surviving if treated, so that patient went first. The rural patient died.

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Jazz Shaw 1:01 PM on December 09, 2022