About one in 10 lung transplants in the United States now goes to COVID-19 patients, according to data from the United Network for Organ Sharing or UNOS.
The trend raises questions about the ethics of allocating a scarce resource to individuals who have chosen not to be vaccinated against coronavirus.
“They are accumulating on a stable basis. So it’s very much a real thing,” said David Klassen, chief physician at UNOS.
“If there were more lungs available for transplants, I think the numbers would be bigger than they are,” he says.
A total of 238 people across the country have received lung transplants due to COVID-19 since the first such surgeries were detected in August 2020, according to the latest UNOS figures from October this year.
Lung transplants for COVID patients increased tenfold between the first year of the pandemic and 2021, according to UNOS data, which also shows that transplants for other top lung diseases, such as emphysema, cystic fibrosis and pulmonary fibrosis, have decreased compared to previous years.
“It’s happening in the United States. It’s happening in Canada, too. There was just a paper from Western Canada saying that this caused a huge increase in the number of lung transplants there. the school. New Haven Health Transplantation Center.
More than 2,000 lung transplants are usually performed each year in the United States, costing about $ 1.2 million for a double lung transplant.
The rise in COVID-related transplants is forcing doctors to struggle with how best to deal with who gets them, especially now that vaccines are widely available.
“When someone gets such severe COVID that they need a lung transplant and they got it by refusing to get a vaccine, it’s a really ethical dilemma,” Mulligan says. “How can they just jump in and take a lung away from someone who is sick but who has done the best they can to take care of themselves and avoid getting COVID?”
Ethics of non-judgment
Transplant centers weigh a lot of different factors when listing people who need an organ. But social and behavioral factors – such as how people became ill – are usually not among them.
People who smoke may be eligible for a lung transplant, just as people who have drunk too much alcohol may also get a new liver if they have stayed smoke-free or sober for six months.
Not judging people’s past behaviors is pretty standard in medicine. But future behavior when it comes to transplants is fair game, according to Olivia Kates, an assistant professor of medicine at Johns Hopkins.
“I think [COVID-19 patients] “should be subject to the same expectation that they should either be vaccinated or be able to demonstrate immunity to COVID-19 in the future so that their next set of lungs is not subject to the same risk,” says Kates.
Some transplant centers have said that patients will lose their place on the list if they are not vaccinated against coronavirus.
However, some say it may be unfair to eliminate anyone who has not received a COVID vaccine from being considered for an organ itself because it may exclude racial, religious or ethnic groups that have lower vaccination rates.
The current system of waiting people for transplantation strives for justice and prioritizes “people who can not wait much longer for their organ, but if they get one, they have a good chance of being able to benefit and keep that organ,” he says. Govind Persad, who teaches bioethics and health law at the University of Denver.
When a transplant is the only option
Candidates for lung transplants after COVID-19 are often young and otherwise healthy, as is 41-year-old Vezna Hang. He received COVID in March this year, not long after moving to Tampa from New York. His symptoms were almost imperceptible, only a loss of taste and smell at first.
“One day I just looked in the mirror and saw that my lips and fingertips were blue,” he says.
Hang had no underlying relationship. But COVID-19 caused inflammation in his lungs that led to permanent scars. A transplant was his only option.
“In the first moment of my life, I was scared. And from day to day, there were times when I honestly did not think I would make it. And to leave my son, you know, it was hard going. My mind. . “
The father of a 5-year-old Hang was not vaccinated when he became ill. Florida did not open vaccine access to his age group, 40 and up, until late March, after he became ill.
But Hang understands people who are unsure of getting shot. He says he was one of them before he got sick.
“This horrible virus affects everyone differently. It’s not predictable at all,” says Hang.
“From what I experienced, being inside the hospital and watching all the people who were not vaccinated get hospitalized, it really made me push to get myself vaccinated, my family and encourage my friends,” he added.
The nurse’s dilemma
There is no national, overall policy on how to deal with vaccine rejection when it comes to transplants. The American Society of Transplant Surgeons recommends vaccination to anyone awaiting a transplant. Doctors say it is because the immune response is stronger if a patient receives the vaccine before, rather than after, their transplant.
Deborah Adey, a kidney transplant specialist at the University of California San Francisco, says it is often not the patients who are hard to convince.
“Where we’ve run into problems have been with caregivers,” says Adey, who has seen patients who were transplanted years ago become dangerously ill with COVID after living with unvaccinated family members.
“There have always been anti-waxers around. It’s not exactly new. But this degree of resistance to doing something for the public good? I’ve just never seen anything like it,” Adey adds.
Community exposure poses serious risks, especially with a highly contagious variant such as delta, says Kiran Dhanireddy, executive director of the Transplant Institute at Tampa General Hospital.
“Especially in this last increase, we have had several transplant patients die of COVID,” he says. “And it was patients who were for the most part vaccinated, but because their immune system is suppressed, they do not give a normal immunological response to the vaccine and therefore do not have the same degree of protection that a normal individual would.”
People living with donated organs must take immunosuppressive drugs for life to prevent their bodies from attacking and repelling the new organs, making them more vulnerable to COVID-19 for as long as they exist.