International Practices on COVID-19 Vaccine Mandates for Transplant Candidates

Yasar Caliskan, Benjamin E. Hippen, David A. Axelrod, Mark Schnitzler, Kennan Maher, Tarek Alhamad, Ngan N. Lam, Siddiq Anwar, Vivek Kute, Krista L. Lentine

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Key Points The approach to pretransplant coronavirus disease 2019 (COVID-19) vaccination mandates is heterogeneous across different countries and international transplant centers. International and US transplant centers without vaccine mandates cited similar concerns with similar frequencies. Increased public education to overcome vaccine hesitancy worldwide is needed to strengthen acceptance of recommended COVID-19 vaccination among transplant candidates. Background The coronavirus disease 2019 (COVID-19) pandemic created unprecedented challenges for solid organ transplant centers worldwide. We sought to assess an international perspective on COVID-19 vaccine mandates and rationales for or against mandate policies. Methods We administered an electronic survey to staff at transplant centers outside the United States (October 14, 2021-January 28, 2022) assessing the reasons cited by transplant centers for or against implementing a COVID-19 vaccine mandate. Each responding center was represented once in the analysis. Results Respondents (N=90) represented 27 countries on five continents. Half (51%) of responding transplant center representatives reported implementing a COVID-19 vaccine mandate, 38% did not, and 12% were unsure. Staff at centers implementing a vaccine mandate cited efficacy of pretransplant vaccination versus post-transplant vaccination, importance for public health, and minimizing exposure of other patients as rationale for the mandate. Of centers with a mandate, the majority (81%) of the centers mandate vaccination regardless of prior SARS-CoV-2 infection status and regardless of prevaccination spike-protein antibody titer or other markers of prior infection. Only 27% of centers with a vaccine mandate for transplant candidates also extended a vaccine requirement to living donor candidates. Centers not implementing a vaccine mandate cited concerns for undue pressure on transplant candidates, insufficient evidence to support vaccine mandates, equity, and legal considerations. Conclusions The approach to pretransplant COVID-19 vaccination mandate policies at international transplant centers is heterogeneous. International transplant centers with a vaccine mandate were more willing to extend vaccine requirements to candidates' support persons, cohabitants, and living donors. Broader stakeholder engagement to overcome vaccine hesitancy across the world is needed to increase the acceptance of pretransplant COVID-19 vaccination to protect the health of transplant patients.

Original languageEnglish (US)
Pages (from-to)1754-1762
Number of pages9
JournalKidney360
Volume3
Issue number10
DOIs
StatePublished - Oct 27 2022

Keywords

  • COVID-19
  • international practices
  • patient safety
  • solid organ transplantation
  • transplantation
  • vaccines
  • waitlist management

ASJC Scopus subject areas

  • Nephrology
  • Medicine (miscellaneous)

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