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When a Colorado woman found out her hospital wouldn't approve her kidney transplant surgery until she got the COVID-19 vaccine, she was left with a difficult decision pitting her health needs against her religious beliefs.
Leilani Lutali, a born-again Christian, went with her faith.
Even though she has stage 5 kidney disease that puts her at risk of dying without a new kidney, Lutali, 56, said she could not agree to be vaccinated because of the role that stem cells have played in the development of vaccines.
"As a Christian, I can't support anything that has to do with abortion of babies, and the sanctity of life for me is precious," she said.
UCHealth requires transplant recipients to be vaccinated because recipients are at significant risk of contracting COVID-19 as well as being hospitalized and dying from the virus, spokesman Dan Weaver said. Unvaccinated donors could also pass COVID-19 to the recipient even if they initially test negative for the disease, he said.
"Studies have found transplant patients who contract COVID-19 may have a mortality rate of 20% or higher," he said.
It's not clear how common this type of policy is.
The American Hospital Association, which represents nearly 5,000 hospitals, health care systems and networks in the United States, said it did not have data to share on the issue. But it said many transplant programs insist that patients get vaccinated for COVID-19 because of the weakened state of their immune system.
While any type of surgery may stress a patient's immune system and leave them vulnerable to contracting COVID-19 later, organ transplants recipients are even more at risk because they have to take a powerful regime of drugs to suppress their immune system to keep their body from rejecting the new organ, which is seen by the body as a foreign object, Nancy Foster, AHA's vice president for quality and patient safety policy said in a statement.
"Further, if patients were to wait to get their vaccine until after the surgery, it is unlikely that their immune system could mount the desired antibody reaction given that they are taking anti-rejection medications," she said.
Transplant centers in Washington, Vermont, Massachusetts and Alabama have policies requiring that recipients be vaccinated, according to news reports.
Cleveland Clinic recently decided to require COVID-19 vaccinations for both transplant recipients and living donors, the organization said in a statement.
Some health care systems recommend or strongly encourage vaccination for transplants, including the Mayo Clinic and Sentara Healthcare, two of the nation's largest. The University of Alabama Birmingham's School of Medicine transplant program only recommends that living donors receive a vaccine, but it does not require it for the donation process.
The best time to get a COVID-19 vaccine is before an organ transplant. If time allows, patients should get their second dose of the available vaccines at least a couple of weeks prior to transplant "so that your body has a good immune response to the vaccine," said Dr. Deepali Kumar, the American Society of Transplantation's president-elect and an infectious disease physician.
Many major religious denominations have no objections to the COVID-19 vaccines. But the rollout has prompted heated debates because of the longtime role that cell lines derived from fetal tissue have played a role, directly or indirectly, in the research and development of various vaccines and medicines.
Roman Catholic leaders in New Orleans and St. Louis went so far as to call Johnson & Johnson's COVID-19 shot "morally compromised." J&J has stressed that there is no fetal tissue in its vaccine.
Moreover, the Vatican's doctrine office has said it is "morally acceptable" for Catholics to receive COVID-19 vaccines that are based on research that used cells derived from aborted fetuses. Pope Francis himself has said it would be "suicide" not to get the shot, and he has been fully vaccinated with the Pfizer formula.
Ethical considerations should take both individual and societal perspectives into account, Dr. Kumar said.
"It's really what's best for the patient at this time and from a societal perspective as well," she said. "The more patients that get vaccinated, you know, we have better outcomes."
To Lutali, a recruiter for tech companies, it seems like her hospital was so insistent on saving her from COVID-19 that is is willing to let her possibly die by blocking her transplant surgery.
Lutali, who does not belong to a denomination, said she does not live in fear of dying because of her belief in the afterlife. She is searching for another hospital, possibly in Texas or Florida, where she could get a transplant without being vaccinated.
"I have hope that something will come along that is something I can live with in terms of my choices," she said.
Nieberg and Slevin reported from Denver.