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Kudos to the Transplant Team at UC Health (University of Colorado Hospital)

Warning: This is a rant.

Last night I came across a story on cable news about the University of Colorado Hospital and their transplant team. They have issued a statement that all potential transplant candidates will need to be vaccinated against COVID to remain on the transplant list. The story didn’t interview any doctors or health officials from the UC Health. It simply highlighted the statement.

Next, it moves to an unvaccinated woman with advanced stage kidney disease in need of a transplant. You guessed it, she’s unvaccinated. They displayed a letter she received stating that if she is not vaccinated in the next 30 days, she will be removed from the transplant list. In the interview she states, “I feel like I am being coerced into doing something I am not comfortable with in order to get my transplant.”

The story then moves to a facebook live feed. U.S. congressmen Tim Geitner from Colorado is defending the woman and calls what the UC Health policy “disgusting.”

I used to believe that human beings were good judges of risk, but I’m really starting to question this assumption due to my observations during this pandemic. I find her choice to be an example of poor judgement. I would go as far to say, completely irrational. She is unwilling to get a vaccine that carries a risk of severe complication in the 1 in a millions range, but she is willing to: 1) undergo a major abdominal surgery with high risk of infection and massive blood loss, 2) be placed on aggressive immunosuppression for the 6 months post operation to ensure the success of the transplant, 3) remain on immunosuppression for the remainder of her life placing her at increased risk for all types of opportunistic infections, 4) accept a 10% risk of transplant failure and ending up where she started, 5) and 20-30% chance of death due to covid while on immunosuppression.

This is not a rational thought process. At some point society needs to stop giving these individuals a voice. It’s not intelligent and does not warrant deliberation in the court of public opinion. The benefit/risk ratio is far in favor of the vaccine. I also find it to be selfish and ungrateful. There are more people involved in this process that the individual. Not only does she have poor judgement, but she places all the stakeholders at risk. More on this later.

I’m tired of this argument that the vaccine is “too new” and “I’m going to wait and see.” This argument has no basis. You’re just being obstinate. COVID is likely going to claim over 1,000,000 lives in the U.S. alone. Its devastated plenty more. There are 10’s of millions of people walking around post vaccine that are completely fine. Look around. There’s nothing left to wait and see. What long term effects do you think the Pfizer and Moderna vaccine’s could actually have on you? The material in the vaccine is chewed up and recycled within a week of the injection. It’s gone! All that’s left is the education your immune system gained.

I’m also tired of this argument “I’m going to do my own research.” It’s fine if you want to do your own research, but you could show some self-awareness when you make that statement. It should be stated like this: “Now, I know this may be dangerous, because I have no formal training or prior knowledge of medical research. Also, I have no training or prior knowledge regarding how to determine if a source is credible. But I’m going to do my own research.” I can appreciate a statement like this.

When I was designing an evidence-based curriculum for the residency program at Beaumont health I came across some interesting statistics. An evidence-based curriculum basically teaches DOCTORS how to “Do their own research.” First, only 30% of post graduate medical education programs offer a formal evidence-based curriculum. Second, only 10% of DOCTORS felt comfortable formally appraising a medical research article. Finally, over 70% of DOCTORS surveyed TRUSTED the results published in peer reviewed journals.

Does anyone see the disconnect here? They don’t quite understand what they are reading, but they trust the author’s final statement anyways. Has anyone seen this phenomenon before?

Let’s talk about the formal training the public receives. First, your science class in high school was not real science. You likely performed a few displays of science and were tested on them. Don’t kid yourself. Your ability to execute the scientific method was not rigorously tested. If you did go to college, you probably didn’t get a degree in statistics. If you had to take introductory statistics for your major, you probably skipped it and crammed for the test. Finally, if you happened to get a PhD or go to medical school you barely remember your epidemiology course. Most students slept through it.

When U.S. drivers were asked a simply question “Do you consider yourself to be a good driver?”, 80% of them responded; Yes. Which we all know is statistically impossible. Only 50% of individuals can be good drivers, the other half are bad drivers. The same goes for doing your own research. Without formal training, its far less than 50%. You’re probably a danger to yourself. Especially when you are trying to choose between a Facebook post that is from: a) Russian bots, b) an over eager journalist, c) shared by your wife’s Aunt.

Now, back to our potential transplant recipient and everyone involved. It’s not just her. The donor kidney must come from somewhere. Most organs come from someone who has either died tragically or is making an incredible sacrifice for that individual. It is a big responsibility to receive an organ. The recipient should be willing to do what is necessary to ensure the transplant survival, not just for themselves, but to honor the donor. Organs are in short supply. Transplant lists are long because there are more people that need them than organs available. Patients are screened partly based on their ability to care for their transplant once they receive it. It’s completely disrespectful to the others waiting on the list if your number comes up and you are unwilling to do something so simple as to receive a vaccine to ensure the safety of that transplant.

There are doctors involved as well. They have to appropriately allocate these resources and care for the recipient after the transplant. It is not easy. These patients run high risk of rejection, infection, and high medical burden after the transplant. There is also the cost. This woman is likely on dialysis, therefore likely on Medicare or Medicaid. Society is paying for her current care, will pay for her surgery, and all of the post-operative care. We are all contributing in these cases. It would be such a waste for this patient to get Covid and die after her transplant if that could have been prevented with a vaccine the U.S. government paid $12 for.

Not to mention she cannot change her mind and get the vaccine post-transplant. She will be on immunosuppression. For a vaccine to work you must have a functioning immune system. Her immunosuppression would have to be interrupted placing her at risk or rejection and the entire process being a big waste of time and effort.

Good for UC Health and shame on this U.S. Congressman that ridiculed them. If this woman doesn’t want the vaccine, that’s fine. She can keep her personal choice and “wait and see.” What she doesn’t have is an inalienable right to a highly scarce resource that requires great effort and a highly technical process to ensure its survival that hundreds of other patient’s lives are hanging in the balance waiting for. The medical community has the responsibility to tell you NO if you choose to be so flippant about the gift you are about to receive.

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