Booster shots for immune compromised
Organ recipients are at greater risk of death from Covid-19, while waiting lists for transplants grow
The department of health will soon enable Covid-19 booster shots for organ transplant recipients. This follows months of lobbying by the South African Transplant Society, the Organ Donor Foundation and the South African Sports Transplant Association. All cite dramatic mortality rates and plummeting organ donations.
With a fourth wave driven by yet another mutation possible before Christmas and just 37% of the population fully vaccinated, the race is on to save those at greatest risk.
The man at the helm of the Covid-19 vaccination campaign, Dr Nicholas Crisp, confirmed that organ recipients and those on dialysis now qualify for additional vaccination doses, as well as anyone on long-term oral steroid therapy or systemic biologics for autoimmune conditions, haematological and immune malignancies, bone marrow transplants, or with a primary immunodeficiency disorder. HIV is still being assessed for additional vaccine dosing.
“The minister of health has approved additional doses for immunocompromised people. We are working on implementation,” Crisp told the Mail & Guardian.
UK studies have shown that the mortality rate among organ recipients drops from a high 40% in those unvaccinated or vaccinated once, to just 8% after a second jab. US research shows that this again drops markedly after a booster shot.
Dr David Thomson, president of the
South African Transplant Society and a surgeon and critical care specialist at Groote Schuur Hospital says in some studies when transplant recipients infected with Covid-19 were compared to the general population, there was a tenfold increase in mortality.
Fewer organ transplants are also being done. A Western Cape study shows organ donor referrals have dropped from 4.8 to 1.8 per month in the first 10 months of the pandemic, compared to the full year prior.
Covid-19 has aggravated existing underperformance in South Africa, where just 25 organ procurement
nursing sisters are spread thinly across the main cities. At the height of Covid-19 surges, they are reassigned to ICUS.
The same holds true for surgeons and anaesthetists being “repurposed” to handle Covid-19 loads. All elective surgery is typically cancelled during the peak of a Covid-19 surge. The most common transplants cancelled are for kidneys, which is considered an elective surgery because a living donor donates a kidney.
Declines in transplants also take place in countries with more robust healthcare systems. The US recorded a 50% drop and France a 90% drop since the pandemic hit.
Thomson says: “We’ve had about a 67% reduction in donor referrals between March and December 2020.” There are other, systemic reasons for South Africa’s low numbers of donations. Thomson says South Africa does not routinely approach the question of organ donation at the end of life. Highly skilled healthcare workers need to counsel a grieving family to discuss donating their loved one’s organs shortly after death.
“I think the healthcare system itself is the biggest barrier. It’s easy to say the religion or culture of potential donors is to blame, but you first need to optimise the healthcare environment and practices,” he adds.
Samantha Nichols, the operational executive director of the Organ Donor Foundation, told the M&G about 3 500 organ donors are now being signed up monthly. Yet, she said, Covid-19 has halved kidney transplants, the procedure with the longest waiting list.
“A lot of donors are also slipping through the cracks because not all hospitals or funeral parlours (for corneas and bone donation) refer. We need more feet on the ground in hospitals to reach more people. Each time, it’s a massive, coordinated effort. Typically, an organ donor is brain dead, on a respirator and certified dead by two doctors not involved with the transplant team,” she explained.
Nichols said while South African transplant centres work together, the country lacks an umbrella body like the United Network for Organ Sharing in the US, backed by an electronic data system that helps ensure that available organs are sent to the person most in need.
She says in Spain, for example, every hospital has a transplant officer, and each death is audited for potential tissue for organ donation.
Thomson says it took Spain nearly 10 years to get transplant coordinators
posted to every ICU before it saw improvement, after “opt out” (presumed consent) legislation was passed. South Africa has an “opt in” organ donation system where relatives must first consent before any organ can be recovered.
Kidney recipient and cancer survivor Dr Michael Bradfield, a geneticist and scientist whose transplant seven years ago transformed his life, told the M&G that Covid-19 had cost a lot of lives of people who needed transplants, but couldn’t get them.
Welcoming the government announcement, he said: “Initially they left us in the lurch by not allowing transplant patients to get vaccinated — we had to go as per normal in the various age groups. That cost a lot of lives — we’re all on the register and could easily have gone for earlier vaccination.”
Bradfield said the pandemic had taken a toll on the South African Sports Transplant Association. Its chair, Stan Henkeman, who had a heart transplant 30 years ago, died of Covid-related complications in December last year and chief executive Herman Steyn, also a heart transplant recipient, succumbed in the same manner in July. Henkeman was also the executive director of the Institute for Justice and Reconciliation.
“We also lost advocate Louis van der Westhuizen, a board member. There may be others,” he added.
Dr Errol Gottlich, a paediatric nephrologist who heads Discovery Health’s renal programme, says the mortality rate among the 3 000+ patients on his programme was about 13% a year, “but I suspect it will be quite a few percent higher over the last 18 months”.
“We’ve now got patients sitting on chronic dialysis longer and having more complications with related death rates because of the nature of this disease,” he said.
The government’s targeted intervention could not have come at a better time. According to the Reuters Global Covid-19 tracker, South Africa is at 3% of its last Covid peak and falling, with only seven infections per 100 000 people reported in the last seven days, as at 19 October.
There were 636 new infections reported each day of that week, 3% of the highest daily average at the peak of the pandemic on 8 July 2021. There have been 88 619 coronavirusrelated deaths in South Africa since the pandemic began, with more than three-million people infected — 5% of the population.
The Organ Donation Foundation website is at
The toll free line is 0800 226611