A Colorado woman couldn't get a kidney transplant because she refused a COVID-19 vaccine - a policy at many hospitals

• A Colorado woman was denied an organ transplant after refusing to get a COVID-19 vaccine, the AP reported.
• Like many hospitals, Colorado's UCHealth prioritizes patients who are more likely to survive after surgery.
• Vaccinated people fall into that category, since they're well protected against COVID-19.

Leilani Lutali was due for an organ transplant to treat her stage 5 kidney disease. But her hospital, UCHealth in Colorado, requires transplant patients to get a COVID-19 vaccine. Lutali refused the shot, the Associated Press reported, leaving her to search for a different hospital that might approve the surgery.

UCHealth is denying transplants to unvaccinated people "in almost all situations," the health system told The Washington Post, since these individuals are more likely than vaccinated people to die of COVID-19.

Dan Weaver, a spokesperson for UCHealth, told The Post that the policy aligns with a common practice of prioritizing people who are more likely to survive a transplant, and less likely to require another one down the line. The Cleveland Clinic, one of the largest hospitals in the US, also requires transplant recipients to get a COVID-19 shot.

Lutali, who works as a tech recruiter, is Catholic, and said her decision not to get the vaccine was based on concerns about the connection between vaccines and aborted fetal cells, the AP reported. COVID-19 vaccines don't contain any fetal tissue - rather, they're developed using cells that descend from fetal tissue collected several decades ago.

Her wait could be long: More than 100,000 Americans are on a waitlist for an organ transplant, and deciding who to prioritize is complicated business. Patients must be deemed a good match for an organ based on their height, weight, blood type, and geographic location. Many transplant centers require patients to get other vaccines and abstain from drinking or smoking.

In transplant decisions, a key question: Who's most likely to live?

Deciding who's eligible for surgery based on vaccination status raises complicated ethical questions.

"Each individual [transplant] center is wrestling with what to do about COVID vaccination status," Arthur Caplan, a bioethicist at New York University, told Insider.

"You try to maximize lives saved, years of life saved, and even, to some extent, quality of life saved with your scarce supply," he added. "I don't see why we wouldn't be doing that with COVID and vaccination status."

Healthcare systems across the US vie for organs from a national waitlist managed by the nonprofit United Network for Organ Sharing (UNOS). UNOS has guidelines for how to make the best use of a limited organ supply and prevent discrimination based on demographic factors like sex, religion, or financial status. But health systems can determine independently whether to add or remove someone from the waitlist.

"The general principle driving the list used to be, 'Who's sickest? Who's going to die if they don't get it?'" Caplan said. "That slowly has been shifting toward, 'Who's most likely to live, and how do we get the most benefit from the scarce supply?'"

There are a few reasons for that, he added: Organ transplants started to have a better success rate around the early 2000s, so transplant centers began to worry more about "wasting" organs on people who were likely to die anyway. Transplant centers are also evaluated based on their success rates, which can inform whether they remain eligible for organs from UNOS.

"That puts even more pressure to have organs that work for one year, two years, and five years," Caplan said. "So they are in a way incentivized not to take higher-risk people - and that would include non-vaccinated people for both flu and COVID."

Many medical experts agree that it's important to consider a person's vaccination status ahead of a transplant, along with other risk factors.

Transplant patients have a much higher risk of dying from COVID-19 than the average person, since their immune systems do a poorer job of vanquishing the virus. Studies have shown that kidney transplant recipients with COVID-19 have a mortality rate between 13% and 39%. (The COVID-19 mortality rate across the entire US is around 1.6%.)

There's also a small risk that transplant patients will receive an organ from someone who's had COVID-19, and could therefore inherit a previously undetected infection.

Overall, unvaccinated Americans are 11 times more likely to die from COVID-19 than fully vaccinated Americans, according to a September study from the Centers for Disease Control and Prevention.

This story has been updated with new information. It was originally published October 7.