Latest NHS advice on COVID-19 vaccine for patients and recipients

13 August 2021

First published 30th June 2021, updated 15 October 2021.

The NHS recommends that vaccination is the best protection for everyone from severe disease, risk of hospitalisation and death due to COVID-19.

Recipients of solid organ and islet transplants and patients listed for a transplant were not included in vaccination trials in the UK. As a result, there has been uncertainty about the level of protection from vaccination in these groups as compared to healthy volunteers and the general population. There was concern that the vaccine may not be as effective for patients classified as clinically extremely vulnerable from COVID-19 due to underlying health conditions and/or the need to take anti-rejection medication (immunosuppression).

Recently, data from Public Health England, which identifies patients testing positive for COVID-19, and the national vaccine registry were linked with the NHS Blood and Transplant (NHSBT) transplant registry. The combined data was used to identify transplant recipients and patients on the transplant waiting list in England who have received one or two doses of the COVID-19 vaccine and who have subsequently tested COVID-19 positive. This is a practical way to look at the impact of vaccination and its ability to prevent the most severe forms of COVID-19.

Analysis performed by NHSBT shows that approximately 80% of transplant recipients and patients waiting for a transplant in England had received both doses of the vaccine by 24th June 2021. The uptake of COVID vaccination was lower in London (75%) and in people from Black, Asian, Mixed Race and Minority Ethnic backgrounds (65-75%).

Between 8th Dec 2020 – 24th of June 2021:

  • Of approximately 6700 transplant recipients who had not received even one vaccine dose, 7% (466) contracted COVID-19. Of these, 40% (189) died within 28 days of a positive COVID test
  • Of approximately 39,000 transplant recipients who had received both vaccine doses, less than 1% (76) contracted COVID-19 two weeks or more after second vaccine dose. Of these 8% (6) died within 28 days of a positive COVID-19 test
  • Of approximately 650 patients on the transplant waiting list who had not received even one vaccine dose, 8% (51) contracted COVID-19. Of these 17% (8) died within 28 days of the positive test
  • Of approximately 3100 patients on the transplant waiting list who received both vaccine doses, less than1% (5) contracted COVID-19 two weeks or more after the second vaccine dose and none died within 28 days of the positive test

This data strongly supports the recommendation that, in the absence of any other health contraindication, suitable transplant recipients and patients on the transplant waiting list should accept the offer of two doses of the vaccine for maximum protection against contracting or dying from COVID-19. This analysis also confirms that amongst transplant recipients and patients waiting for a transplant, unvaccinated patients had a very high chance of dying if they contracted COVID-19.

The NHS is planning to offer a 3rd COVID vaccine dose from Sept 2021, with transplant patients prioritised to be amongst the earliest to receive the 3rd dose. To ensure continued and adequate protection against COVID, it is recommended that suitable transplant patients and those on the waiting list accept a third dose of the vaccine when one is offered to them.

Studies will continue on how best to measure and improve the effectiveness of the response to COVID-19 vaccination in immunosuppressed or immunocompromised patients. Transplant recipients and patients waiting for a transplant and their close contacts must continue to follow latest government advice, to reduce the risk of infection, even when vaccinated.

Does the Covid-19 vaccine affect organ donation and transplantation?

You can receive a transplant whether you have had the Covid-19 vaccination or not, as long as you are eligible. Being on the active waiting-list for a transplant is dependent, not on vaccination status, but a range of clinical factors.

When it comes to donation, you can also be an organ donor regardless of whether you have received the vaccine.

We would always advise people to have the vaccination if possible, as it gives people the best chance of protection against the most severe consequences of Covid.

As transplantation requires a patient to be immunosuppressed, in some cases it may be safer for some patients to hold off or wait for a transplant, rather than undergo the transplant if it will increase their risk of contracting or dying from Covid. The risks versus benefits of transplantation are always discussed in detail with the patient and kept under regular review.

 

Further advice and information

Follow these links to access more information and guidance around COVID-19 vaccination and current coronavirus restrictions.

NHS Blood and Transplant COVID-19 vaccine Q&As for clinicians and patients

British Transplantation Society COVID-19 information and resources

Government coronavirus advice

NHS COVID-19 vaccination advice