Frequently asked questions
What does it mean to be "immunocompromised"?
A person is considered immunocompromised when their immune system can’t readily recognize foreign cells including bacteria or viruses. Many different conditions and treatments can cause a person to be immunocompromised or have a weakened immune system. People who have received an organ transplant and many people who are waiting for a transplant are considered immunocompromised.
Why are transplant recipients considered more vulnerable to illnesses like COVID?
Having a weakened immune system can make you more likely to get severely ill from illnesses like influenza and COVID-19. Everyone who receives a transplant must take medicine to lower their immune system response, in order to prevent transplant rejection. This is known to increase their risk of getting infection. In addition, they are more likely to spend additional time in other healthcare settings such as a dialysis clinic or an outpatient lab, increasing their risk of exposure to illness.
What are the recommended precautions immunocompromised people should take to protect against coronavirus?
If you are a transplant recipient and taking immunosuppressive medications, you may not be fully protected even if you are up to date on your vaccinations. You should continue to take precautions recommended for unvaccinated people, until advised otherwise by your healthcare provider.
Actions you can take to protect yourself and others include:
- Staying up to date with your COVID-19 vaccines
- Wearing a well-fitting mask
- Avoiding crowds and poorly ventilated spaces
- Test to prevent the spread to others
- Washing your hands often
- Cover coughs and sneezes
- Monitor your health daily
- Talk with your transplant team about other preventative treatment options
Vaccine questions (Also view vaccine updates)
Is a COVID-19 vaccination required in order to receive an organ transplant?
Each transplant hospital makes its own decisions about listing and transplanting candidates according to the hospital’s best clinical judgment, including whether or not any specific vaccination is part of their eligibility criteria. If you have questions about listing or transplant criteria at your hospital, we encourage you to contact the hospital directly. UNOS does not track which transplant centers require a COVID-19 vaccine.
As a transplant recipient, do I qualify for an additional booster of an mRNA vaccine (Pfizer, Moderna) or a Johnson & Johnson vaccine?
The U.S. Centers for Disease Control and Prevention (CDC) has posted new information for certain immunocompromised individuals, which includes transplant recipients. You can read the latest guidance on the CDC website. Always consult with your transplant team when considering COVID-19 prevention and treatment options.
Are there any ongoing concerns about the impact of COVID on fully-vaccinated transplant recipients?
Studies and real-life data show that even fully-vaccinated, immunocompromised transplant patients have an increased risk of developing severe COVID-19 infections. That is why additional boosters have been approved by the CDC and why some transplant programs have chosen to inform their patients to continue wearing masks and social distancing.
If you have specific questions about the impact of COVID-19 on you as a transplant recipient, please contact your healthcare provider.
Can I still be a living organ donor if I have/have not received a COVID-19 vaccine?
As with other vaccines, receiving the COVID-19 vaccine does not prevent you from being a living organ donor.
If you have not received a COVID-19 vaccine, your ability to be a living donor depends upon the specific eligibility requirements established by your transplant hospital. If you have questions about organ donor criteria at your hospital, we encourage you to contact the hospital directly.
Are organ donors tested for COVID-19? Can those who have had or currently have COVID-19 still donate? What about donors who have had or currently have “long COVID”?
All organ donors are tested for an active COVID-19 infection (and a variety of other illnesses and diseases) prior to donation. People who have recovered from COVID-19 and no longer have an active COVID-19 infection can be an organ donor. The OPTN Disease Transmission Advisory Committee has developed donor testing guidance for professionals. The guidance is regularly updated.
While people who have active COVID are not generally considered as donors, in some rare cases, transplants from COVID-positive donors have been performed. These have taken place in limited numbers and on a case-by-case basis after careful assessment of the risks and benefits by clinicians and potential recipients.
Long COVID is a variety of symptoms that persist following resolution of an active COVID infection. Long COVID is not an active COVID infection.
As with all potential donors, following thorough testing, if the organs from a deceased donor who experienced long COVID are found to be suitable for transplant, they can be considered for transplantation on a case-by-case basis.
How has COVID-19 impacted living donor organ transplants?
Most programs have fully resumed doing living donor transplants after initially postponing them. Your transplant team is best able to advise you on their current status. However, the recent surge in COVID-19 cases related to the Omicron variant has the potential to impact the ability of some programs to do living donor transplants.
Earlier in the pandemic, some transplant programs temporarily postponed some or all living donor transplants. This was partly due to the availability of resources in the hospital and partly to minimize the potential risk of exposure to the virus.
What COVID-19 treatments are available for those who are immunosuppressed?
There are a variety of treatments available for COVID-19, including pre-exposure medication (specifically for immunosuppressed individuals) as well as monoclonal antibody treatment specified for use against the Omicron variant. The most appropriate treatments continue to evolve and should be evaluated by the patient and their provider on a case-by-case basis.
If you have specific questions about these or other treatments, we encourage you to contact your healthcare provider to determine if any of them are right for you.
Are transplant programs changing appointments/clinics/lab tests due to COVID-19?
Each program is making decisions based on the availability of staff to help you and their assessment of the risk to patients by continuing these services in the short term. In some cases, programs are temporarily postponing some services or making new arrangements (such as telemedicine appointments) in the interest of patient safety.
Your transplant team is the best source of information regarding their current schedule and arrangements. Keep in mind that they may continue to be adjusting them to meet new needs. If you have a scheduled appointment or procedure, you may wish to contact them in advance to see if anything has changed.
If I do not get labs or other testing as scheduled, will that affect my listing status?
The Organ Procurement and Transplantation Network has temporarily changed policy requirements for transplant programs. If the program cannot perform a test because of COVID-19, or if it believes doing a test right now would expose patients to unnecessary risk, the program may instead submit the most current results available for you. Doing so will not affect your current listing status.
This is a temporary measure. Once testing can be performed routinely nationwide, programs will be expected to resume their normal schedule. Transplant programs have autonomy in their medical judgment regarding patients they have listed. Therefore, a transplant program may, ultimately, choose to inactivate patients who have outdated testing.
What happens if I am temporarily put in an inactive status? Do I lose any priority on the waiting list?
Some transplant programs, using their medical judgment, are determining it is best not to currently accept organ offers for some transplant candidates. This is based on the relative risk of your potential exposure to the virus during and soon after surgery as compared to your current level of urgency for a transplant.
A temporary inactivation does not mean that you are removed from the waiting list. It means that for a period of time determined by the transplant program, you would not be considered for organ offers. The transplant program may reactivate you at any time they believe they can resume transplanting patients as usual.
If you are awaiting a kidney and/or pancreas transplant, or if you have a child younger than age 12 needing a lung transplant, the priority you accrue based on waiting time will continue as long as you remain inactive. When you are reactivated you will keep all the waiting time you have gained.
If you need a different organ type, or you are a lung candidate older than age 12, you only accrue waiting time while you are in an active listing category. In this case, your transplant program may temporarily change the criteria for organ offers you might receive. That will allow you to remain active and continue to gain waiting time. You would, however, not be considered for organ offers until the program resets the criteria.
Your transplant program can discuss with you your current status and any conditions where they believe it is best to not accept organ offers for you for a limited time.
If my relative or friend needs a transplant, or just had a transplant, can I visit them at home or in the hospital?
In general, you should follow current medical recommendations for masking and social distancing. The federal Centers for Disease Control and Prevention is continually updating its COVID-19 resource page with guidance and information. If you have specific questions about contact, your friend or loved one’s transplant team may offer more guidance.
Keep in mind that all transplant recipients take medicine to prevent organ rejection. That same medication may lower their normal immune response to common illnesses. People who have recently had an organ transplant often are on higher doses of these medications and must take additional precautions to lower their risk of infection.
Even if you are unable to visit them close and in person, you can continue to show your support and caring by sending them a card or gift, a call or video chat, or supporting them on social media.
Risk of transmission
Risk of transmitting disease through solid organ transplantation is very low. In April 2021, the OPTN Disease Transmission Advisory Committee released a Summary of Current Evidence and Information about donor testing and organ recovery from donors with a history of COVID-19. The Centers for Disease Control and Prevention COVID-19 website provides the most up-to-date information regarding recommended precautions, global risk assessment, and travel.
- newAST releases joint statement on COVID-19 vaccines and transplant (12/9/22)
- newNIH releases website to report results of at-home COVID-19 tests (12/9/22)
- newNIH updates guidance for use of bebtelovimab (12/9/22)
- newCDC updates guidance on boosters for the immunocompromised (12/9/22)
- CDC updates guidance on boosters. (10/6/22)
- NIH updates guidance on influenza season. (10/6/22)
2022 vaccine updates (Jan. – Sept.)
- FDA authorizes updated booster. (9/13/22)
- CDC updates vaccination guidance for immunocompromised and updated vaccination schedule. (9/13/22)
- NIH updates guidance on monoclonal antibodies. (9/13/22)
- NIH: updates guidance for the immunocompromised. (8/19/22)
- FDA: advises repeat testing following a negative COVID-19 test. (8/19/22)
- FDA: state-licensed pharmacists can prescribe Paxlovid to eligible patients, with limitations. (7/21/22)
- FDA: Novavax vaccine, Adjuvanted for prevention 18 years of age and older. (7/21/22)
- CDC interim recommendations for vaccines in children from 6 months of age. (7/8/22)
- FDA: advisory committee voted for SARS-CoV-2 omicron component in vaccine boosters beginning fall 2022. (7/8/22)
- FDA authorized emergency use of Moderna and Pfizer-BioNTech vaccines to include use in children from 6 months of age. (6/17/22)
- CDC has released a new infographic showing vaccine schedules for most people and for those who are immunocompromised. (PDF)
- NIH updates vaccine guidance for potential organ donors (5/31/22)
- FDA expands Pfizer-BioNTech vaccine booster eligibility to children 5 through 11 years (5/26/22)
- FDA authorizes first nonprescription test that also detects flu and RSV (5/26/22)
- FDA revises committee meeting schedule to discuss vaccines (5/26/22)
- FDA limits use of Janssen vaccine (5/12/22)
- NIH updates guidance for second doses of Evusheld (5/12/22)
- FDA approves first treatment for young children (4/29/22)
- FDA authorizes diagnostic test using breath samples (4/29/22)
- NIH no longer recommends sotrovimab as a treatment option for nonhospitalized patients (4/15/22)
- FDA authorizes second booster dose of two vaccines for older and immunocompromised individuals (3/29/22)
- NIH statement: Role of Bebtelovimab for treatment of high-risk, nonhospitalized patients with mild to moderate COVID-19 (3/2/22)
- FDA authorizes new monoclonal antibody treatment (2/11/22)
- NIH statement: prophylaxis Evusheld (2/1/22)
- FDA gives full approval to the Moderna vaccine (1/31/22)
- AST: Vaccine FAQ (updated 1/28/2022)
- NIH statement: therapies for high-risk, nonhospitalized patients with mild to moderate COVID-19 (1/19/22)
- FDA takes multiple actions to expand use of Pfizer-BioNTech vaccine (1/3/22)
- Third dose of vaccine approved for immunocompromised children ages 5 through 11 (1/3/22)
National Kidney Foundation
- Information and resources for patients and caregivers
Medicare B immunosuppressive drug benefit eligibility
Starting Jan. 1, 2023, a new Medicare benefit is available for certain kidney recipients to help cover the costs of immunosuppressive medications.
The American Society of Transplantation (AST)
- Transplant community FAQ resources for professionals, transplant candidates and recipients (regularly updated)
- Recommendations and guidance for organ donor testing
- Hoja de preguntas frecuentes sobre la vacuna (Vaccine FAQs)
- ¿Qué debo hacer si tengo COVID-19? (What Should I Do if I Have COVID-19?)
- y más
AST: Handouts for recipients and candidates You’ll find:
- Home monitoring for exposure or infection
- Home monitoring guide and log
- What should I do if I have COVID-19?
- Safer living: Tips for transplant patients
COVID-19 and the transplant community: Answering your questions on treatment and prevention
July 7, 2022: Watch recording.
A panel of experts share the latest updates on COVID-19 and transplantation.
The Transplant Center at Massachusetts General Hospital
Update on COVID-19 in Transplantation: from Travel to Treatment
May 24, 2022: Watch recording
A panel of experts share the latest updates on COVID-19 and transplantation—from vaccine recommendations, use of monoclonal antibody therapy, what to do when symptomatic or positive and traveling during the pandemic.
COVID-19 and transplant
Jan. 20, 2021: Answering the vaccine-related questions you have been asking, UNOS Chief Medical Officer David Klassen, M.D., addresses COVID-19 concerns for organ donation and transplantation.
- In your professional opinion, should transplant patients and/or those on the waitlist take the COVID-19 vaccine?
- Why are transplant recipients not in a higher phase for COVID-19 vaccines?
- Could the COVID-19 vaccine be harmful to an organ recipient?
- I’m a living donor who is currently undergoing testing to donate an organ. Can I take the COVID-19 vaccine?
- What are the potential risks associated with COVID-19 and receiving a living transplant?
- I need an organ transplant, but my local transplant center isn’t currently performing living donations due to COVID-19. What can I do?
- Are COVID-19 deceased donors eligible to donate organs? I’m concerned about contracting the virus.
Transplant Families & American Society of Transplantation
COVID-19 Vaccine – What does it mean for our transplant children?
Nov. 4, 2021: Watch recording
What the transplant infectious diseases community has learned, and specific medical effects COVID-19 may have on our kids.
Webinar: Patient questions answered
Sept. 22, 2021: Watch recording
UNOS Chief Medical Officer David Klassen, M.D. answered the most common COVID-19 questions from OPTN Patient Services. Made possible by a generous gift from CareDx.
Transplant Families & American Society of Transplantation
COVID-19 Q&A for pediatric patients
April 16, 2020: Watch recording
Transplant Families, in partnership with several pediatric transplant centers and professional organizations, hosted a COVID-19 Question & Answer session to help address parental concerns as it pertains to the virus and pediatric transplant community.
American Association of Kidney Patients
Coronavirus and Transplant Patients: Get the Facts, Save a Life.
April 14, 2020: Watch recording
Impact of COVID-19 on kidney transplant recipients and individuals waiting for a kidney transplantation. Find out what questions, you as the patient, should be raising to your care team. Emily Blumberg, MD and Lloyd Ratner, MD, MPH, FACS lead the webinar.
American Society of Transplantation & American Society of Transplant Surgeons
Coronavirus and Kidney Patients
March 27, 2020: Watch recording
Provides in-depth answers to COVID-19 patient questions for recipients and candidates.
April 2020: Navigating the coronavirus pandemic is difficult for everyone, but brings special challenges for transplant patients. UNOS Chief Medical Officer David Klassen, M.D., answers questions for patients about COVID-19 and the waiting list, inactivation, donor testing and other important topics.
“The transplant community shares the common goal of saving as many lives through transplantation as possible.”
Brian Shepard, CEO (former), United Network for Organ Sharing