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People with heart conditions and heart transplants may have a higher risk of severe COVID-19 infection. This increased risk is due to immunosuppressive drugs and co-occurring health conditions. Many transplant centers strongly advise having COVID-19 vaccinations prior to receiving a heart transplant. These centers may refuse people without vaccinations. Why are transplant patients advised to have a COVID-19 vaccination Share on PinterestDesign by Medical News Today; photography by Thierry Dosogne/Getty ImagesTransplant centers advise people waiting for a heart transplant to have all the recommended COVID-19 vaccinations because transplants weaken the immune system. People who receive a heart transplant have to take lifelong immunosuppressant drugs. A suppressed immune system and additional health conditions, such as high blood pressure, can increase the risk of severe COVID-19 infection. Learn more about heart transplants. Why might doctors refuse a transplant to an unvaccinated person Transplant centers may refuse a transplant candidate if they do not have vaccinations for the following reasons: Immunosuppression To ensure the immune system does not reject the new organ, people need to take immunosuppressive drugs following a heart transplant. Immunosuppressants prevent the immune system from rejecting the transplanted organ, or graft, as a foreign body. This suppression of the immune system can increase the severity and risk of death from COVID-19. Nonadherence Transplant centers may view refusal of a COVID-19 vaccine as nonadherence. People requiring a heart transplant have to meet certain criteria and follow treatment regimes to be eligible for the waiting list. If people are not willing to receive all of the recommended COVID-19 vaccinations, a transplant center may refuse them. Best use of organs A transplant center may refuse a person who is unvaccinated due to an increased risk of graft loss and death due to COVID-19. Both of these conditions may have been preventable with COVID-19 vaccinations. People with heart failure or those who have received a heart transplant may have an increased risk of death from COVID-19. This increased risk occurs due to suppression of the immune system and co-occurring health conditions. The Organ Procurement & Transplantation Network (OPTN) Ethics Committee lists general considerations to assess if someone seeking a transplant is eligible. OPTN states that people with a longer life expectancy may benefit most from a transplant. This is due to the number of years the transplant may add to that person’s life. Safety of the transplant team Heart transplant candidates who are unvaccinated may pose an unnecessary risk to healthcare professionals through potential exposure to COVID-19. Transplant centers that cannot meet certain certain requirements from the Centers for Medicaid & Medicare Services (CMS) may risk losing their participation in the program. Safety of other transplant patients Candidates who are unvaccinated may come into contact with other heart transplant candidates in hospital and outpatient settings. This may put other candidates at an increased risk of COVID-19. Listen to our podcast or read the article: What is behind vaccine hesitancy? Is there a COVID-19 vaccine for immunocompromised patients The Centers for Disease Control and Prevention (CDC) provides a recommended vaccine schedule for people of all age groups with compromised immune systems. This schedule covers all of the available COVID-19 vaccinations. The American College of Cardiology (ACC) recommends transplant candidates receive a SARS-CoV-2 mRNA vaccine. The ACC also recommends a booster vaccine with a third dose of the mRNA vaccine for people who are immunocompromised. A third mRNA vaccine may increase protection and immune response to COVID-19. Learn more about COVID-19 vaccines. Evusheld vs vaccine Evusheld is a combination of two antibodies, tixagevimab/cilgavimab, which provides further protection against COVID-19. Evusheld is a preexposure treatment, meaning it can help protect people with weakened immune systems before they encounter the COVID-19 virus. The CDC recommends Evusheld injections every 6 months alongside the recommended COVID-19 vaccination schedule for people who are moderately to severely immunocompromised. The CDC states that Evusheld is not an alternative to COVID-19 vaccinations. It is an additional measure to protect people who are immunocompromised. A 2022 critical analysis urges the need to reassess the efficacy of Evusheld in vaccinated, immunocompromised people, as the available data is not robust. Precautions for immunosuppressed people The CDC provides the following list of precautions for immunocompromised people to help protect against COVID-19 infection:Stay up to date on all recommended COVID-19 vaccinations.People who are living with or spending frequent time with people who are immunocompromised should also stay up to date with vaccinations to protect their loved ones.Talk with a healthcare professional about having Evusheld injections as additional protection.Wear a properly fitting, high quality mask or respirator, which provides the best protection.Avoid crowded or poorly-ventilated indoor areas.If indoors with other people, try to keep windows open or improve ventilation where possible.Wash hands frequently with soap and water or use a hand sanitizer containing at least 60% alcohol.Learn the symptoms of COVID-19. If a test result is positive, contact a healthcare professional right away, as antibody treatments are available to help prevent severe illness. Learn more about COVID-19 here. Frequently asked questions Where can I get a COVID vaccine People can find a local COVID-19 vaccination location using this search tool. People can also text their ZIP code to 438829 to find a location near them, or call 1-800-232-0233. Are donated organs safe New research suggests that organ donation from donors with COVID-19 is safe and does not transmit the SARS-CoV-2 virus to people receiving the organ. Transplant centers test all organ donors for COVID-19, as well as other infections and diseases, before an organ transplant. Learn more about how organ transplants work. Do transplant recipients develop an antibody response to the COVID-19 vaccine A current study from the National Institutes of Health (NIH) is investigating ways to improve antibody response in transplant recipients who receive COVID-19 vaccinations. Research shows that the immunosuppressant medications all organ transplant recipients must take reduce the immune response to vaccines and infectious diseases. People on immunosuppressants with a full primary vaccination schedule and a third dose of the mRNA vaccine still may not produce an antibody response. Alternatively, they may only produce weak antibodies. According to the ACC, around one-half of heart transplant recipients do not create certain antibodies after two doses of the mRNA vaccine. A third dose of the mRNA vaccine may create a significant increase in immunity against COVID-19. Research has shown that the mRNA’s third dose provided an antibody level above 100 units per milliliter (U/ml) in 55% of transplant recipients. This is above the protective threshold. The ACC recommends transplant recipients take additional protective measures, such as mask-wearing. The organization also encourages friends and relatives to vaccinate. Learn more about COVID-19 antibodies. Outlook According to the ACC, COVID-19 vaccinations are safe and effective for heart transplant recipients. Additionally, a third dose of the mRNA vaccine may increase immunity and protection against severe COVID-19 infection. The CDC recommends that people who are immunocompromised stay up to date with COVID-19 vaccinations. These people may also wish to consider Evusheld as an extra precaution. Vaccination may increase antibodies against COVID-19. However, it may not provide as much protection as it does to people who are not immunocompromised. Certain transplant centers may refuse a transplant candidate if they are not up to date with all the recommended COVID-19 vaccinations. Other transplant centers strongly recommend vaccination but may accept transplant candidates who are unvaccinated. Summary Heart transplant recipients have to take lifelong immunosuppressant drugs to prevent the body from rejecting the new organ. These drugs suppress the immune system, putting heart transplant recipients at a much higher risk of severe complications or death from COVID-19. Being unvaccinated may reduce life expectancy and pose a risk to healthcare staff and other transplant candidates. Therefore, some transplant centers may refuse people who are unvaccinated. Evidence suggests that COVID-19 vaccinations are safe for people with heart failure and heart transplants. These vaccines may lower the risk of severe complications from infection. Last medically reviewed on October 5, 2022SurgeryCardiovascular / CardiologyTransplants / Organ DonationsCOVID-19 11 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Bozkurt, B., et al. (2021). Cardiac transplant patients should receive a booster for COVID-19 vaccination.https://www.acc.org/latest-in-cardiology/articles/2021/08/13/16/21/cardiac-transplant-patients-should-receive-a-booster-for-covid-19-vaccinationCOVID-19 frequently asked questions. (2022). https://www.organdonor.gov/learn/process/covid-19-frequently-asked-questionsEuropean Congress of Clinical Microbiology & Infectious Diseases. (2022). Early study shows that organ donation from dying patients that have tested positive for COVID-19 is safe and does not infect recipients with SARS-CoV-2 [Press release].https://www.eurekalert.org/news-releases/947131Focosi, D., et al. (2022). A critical analysis of the use of cilgavimab plus tixagevimab monoclonal antibody cocktail (Evusheld™) for COVID-19 prophylaxis and treatment.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9505619/General considerations in assessment for transplant candidacy. (2021). https://optn.transplant.hrsa.gov/professionals/by-topic/ethical-considerations/general-considerations-in-assessment-for-transplant-candidacy/Heart transplant. (n.d.).https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/heart-transplantImmunocompromised. (2022).https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-who-are-immunocompromised.htmlLease, E. (2021). Quick tips and considerations for COVID-19 vaccination in heart failure and transplant patients.https://www.acc.org/latest-in-cardiology/articles/2021/03/05/14/38/quick-tips-and-considerations-for-covid-19-vaccination-in-heart-failure-and-transplant-patientsNational Institutes of Health. (2022). Trial tests strategy to augment response to COVID-19 vaccines in transplant recipients [Press release].https://www.nih.gov/news-events/news-releases/trial-tests-strategy-augment-response-covid-19-vaccines-transplant-recipientsRoss, L. F. (2022). COVID-19 vaccine refusal and organ transplantation.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894498/Use of COVID-19 Vaccines in the U.S. (2022).https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.htmlFEEDBACK:Medically reviewed by Darragh O'Carroll, MD — By Beth Sissons on October 5, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? 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