Table 3: Preliminary best practices for transplantation when working with non-vaccinated patients.

Table 3 recommends best practices that can be implemented in all centers regardless of institutional policy while awaiting a consensus statement regarding transplant listing for candidates who refuse recommended vaccines.

Before Transplant

Candidates should be evaluated by an infectious diseases physician prior to transplant44 Clinicians should obtain a detailed immunization history and serologic evaluation9 The transplant team should counsel candidates about the importance of vaccination and the added benefits of completing vaccination before transplant Educational materials should be developed in partnership with community representatives, with a focus on cultural competency. Materials should be made available in multiple languages. Close contacts should receive all recommended vaccinations beginning before the transplant, to ensure protection during the early post-transplant period when patients are most vulnerable9 The transplant team and living donor advocate should inform potential living donors that a recipient’s vaccine refusal may lead to an unfavorable outcome after transplant

After Transplant

Transplant recipients should limit their contact with non-vaccinated people, and use additional precautions such as masking when exposed to non-vaccinated peoplea,45 Non-vaccinated transplant recipients should routinely use precautions such as masking, frequent hand-washing, and distancing Non-vaccinated transplant recipients should be educated to report all exposures and made aware of the process for obtaining post-exposure prophylaxis in the event of exposure to a vaccine-preventable illness Non-vaccinated close contacts should use precautions when in contact with the transplant recipient Non-vaccinated transplant recipients or their contacts should use precautions whenever they are in shared clinical spaces with other patients, including masking and distancing The transplant team should continue to counsel recipients about the importance of vaccination and the opportunity to complete some vaccinations after transplant

^aRecommendations for basic precautions to protect patients from vaccine-preventable illnesses may not be sufficient in the context of widespread disease activity or a novel contagion. These practices do not replace specific recommendations from public health organizations which may include universal masking, physical distancing, or stay at home orders.