FAQ: COVID-19 Basics for Transplant Patients
Vaccine dose #3:
Are you eligible?
UCSF is now offering a third Pfizer or Moderna shot to many immunocompromised patients. Visit our COVID-19 vaccine page to find out:
- Exactly who is eligible
- How long to wait after your second dose to get the third one
- How to find a UCSF walk-in vaccine clinic or schedule an appointment at a community pharmacy
Last updated Oct. 7, 2021
If you or a loved one is a UCSF transplant patient, you can find answers here to questions about the coronavirus (COVID-19), vaccines for COVID-19 and how to otherwise minimize your risk of infection.
What is the position of the experts at UCSF transplant services on the COVID-19 vaccines?
We currently have several effective vaccines against COVID-19. The benefits of vaccination far outweigh the risks, so we encourage all our transplant patients to get vaccinated. For post-transplant patients, the recommendation is to get either the Moderna or the Pfizer vaccine.
Some studies have shown that transplant patients don't have the antibody response to the vaccines that other patients develop. This means the vaccine may not cause your body to make enough antibody against the virus and therefore, despite vaccination, you may still contract COVID-19 and your condition might progress to severe disease. It's wise to assume that you are not protected against severe disease after vaccination.
We also don't recommend routine testing for COVID-19 antibodies after vaccination. Antibodies reflect only part of the immune response to a vaccine. Researchers haven't determined the antibody level that provides protection or whether patients without antibodies after vaccination are at higher risk. There are various antibody tests, and those that will ultimately be helpful in guiding medical decisions need to measure the levels of antibodies to the so-called spike protein of the coronavirus.
In sum, if you are a transplant patient, we encourage you not only to get vaccinated but to continue to wash your hands frequently, wear a well-fitting mask and practice social distancing, especially when indoors and around people who are not vaccinated. We strongly recommend that all eligible household members of transplant recipients be vaccinated.
FAQ: Additional COVID-19 vaccine doses for transplant recipients
I’m a fully vaccinated transplant recipient. Should I get an additional vaccine dose?
Yes. UCSF Health’s transplant specialists strongly encourage all transplant recipients who got the Pfizer or Moderna vaccine to get an additional dose of the same vaccine they initially received. This third dose may help your body respond more robustly to the vaccine and result in better protection against COVID-19 infection.
When can I get the additional dose?
You should wait at least 28 days after completing your first vaccine series before getting the third dose. Also, you should wait at least one month after your transplant to get the additional dose.
How effective is the additional vaccine dose in transplant patients?
The response in this population is variable. Studies show that the additional dose increases antibody levels in some patients, yet these studies also show that even after an additional dose, some transplant patients continue to have a lesser response to the vaccine than people who aren’t immunocompromised. For this reason, it’s important that you continue to protect yourself by wearing a mask, social distancing, and encouraging your family and household members to get vaccinated.
Where can I get the additional dose?
You can get it at your local vaccination site.
Do I need to show proof that I’m a transplant recipient?
No. Medical documentation of transplant status is not required to get the additional dose.
Which brand of vaccine should I get?
The FDA has authorized additional doses of the Pfizer and Moderna vaccines (mRNA vaccines). Transplant recipients are eligible to receive an additional dose from one of these two manufacturers. The recommendation is to get the same brand that you received previously. But if that brand isn't available, we recommend taking the brand that’s available to you.
I got the Johnson & Johnson vaccine. Should I get another dose of that?
The FDA has not authorized an additional dose of the J&J vaccine. We are awaiting further information from the CDC about patients who received this brand. Please check this page regularly for updates. You can also check CDC updates.
I’m on the transplant waiting list. Can I get an additional vaccine dose?
At this time, the FDA is authorizing additional doses only for transplant recipients and patients whose immune response is moderately to severely affected by medical conditions or treatments. Please check with your primary care provider or specialist to see whether your condition qualifies you for an additional vaccine dose. For recommendation updates, check this page regularly and visit the CDC’s vaccine information page for the immunocompromised.
A member of my household is a transplant recipient. Should I get an additional vaccine dose?
We highly encourage all eligible family and household members of transplant recipients to get the standard vaccine regimen. At this time, the only people eligible for an additional dose are transplant recipients and patients whose immune response is affected by medical conditions or treatments for them.
Do I need a prescription for the additional shot?
How much does the additional dose cost?
The vaccine is provided free to all patients.
FAQ: COVID-19 vaccine general information for transplant recipients
Is the COVID-19 vaccine safe?
We believe the vaccine is safe for nearly everyone. We recommend COVID-19 vaccination for all pre- and post-transplant patients as well as all living donors. Early data shows that efficacy may be reduced in immunosuppressed individuals. We expect more data about this over the weeks and months to come. Please remain cautious by wearing a mask, washing your hands and practicing social distancing. You can find more information in this COVID-19 vaccine FAQ sheet from the American Society of Transplantation.
I am taking medications that suppress my immune system. Do I need to take special precautions with regard to COVID-19?
Based on experience with other viral respiratory infections, it's possible that COVID-19 infection will be more severe in immunosuppressed people. Immunosuppressed patients should take the following precautions:
- Continue to wear a mask and practice social distancing in public, even after receiving the vaccine.
- Wash your hands often with soap and warm water, scrubbing for at least 20 seconds each time. When soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60 percent alcohol.
- Practice normal infection-prevention techniques, such as regular handwashing, covering your nose and mouth when coughing, and avoiding people who are sick.
Should I continue to take my immunosuppressive medications?
Yes. If you develop any signs of illness, such as fever or respiratory symptoms, contact your medical team for guidance on whether to continue these medications as well as whether to seek care. If you have any questions about your regimen, check with your doctor.
Are donated organs safe?
Yes, organ procurement organizations test all potential deceased donors for COVID-19 before offering the organs for transplant.
Is living organ donation safe during the pandemic?
All living donors are tested for COVID-19 the week before surgery and are advised to quarantine at home until they're admitted to the hospital for the procedure. All patients, including donors and recipients, are also tested at the time of admission.
Should living donors be vaccinated for COVID-19?
We recommend the COVID-19 vaccine for all living donors. They should receive it no less than 48 hours before surgery. This allows time to monitor for any reaction.
National Kidney Registry donors should receive the vaccine at least seven days before surgery, so that entire chains aren't jeopardized and there's time to monitor for any reaction.
As someone with immunosuppression, how do I talk with my employer about workplace accommodations?
These letters from UCSF Transplant Services may help you communicate with your employer about precautionary measures in the workplace that can help keep you and your family safe.
Where and when can I get a COVID-19 vaccine?
At this time, the vaccine is readily available through state vaccination sites as well as clinics and pharmacies. Contact your local pharmacy or make an appointment with a vaccine clinic near you at myturn.ca.gov.
Will the COVID vaccine hurt my transplanted organ?
As previously noted, the recommendation is to wait at least one month after your transplant surgery to receive either of the available COVID-19 vaccines. You can find more information in the American Society of Transplantation's COVID-19 vaccine FAQ sheet.
Is it OK to get the vaccine if I have another underlying condition, such as cancer or heart failure, or if I've had a multiorgan transplant?
Anyone with multiple or complex health conditions should consult their primary care provider about whether the vaccine is right for them.
What if I've had allergies to vaccines in the past?
If you've ever had an allergic reaction to a vaccine, please talk to your primary care provider about whether the vaccine is right for you. Also, the CDC offers an information page on allergic reactions to COVID and other vaccines.
Has anyone had life-threating reactions to the COVID-19 vaccines?
The CDC notes that there have been reports of severe reactions that required treatment with epinephrine or a trip to the hospital. If you have had a serious reaction to any of the ingredients in the currently available COVID-19 vaccines, the CDC recommends that you do not get one of these vaccines. Read more from the CDC about vaccine reactions.
What if I feel sick after receiving the vaccine?
You may be having a response to the vaccine. Consult your primary care provider right away for guidance, including on whether to seek treatment. The CDC's information page on vaccine reactions offers additional information.
Should I take anything before the shot to prevent side effects from the vaccine?
No, do not premedicate. In general, taking over-the-counter medications – such as aspirin, acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) – before receiving a vaccine can blunt your immune system's response to the vaccine, reducing its effectiveness. However, if you have symptoms that make you uncomfortable after your vaccination, you may take an over-the-counter pain reliever to help you feel better. As always, please only take over-the-counter medications that are recommended by your transplant team.
Should I receive two vaccine doses, and do they have to be the same brand?
The Pfizer and Moderna vaccines both require two doses, while the Johnson & Johnson vaccine requires only one.
Ideally, if you receive a vaccine that requires a second dose, the second dose should be the same brand. You must receive both doses to achieve optimal protection.
- The Pfizer vaccine doses are given 21 days apart.
- The Moderna vaccine doses are given 28 days apart.
Can I choose among Pfizer, Moderna and Johnson & Johnson?
We recommend that you get one of the mRNA vaccines (Pfizer or Moderna).
Should I continue to wear a mask after being vaccinated?
Yes. Your body's response to the vaccine takes time, and early data shows that immunocompromised individuals may not respond as robustly to the vaccine as other people. You should therefore wear a mask and practice social distancing when outside of your household, even after receiving the vaccine.
I've received my organ transplant. Will the COVID-19 vaccines work for me?
Researchers are examining the immune response of organ transplant recipients to the vaccines, and so far, the evidence suggests it's not as strong as we would wish. Whereas the general population shows rates of seroconversion (producing specific antibodies in response) above 80 percent, one study of 658 vaccinated organ recipients found a seroconversion rate of 54 percent about four weeks after the second dose. Patients who had received certain kinds of medications, such as antimetabolites, were less likely to have an antibody response to their vaccination.
While you will likely have incomplete protection from COVID-19, we recommend that you get the vaccine. Being fully vaccinated may still lower your risk of getting infected as well as your risk of becoming seriously ill if you do catch the virus. In addition, be sure to encourage your friends and family members to get vaccinated, and continue to exercise preventive measures, such as social distancing and masking, when around unvaccinated people or anyone whose vaccination status is unknown.
Should I get a blood test to measure my response to my COVID-19 vaccination?
The Food and Drug Administration does not recommend routinely checking antibody response after vaccination, particularly as it’s unclear what the results actually mean about how well an individual is protected. Doctors are working to translate relevant study findings into guidance for their patients, so the best place to turn with specific questions is your own providers.
If I do get COVID-19, what should I know about therapy alternatives, such as monoclonal antibodies?
Currently, the evidence suggests that early administration of monoclonal antibodies for the COVID-19 virus may benefit patients who have an elevated risk of becoming seriously ill, reducing the likelihood of hospitalization and death.
The evidence for using convalescent plasma (donated by people who have recovered from COVID-19 infection) is less convincing. One small study showed benefit, but a more recent study showed no effect on survival. Theoretically, antibody-based therapies may help immunosuppressed transplant patients early in the course of illness from the coronavirus, but further data is needed to determine whether these treatments actually lead to better outcomes.
- COVID-19 Information From the Centers for Disease Control and Prevention
- COVID-19 FAQs From Transplant Candidates and Recipients (American Society of Transplantation)
- COVID-19 Vaccine FAQ Sheet (American Society of Transplantation)
- COVID-19 Resources for the Transplant Community (American Society of Transplantation)
- COVID-19 Transplant Resource (COVID-19 Transplant Community Coalition)
- SARS-CoV-2 Vaccination in Heart and Lung Transplantation (International Society for Heart and Lung Transplantation)
- COVID-19 Vacunas para Pacientes Hispanos y Transplantes (AST webinar, "COVID-19 Vaccines for Hispanic Transplant Patients with special guest, José Luis Rodríguez)
Webinars: Organ Transplants and Donation During COVID-19
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.