Organ transplants remain unreliable in America with thousands of wait-listed people dying each year before they get a transplant. For people with a history of addiction, the ability to get an organ is even more uncertain as many hospitals and states interpret rules for getting a transplant in different ways.
The medical science behind organ transplants is decades old, but the guidelines governing who gets a transplant are still murky. Before the 1984 National Organ Transplant Act, transplant centers and surgical teams made their own decisions about who qualified for a transplant. Even with a current national registry and rules that require transplants to be based on medical criteria, there is plenty of wiggle room in the system allowing individual centers to make final determinations.
On the most basic level a person needs access to a physician to get a referral for a transplant. Even with a referral, several factors govern acceptance, including a history of substance use. Transplant center staff choose who is accepted; some allow a history of addiction, while others do not. Studies show people with a history of addiction rarely relapse after receiving a donor organ. Around 6 percent of alcoholics and 4 percent of illicit drug users relapse after an organ transplant. Many people with a history of substance use are susceptible to organ disease, particularly liver diseases. Without a new liver, these patients die.
Considering how difficult it is for anyone to get an organ transplant, particularly someone in recovery, it’s difficult to imagine someone receiving two transplants due to relapse. Ethically, the idea of giving a person two transplants is complicated when the number of available organs is limited.
One case of a woman in western Australia illustrates the complexity of the issue. Claire Murray, 24, received a liver transplant after a history of heroin and amphetamine use. After relapsing to heroin use, she needed a new liver, but could not get approval for a new one in Australia. After an emotional campaign by her family, she received a $250,000 interest-free loan from the western Australia government to undergo an experimental live liver transplant in Singapore. Murray died due to complications from surgery, making the case even more gut wrenching and complicated.
Should Threat of Relapse Prevent a Transplant?
Some activists point to the fact Murray wasted her opportunity with her first liver transplant as proof patients who relapse shouldn’t get a second chance. A former drug addict has a difficult time getting onto a transplant list, period. Some organizations won’t include anyone with a history of drug and alcohol use, especially if relapse is an issue.
The ethical considerations of any organ transplant make judgment calls difficult. For example, who decides what kind of substance use should keep someone off the list? Some hospitals allow patients who smoke or drink alcohol on the list but prohibit patients who use medical marijuana. Some believe the United States needs to standardize organ transplant guidelines and develop a list of medical criteria that governs who is put on the waiting list.
Even without standard guidelines, many hospitals are more open to offering transplants to recovering addicts. Moderns research into addiction and the psychological elements of the disease take away some of the moral stigma that governed past transplant decisions.
Are There Other Viable Options for Drug Addicts?
For most, though, if denied a spot on the transplant list, there are no other options. Some believe the current status is justified while others see the system as flawed.
Providing treatment for drug addiction is a good option for those who hope for a transplant organ. Learning how to live without drugs and alcohol is a benefit for anyone struggling with addiction, but doubly so for those with co-occurring disorders like liver disease.
Michael’s House is an evidence-based provider of addiction treatment with experience treating addiction and co-occurring mental health disorders. For questions about finding the right treatment for you or your loved one, call our admissions coordinators today.
 Minelli, Erin & Liang, Bryan A. (2011). Transplant Candidates and Substance Use: Adopting Rational Health Policy for Resource Allocation. University of Michigan Journal of Law Reform. Retrieved Mar. 27, 2017 from http://repository.law.umich.edu/mjlr/vol44/iss3/4
Caplan, A. (2014). Bioethics of Organ Transplantation. Cold Spring Harbor Perspectives in Medicine. Retrieved Mar. 27, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935394/.
 Wiley-Blackwell. (2008). Former Substance Abusers Rarely Relapse After Organ Transplantation. ScienceDaily. Retrieved Mar. 27, 2017 from https://www.sciencedaily.com/releases/2008/02/080204111816.htm.
 Sapienza, Joseph. (2010). Family, friends farewell Claire Murray. WAToday. Retrieved Mar. 27, 2017 from http://www.watoday.com.au/wa-news/family-friends-farewell-claire-murray-20100413-s5rk.html.