Liver Transplant: No Methadone Users Need Apply, Please
Feb. 27, 2001 -- Today, more than 17,000 Americans are marking time on a waiting list for liver transplants. About half of them are on the list because they have hepatitis C, a viral infection that silently stalks and destroys livers in about 10,000 Americans each year.
Hepatitis C is a blood infection: People get it either from transfused blood that carries the virus, or from infected drug users sharing needles, with heroin addicts high on the list -- a medical fact of life that is causing controversy in the tight-knit organ transplant community.
It's a well-known fact that the number of people waiting for new livers is far greater than the available supply of donated organs -- on average, only about a third of those on the list will receive new livers -- the rest will die waiting.
With so few livers and so much need, transplant programs jealously guard each place on the list, carefully assessing candidates and choosing only those considered most likely to gain long-term survival with a new liver.
That selection process is creating a clash between those who treat the addictions that destroy livers and the surgeons who implant new livers.
The flash point is methadone, a legal drug given to heroin addicts as a substitute for the illegal drug. Methadone, which is taken orally, rather than as an injection, is doled out in daily doses to recovering addicts. It reduces the risk of them returning to heroin abuse and reduces the risk of spread of infection. Some take it for relatively short periods of time, while others are "maintained" for years.
Chemical dependency experts say methadone maintenance is a good medical treatment. Surgeons are not so sure. Many former heroin addicts who take methadone are not carefully monitored but instead are "using methadone as a way to stay legally addicted," says Richard Freeman, MD, and chair of the United Network for Organ Sharing liver transplant committee.
The United Network for Organ Sharing is neutral on the issue of whether methadone users should qualify for liver transplants, since it has "neither a positive nor a negative policy," Freeman says.
But at the New England Medical Center, where Freeman heads up the liver transplant program, the policy is more clear-cut. Freeman says the thinking there is that most persons on methadone maintenance should not get new livers.
"Our guidelines allow for individual evaluation, but in general we have not accepted patients who are on methadone maintenance except for certain circumstances." He says those circumstances include patients who "are in the process of coming off methadone, who are in active treatment programs, and who have family support."
Freeman's opinions are not unique. A survey of liver transplant programs suggests that many liver programs may be consciously or unconsciously discriminating against patients taking methadone. The findings are available in the current issue of the Journal of the American Medical Association.