Liver Transplant: No Methadone Users Need Apply, Please
The authors, Monika Koch, MD, and Peter Banys, MD, conducted a mail survey of 97 adult liver transplant programs and found that although 56% of the programs said they would accept patients who were taking methadone, almost a third of those that accept patients would require that the patients discontinue methadone as a precondition for getting a new liver.
But requiring people to stop methadone is bad medicine, according to Mary Ellen Olbrisch, PhD, a consultant to transplant programs and an associate professor of psychology and surgery at Virginia Common Wealth University in Richmond.
Olbrisch says she thinks the anti-methadone policies are the result of "prejudice against patients with a history of opioid abuse." She says the prejudice is probably more common against patients with a history of injection drug abuse, the very patients who may need a liver transplant because they have hepatitis C.
Douglas Hanto, MD, director of the liver transplant program at the University of Cincinnati, shows that Olbrisch is fighting an uphill battle. "[Our program] has taken the position that patients on methadone are not candidates for transplant," he tells WebMD.
Hanto says, however, that "it hasn't come up as an issue where a specific patient has been turned down, but it has been discussed, and our reasons are that we think if someone is on methadone for a long time, they are simply substituting [for the drug], and we think they have not adequately dealt with the chemical dependency issue."
Ironically, Olbrisch says that a patient who is in a methadone program may be a "better risk for liver transplant. These are patients on whom we have a number of drug screens, persons who are closely involved in a drug treatment regimen; they are definitely not in denial."
By contrast, "we just have to take the word of the alcoholic about how clean they are," Olbrisch says.
Hanto disagrees. "In Ohio, we require that all substance abuse patients be in well-documented programs. We have very tight criteria, and all patients are very carefully evaluated and screened," he says.
Olbrisch says that attitudes like Hanto's may change with experience. "We actually have only a few of these patients at this time, and we will need to accumulate more data ... before we can make recommendations about guideline criteria," she points out.
This lack of experience also is noted by the authors of the survey. They write that only 10% of centers had experience with five or more methadone patients, and currently there are only 102 methadone patients on the transplant list.