Liver Transplant: No Methadone Users Need Apply, Please
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.
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."