Reducing Discrimination in Organ Transplant Candidacy Evaluation Against Persons Who Use Drugs

Many organ transplant centers deny persons who use drugs eligibility for receiving a transplant because of concerns about the impact of drugs on transplant success. These policies are often not based on sufficient medical evidence and are highly variable between transplant centers. Restricting persons who use drugs from organ transplantation can exacerbate existing racial and geographic inequities in access to organ transplantation. This paper explores discrimination against persons who use drugs in organ transplantation. I examine when considering a patient’s drug use in organ transplant eligibility assessment is illegal and when it is immoral and I offer recommendations for statutory, regulatory, and policy reform to combat such discrimination. Existing legal protections against drug-related discrimination in organ transplantation are limited because they only include patients who are recovering from substance use disorder and depend upon substance use disorder being considered as a disability. Through an analysis of bioethical principles implicated in organ transplantation, I argue that a patient’s drug use should only be considered in organ transplant candidacy evaluation if the transplant is likely to fail or there is strong evidence that the patient will suffer very poor health outcomes. Congress, federal agencies, and transplant centers should take action to combat discrimination against persons who use drugs including increasing consistency in transplant eligibility policies, funding research on the impact of drug use on post-transplant health outcomes, and enacting policies to identify and reduce discrimination within transplant centers.