Transplants II

The social history matters in organ transplantation. We spend a substantial amount of time assessing if a patient has the right social milieu for a transplant. They need to be free of drugs, drinking (especially in liver transplant), and smoking. They need to have good social support. I recently did a transplant evaluation on a person who had a positive urine toxicology for methamphetamines. Unfortunately, this meant that he could not be listed, and would have to contract to stay clean for 6 months with random urine screens prior to being listed. It was devastating to the patient, especially because he needs that organ to live. But these are the rules within which we operate. Organ transplantation is a major surgery, and afterwards, a lot of commitment is necessary to take one's medications, follow up in appointments, work with rehabilitation, etc. This is essential; post-transplant loss to follow-up is loss of that organ. And so we try to ensure that our transplant candidates have the family and friend support they need to succeed afterwards. But all of this social stuff raises interesting questions. Do richer people have better social support and use fewer drugs than poor people? What about certain ethnicities? Or people living in specific geographic locations? While these rules don't necessarily represent discrimination, they may be more severe on some demographics than others.