Opioid Use Disorders in Organ Transplantation

Opioid use disorder is a serious condition affecting more than 2 million individuals in the United States. Opioid use disorder is characterized by mild-to-severe symptoms related to tolerance, withdrawal, psychosocial impairment, and misuse. Patients with opioid use disorders are underrepresented in the organ transplant population and in some centers opioid use and/or opioid substitution therapies continue to be relative contraindications to organ transplant. Evaluation of patients with opioid use presenting for transplant generally focuses primarily on relapse risk, and patients on opioid substitution therapies are often viewed at higher risk for relapse without considering other factors. These patients should be evaluated similarly to other patients with a comprehensive medical and psychosocial evaluation. Continuation of opioid substitution therapies in these patients will likely mitigate relapse risk in these patients. This case illustrates many of the key issues in the evaluation and treatment patients with opioid use disorder presenting for organ transplantation.