Evaluation of Transplant Candidates With a History of Nonadherence: An Opinion Piece:

The transparency and validity of assessing the candidacy of a patient for a solid organ transplant have recently been called into question by the media.1 Transplant centers perform a lengthy medical, surgical, and psychosocial evaluation on candidates with organ failure. This process ensures that there are no contraindications to surgery and to the use of long-term immunosuppressive medications. In addition, it helps ascertain if transplant candidates are likely to benefit from the transplant surgery over long term. Pretransplant nonadherence to prescribed therapy, medications, investigations, and clinical visits, is recognized as a relative or an absolute contraindication by transplant programs. For example, the Canadian Society of Transplantation states, given the use of immunosuppressive agents with a narrow therapeutic window, the impact of nonadherence to therapy on the risk of acute rejection and premature graft loss, and the scarcity of donor organs, nonadherence is a contraindication to kidney transplantation.2 This echoes the recommendations of some of the other major transplantation societies as summarized in Table 1.2-8 Most recommend delaying transplant surgery until patients have demonstrated adherence to therapy for 6 months. Table 1. Current Guidelines in the Assessment of Transplant Candidates With a History of Nonadherence.