Understanding Substance use Policies and Associated Ethical Concerns: A survey of Pediatric Transplant Centers

Abstract

Rates of the demand for transplantation continue to rise and exceed the supply of available organs. 1 To maximize the successful transplantation of a limited number of available organs, research has highlighted the importance of identifying and treating psychosocial factors, including substance use, present at the pre-transplant evaluation, due to their association with poor post-transplant outcomes (ie, nonadherence, increased risk for rejection, and graft failure). [2][3][4] Studies have examined risk by organ type, but the existing literature largely focuses on marijuana and alcohol use within predominantly adult transplant populations. 5 Though less data exist on substance use rates in pediatric transplant patients, youth substance use in the general population remains a public health concern. 6 Several large longitudinal studies highlight increases in marijuana use as adolescent age increases,

Substance use and solid organ transplantation in adolescents and young adults: Current findings and implications

“…Only one study directly addressed alcohol use policies in pediatric populations 27 . An additional study addressed alcohol use policy in adult liver recipients 28 . Most studies were specific to alcohol use among liver transplant recipients or candidates.…”

“…Four studies looked at the opinions of clinicians and other stakeholders on marijuana use policies 28,50,51,52 . Phillips et al 50 surveyed cardiac transplant providers about institutional policies related to marijuana use.…”

“…However, only 57% believed it was a contradiction for legal recreational users and 21% for legal medical users. And interestingly, only one other survey found that of respondents from the eight centers with a substance use policy, 88% reported that their institution had some policy around marijuana use and 82% included marijuana in pretransplant toxicology screening 28 . Internationally, the work of Neyer et al 51 provided insights on marijuana use and listing decisions in a sample of 360 heart transplant providers from 26 different countries.…”

“…Only the previously cited study by Monnin et al 28 directly addressed other substances besides alcohol, marijuana, opioids, and tobacco. They found that among respondents from pediatric and mixed centers, 98% of participants would be concerned about hallucinogens, 94% about stimulants sedatives hypnotics, or anxiolytics, and 90% about inhalants.…”

“…27 An additional study addressed alcohol use policy in adult liver recipients. 28 Most studies were specific to alcohol use among liver transplant recipients or candidates. Among pediatric transplant centers one study found that 87% of respondents based in transplant teams reported that their site did not have a policy.…”