The Transplant Patient with Cocaine Use Disorder and Attention Deficit/Hyperactivity Disorder

Given the high prevalence of substance use disorders in the general population and the inevitable ill-effects substances can have directly or indirectly on organs, a large portion of patients that present for transplant evaluation have either a current and/or lifetime history of a substance use disorder. The transplant team is then faced with assessing the patient’s candidacy as it relates to their alcohol or illicit drug use. This case discussion illustrates a patient with cocaine use disorder who, with an ongoing focus on active recovery as well as optimal management of his co-occurring attention-deficit hyperactivity disorder (ADHD), was able to successfully undergo living kidney donor transplantation. Future considerations regarding management of patients with cocaine use disorder in need of organ transplantation should have less emphasis on length of abstinence, but rather addressing factors that will decrease the risk of relapse, including active engagement in substance abuse and psychiatric treatment.