What disqualifies you from getting an organ transplant? A comprehensive guide to eligibility

September 22, 2025 •

5 min read

Over 100,000 people are on the national transplant waiting list at any given moment, with each potential recipient undergoing a thorough evaluation. Knowing what disqualifies you from getting an organ transplant is crucial, as transplant centers carefully weigh various medical, social, and psychological factors to ensure the best outcome for both patient and donated organ.

Quick Summary

Eligibility for an organ transplant is based on a strict evaluation process, considering factors that could compromise the procedure's success or the patient's post-transplant health. Disqualifications can include active infections, certain cancers, severe systemic diseases, and ongoing substance abuse.

Key Points

Absolute Disqualifiers: Active infections, metastatic cancer, and irreversible damage to other major organs are generally considered absolute disqualifications for an organ transplant.
Lifestyle Factors: Ongoing substance abuse, including smoking and alcoholism, can prevent a patient from being listed due to the high risk of poor adherence post-transplant.
Psychosocial Evaluation: A patient's mental and emotional stability, coping mechanisms, and social support system are thoroughly evaluated to ensure they can manage the demanding care regimen.
Relative Contraindications: Factors like morbid obesity or a history of controlled conditions may not automatically disqualify a candidate but require addressing before a transplant can proceed.
Commitment to Adherence: The transplant team must be confident that the patient will consistently follow a strict, lifelong medical protocol, as non-compliance is a major cause of graft failure.
Re-evaluation is Possible: Being initially disqualified is not always permanent. Patients can sometimes be re-evaluated if they successfully address the underlying issues, such as achieving sobriety or losing weight.
Transplant Center Variations: Specific eligibility criteria can vary by transplant center, making it important to research and understand the requirements of different hospitals.

The purpose of transplant eligibility criteria

Organ transplantation is a complex and life-saving procedure. Given the scarcity of donor organs, transplant centers use rigorous criteria to determine a candidate's suitability for a transplant. The primary goal is to ensure the donated organ is used to maximize a patient's long-term survival and quality of life. This means evaluating a person's overall health, likelihood of surviving the surgery, ability to adhere to a demanding post-operative medical regimen, and other psychosocial factors.

Absolute vs. relative contraindications

Transplant programs typically categorize disqualifying factors into two groups: absolute contraindications and relative contraindications. Understanding the difference is key to grasping the complexities of the evaluation process.

Absolute contraindications: automatic disqualifications

These are conditions that almost always prevent a patient from being a transplant candidate, at least until the condition is resolved. They represent an unacceptably high risk to a successful transplant. Examples include:

Active or metastatic cancer: A history of certain cancers, especially within the last five years, is often an absolute disqualification. This is because immunosuppressant medications, necessary to prevent organ rejection, can cause dormant cancer cells to spread rapidly.
Irreversible heart, lung, or neurological disease: If a patient has severe and irreversible dysfunction in another major organ system, the risk of transplant surgery may be too high. For example, a heart transplant candidate may be disqualified if they have irreversible lung disease.
Active, severe infection: An uncontrolled, systemic infection can be life-threatening and must be resolved before a transplant can be considered.
Persistent substance abuse: Ongoing, active abuse of alcohol or illicit drugs is a major disqualifier, particularly for liver transplants. This behavior is a significant risk factor for non-adherence to the complex and lifelong post-transplant medical requirements.
Severe, unmanageable psychiatric illness: Uncontrolled mental health conditions that prevent a patient from understanding or following a strict post-transplant regimen can be a disqualifying factor.

Relative contraindications: case-by-case decisions

These are conditions that do not automatically disqualify a patient but require careful consideration by the transplant team. The team may proceed with the transplant if the patient can manage the condition or mitigate the associated risks. Examples include:

Morbid obesity: Excessive weight can increase the risk of surgical complications, slow wound healing, and affect long-term graft survival. A patient may be required to lose a certain amount of weight before being placed on the list.
Certain pre-existing conditions: Conditions like controlled diabetes or high blood pressure do not automatically disqualify a person. However, if they have caused significant end-organ damage, they may become a relative contraindication.
History of resolved substance abuse: If a patient has a history of substance abuse but has maintained a sustained period of sobriety and compliance with treatment, they may be re-evaluated.
Advanced age: While there is no universal age limit, transplant centers evaluate older candidates on a case-by-case basis, considering overall health and organ function.
Inadequate social support: The post-transplant period requires extensive support. If a patient lacks the necessary familial or social resources, it could be a relative contraindication.

Medical and psychosocial evaluations

The evaluation for a transplant is a multi-faceted process conducted by a team of specialists, including transplant surgeons, cardiologists, nephrologists, social workers, and psychiatrists. This team assesses a potential recipient's full medical and psychosocial history.

Medical evaluation

This involves a series of tests to assess the patient's overall physical condition, including heart function, lung capacity, and the presence of any other systemic diseases. The evaluation aims to determine if the patient is healthy enough to endure the surgery and the lifelong medication regimen that follows.

Psychosocial evaluation

This is a critical component of the assessment, focusing on the patient's mental and emotional stability, adherence to previous medical treatments, and their ability to cope with the stress of the transplant process. It also explores the patient's support system and financial resources. Non-compliance with past medical recommendations is a major red flag for transplant teams.

Transplant eligibility: Absolute vs. relative contraindications


Feature	Absolute Contraindications	Relative Contraindications
Definition	Conditions that present an unacceptably high risk for a transplant procedure and success.	Conditions that increase risk, but which may be mitigated, managed, or improved before transplant.
Patient Condition	Active, uncontrolled, or irreversible.	May be historical, controlled, or reversible with intervention.
Example (Cancer)	Metastatic cancer or recent cancer history.	History of a localized, treated cancer.
Example (Lifestyle)	Active, ongoing substance abuse.	History of substance abuse with sustained sobriety.
Example (Infection)	Uncontrolled systemic infection.	A treatable, localized infection.
Decision Outcome	Patient is typically ineligible for listing until condition changes.	Transplant team makes a case-by-case decision based on risk assessment.

The importance of post-transplant adherence

For a transplant to be successful, a patient must commit to a lifelong regimen of medication, frequent follow-up appointments, and a healthy lifestyle. Immunosuppressant medications prevent the body from rejecting the new organ, but they must be taken exactly as prescribed, without fail. Non-adherence to this regimen is a primary cause of organ rejection and failure.

Compliance issues: A history of failing to follow medical advice, such as missing dialysis appointments or not taking medications, is a significant concern for transplant teams. It suggests a potential risk of poor adherence post-transplant.
Psychological readiness: The psychosocial evaluation also gauges a patient's readiness for the significant lifestyle changes required after a transplant. The emotional toll of waiting, recovering, and managing lifelong care can be immense, and the team needs to ensure the patient can handle it.

What if you are disqualified?

Being deemed ineligible for a transplant is not always the final answer. Some disqualifying factors, particularly relative contraindications, can be addressed. Patients may be encouraged to enter a rehabilitation program for substance abuse, lose weight, or seek counseling for a mental health issue. If these concerns are resolved, a patient can be re-evaluated for the transplant list. It is also worth noting that criteria can vary slightly between different transplant centers, so exploring other options is sometimes possible. For more information on the process, consult the FAQs on the United Network for Organ Sharing (UNOS) website, the private, non-profit organization that manages the U.S. transplant system: https://unos.org/transplant/frequently-asked-questions/.

Conclusion

The criteria for organ transplantation are a complex but necessary set of standards designed to ensure the best possible use of a scarce resource. While conditions like active cancer or ongoing substance abuse are generally absolute disqualifications, other issues may be relative and reversible. The comprehensive evaluation process scrutinizes a candidate’s medical, psychological, and social readiness to not only survive the procedure but also to thrive and care for their new organ long-term. Understanding these strict guidelines is a vital step for any potential transplant recipient.

Frequently Asked Questions

The most common reasons for disqualification are related to factors that compromise the long-term success of the transplant. These can include a recent cancer diagnosis, active substance abuse, uncontrolled infections, and the inability to follow the intensive, lifelong medical regimen.

Age is not an automatic disqualification, but it is a factor considered during the evaluation. Each transplant program has its own guidelines, and a patient's overall health and physiological age are often more important than their chronological age.

Active, ongoing substance abuse is a major disqualifying factor. However, a patient with a history of abuse who has demonstrated a sustained period of sobriety and compliance with treatment programs may be reconsidered after a thorough psychosocial evaluation.

Morbid obesity is often a relative disqualification. It can increase the risks of surgery and negatively impact graft survival. In many cases, a patient may be required to lose weight to meet specific criteria before being added to the transplant waiting list.

The financial cost of post-transplant medications is a serious consideration. The transplant team will evaluate a patient's financial stability and insurance coverage during the assessment process to ensure they can afford the lifelong medication regimen. Lack of resources can be a disqualifying factor.

Historically, HIV was an absolute disqualifier, but with modern medical advances, this is no longer the case. Patients with well-controlled HIV who are stable on their medication and meet other health criteria may be eligible for a transplant.

A strong and reliable support system is critical for a transplant candidate. The post-transplant recovery period is demanding and requires help with transportation, medication management, and emotional support. A lack of adequate support can be a disqualifying factor.

Yes, in many cases. If a disqualifying factor was relative and addressable, such as a curable infection or achieving sobriety, a patient can be re-evaluated. They must demonstrate that the health concern has been resolved and that they are fully committed to the post-transplant regimen.