A nurse is discussing kidney transplant with a client who has end-stage renal disease (ESRD). Which of the following should the nurse identify as a contraindication for this treatment?

Choice A reason: Having a pacemaker is not a contraindication for kidney transplantation. Many transplant candidates have cardiac devices due to comorbid conditions. As long as cardiac function is stable and the patient meets other criteria, they may be eligible for transplant. Choice B reason: Age alone is not a contraindication. While older age may increase surgical risk and affect recovery, many transplant centers evaluate candidates based on overall health, functional status, and comorbidities rather than age alone. A 65-year-old can be a viable candidate if otherwise healthy. Choice C reason: Active alcohol use disorder is a contraindication for kidney transplantation. Substance abuse can impair adherence to post-transplant immunosuppressive therapy, increase risk of complications, and affect long-term outcomes. Candidates must demonstrate sustained sobriety and commitment to treatment protocols. Choice D reason: A history of breast cancer with a 9-year disease-free interval is not a contraindication. Most transplant programs require a cancer-free period (often 2–5 years) before listing. A 9-year remission suggests low recurrence risk and acceptable transplant candidacy.