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?

A. Breast cancer survivor for 8 years: A history of cancer may be a concern, but most transplant programs require 2–5 years of remission before eligibility. Being cancer-free for 8 years would not be a contraindication. B. Alcohol use disorder: Active substance abuse is a contraindication because it increases the risk of poor medication adherence, post-transplant complications, and graft failure. Patients must demonstrate sobriety before being considered. C. 65-years of age: Older age alone is not a contraindication. Many transplant centers accept patients in their 60s and even 70s, as long as they are otherwise healthy and suitable candidates for surgery. D. Pacemaker: The presence of a pacemaker is not a contraindication to transplantation. It is compatible with surgery and long-term management, provided cardiac function is stable.