A nurse is reviewing the medical record of a client who receives routine hemodialysis. The client asks if he is a candidate for a kidney transplant. The nurse should identify that which of the following findings are contraindications for receiving a kidney transplantation? (Select all that apply.)

Kidney transplantation is contraindicated in clients whose underlying conditions would make surgery unsafe, increase the risk of rejection, or render the transplant medically futile. Heart failure is a contraindication because the cardiovascular stress of major surgery and immunosuppression poses a prohibitive risk; the failing heart cannot adequately support the demands of a transplant procedure and recovery. Metastatic renal cell carcinoma is a contraindication because immunosuppression required post-transplant would accelerate tumor growth and dissemination, making transplantation medically inappropriate in the setting of active or metastatic malignancy. Alcohol use disorder is a contraindication because ongoing substance misuse raises concerns about medication adherence, the risk of recurrent organ damage, and transplant program criteria that typically require documented sobriety for a defined period before listing. Age of 65 years alone is not an absolute contraindication; many transplant programs accept older adults based on functional status and comorbidities rather than age as a strict cutoff. Chronic kidney disease is the underlying reason the client is on dialysis and is actually the indication for transplant, not a contraindication — the transplant is intended to replace the failed kidneys. Students sometimes confuse the diagnosis that leads to dialysis with factors that would preclude transplantation; the distinction is clinically important when counseling clients about candidacy.