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Medical-marijuana use can block chance at transplant

Timothy Garon’s face and arms are hauntingly skeletal, but the fluid building up in his abdomen makes the 56-year-old musician look eight months pregnant.

His liver, ravaged by hepatitis C, is failing. Without a new one, his doctors tell him, he will be dead in days.

But Garon has been refused a spot on the transplant list, largely because he has used marijuana, even though it was legally approved for medical reasons.

“I’m not angry, I’m not mad, I’m just confused,” said Garon, lying in his hospital bed a few minutes after a doctor told him the decision of the hospital’s transplant committee Thursday.

Because of the scarcity of donated organs, transplant committees such as the one at the University of Washington Medical Center use tough standards, including whether the candidate has other serious health problems or is likely to drink or do drugs.

And in cases such as Garon’s, they also have to consider — as a dozen states now have medical-marijuana laws — whether using dope with a doctor’s blessing should be held against a dying patient in need of a transplant.

Most transplant centers struggle with the how to deal with people who have used marijuana, said Dr. Robert Sade, director of the Institute of Human Values in Health Care at the Medical University of South Carolina.

“Marijuana, unlike alcohol, has no direct effect on the liver. It is, however, a concern … in that it’s a potential indicator of an addictive personality,” Sade said.

The Virginia-based United Network for Organ Sharing, which oversees the nation’s transplant system, leaves it to each hospital to develop criteria for transplant candidates.

Dr. Brad Roter, the Seattle physician who authorized Garon’s pot use for nausea and abdominal pain and to stimulate his appetite, said he did not know it would be such a hurdle.

That’s typically the case, said Peggy Stewart, a clinical social worker on the liver-transplant team at the University of California, Los Angeles, who has researched the issue. “There needs to be some kind of national eligibility criteria,” she said.

The patients “are trusting their physician to do the right thing. The physician prescribes marijuana, they take the marijuana, and they are shocked that this is now the end result,” she said.

No one tracks how many patients are denied transplants over medical-marijuana use.

Pro-marijuana groups have cited a handful of cases, including at least two patient deaths since the mid-to-late 1990s, when states began adopting medical-marijuana laws.

Many doctors agree that using marijuana is out of the question post-transplant. The drugs patients take to help their bodies accept a new organ increase the risk of aspergillosis, a frequently fatal infection caused by a common mold found in marijuana and tobacco.

But there’s little information on whether using marijuana is a problem before the transplant, said Dr. Emily Blumberg, an infectious-disease specialist who works with transplant patients at the University of Pennsylvania Hospital.

Dr. Jorge Reyes, a liver transplant surgeon at the UW Medical Center, said that while medical-marijuana use isn’t in itself a sign of substance abuse, it must be evaluated in the context of each patient.

“The concern is that patients who have been using it will not be able to stop,” he said.

Doctors worry that patients who used pot won’t be able to stop after their transplant.
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source: The Columbus Dispatch

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