A rise in the use of medical marijuana has spurred a debate about organ transplantation, and it’s changing some laws across the nation.
Garry Godfrey found out in 2010 that he was removed from an organ transplant waiting list in Maine due to a health risk associated with his use of medical marijuana, CNN affiliate WGME reported. Now Godfrey is speaking out in support of a bill in Maine that would prohibit hospitals from determining a patient’s suitability for transplantation solely on the basis of medical marijuana use (PDF).
That bill is in committee, and similar legislation has been passed in other states, including California, Washington, Illinois, Arizona, Delaware and New Hampshire.
Godfrey, 32, uses marijuana to relieve pain and other symptoms he suffers due to Alport syndrome, a genetic condition that can cause renal failure — and he needs a new kidney, WGME reported.
“I’ve tried so many pharmaceuticals and none of them worked, but the medical cannabis does,” Godfrey told WGME. “It helps me function. It helps me take care of my kids.”
But if a transplant candidate already has a compromised immune system and is taking prescribed or recreational marijuana, that can increase their risk of a deadly fungal infection known as Aspergillosis during the transplantation process, according to a press statement released this week by the Maine Transplant Program. Once off marijuana, patients can be put back on the waiting list.
Meanwhile, researchers are desperately trying to better understand the potential health risk that may be associated with marijuana use and organ transplantation.
‘When we turn someone down, it’s a personal failure’
“The thing that comes up with marijuana is the risk of pulmonary infections, (specifically) fungal infections with Aspergillosis,” said Dr. David Klassen, chief medical officer at the United Network for Organ Sharing.
Such infections “can be an absolutely devastating complication but, you know, how often does that really happen? How likely is it? Those questions are less well understood,” Klassen said. “It’s a question of how much risk does that really impose versus the benefit that the patient potentially gets from getting the transplant.”
The Maine Transplant Program has a policy in place around marijuana because two people who had transplants died as a result of the fungal infection, Maine Medical Center spokesman Clay Holtzman said. Both patients had smoked marijuana, which suggests it might have been the cause of the infections. It’s not clear what the risks are around edible medical marijuana, he said.
The issue is an emerging puzzle that is also shaping conversations within the transplant community, said Dr. James Whiting, surgical director of the Maine Transplant Program at Maine Medical Hospital.
“These conversations around medical marijuana will continue, and I think that we will try to find ways, whether they be using edibles or other things, to allow people to be listed and transplanted,” Whiting said.
“The transplant community is always going to be focused on using as many organs as possible,” he said. “Our goal is to transplant as many Mainers successfully as we can. That’s how our program’s evaluated. That’s how I’m evaluated. That’s why we’re here. So when we turn someone down, it’s a personal failure in many ways.”
More than 118,000 people in the United States are waiting for a life-saving organ transplant, according to UNOS.
The behind-the-scenes politics of organ donation
The policies of most transplant programs, which determine who gets on a waiting list, are evaluated through UNOS and the Centers for Medicare and Medicaid Services, among other agencies.
“The decisions for a center to accept anything — (for example) some people say I’m not going to transplant anybody over the age 50 or 60 — they’re allowed to do that,” said Dr. John Fung, chief of transplantation surgery and director of the Transplantation Institute at the University of Chicago Medicine.
Other than protecting against racial or gender discrimination “no rule says you have to transplant any given population,” Fung said. “But each center basically evolves their own criteria,” he said.
‘People feel like they’re in a Catch-22’
“The decision on whether to list the patient or not is really up to the transplant program. We don’t have any real policy that says a patient like this must be accepted or must be denied,” said UNOS’s Klassen.
Yet, “there are some things that are quite common to all transplant programs,” he said. “A patient that has active malignancy cancer, (for example), typically those patients are not for transplant.”
Current or recent cancer diagnoses are among the few widely accepted medical conditions that might rule out organ transplantation, according to UNOS. Morbid obesity, for instance, is also among those common conditions.
Certain long-term medications, including prescribed marijuana, can also impact organ transplantation eligibility, such as, “people who might be on an anticoagulant because they needed a heart stent,” said Maine Medical Hospital’s Whiting.
In some cases, “the only reason they knew they needed a heart stent was because they went through the testing for transplant and now they can’t get the transplant because they’re on an anticoagulant,” he said. “A lot of these people feel like they’re in a Catch-22.”
credit: wtvr.com
