HTTP/1.0 200 OK Content-Type: text/html Patients Using Medical Marijuana Can Be Denied Transplants
Pubdate: Sun, 27 Apr 2008
Source: Deseret Morning News (Salt Lake City, UT)
Copyright: 2008 The Associated Press
Author: Gene Johnson, Associated Press
Cited: University of Washington Medical Center
Cited: Institute of Human Values in Health Care
Cited: United Network for Organ Sharing
Cited: UCLA Medical Center
Cited: Harborview Medical Center
Bookmark: (Marijuana - Medicinal)
Bookmark: (Hepatitis)
Bookmark: (Drug Testing)


SEATTLE -- 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's 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 hospital 
transplant committee's decision Thursday.

With the scarcity of donated organs, transplant committees like 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 with cases like Garon's, they also have to consider -- as a dozen 
states now have medical marijuana laws -- if using dope with a 
doctor's blessing should be held against a dying patient in need of a 

Most transplant centers struggle with 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 individual hospitals to 
develop criteria for transplant candidates.

At some, people who use "illicit substances" -- including medical 
marijuana, even in states that allow it -- are automatically 
rejected. At others, such as the UCLA Medical Center, patients are 
given a chance to reapply if they stay clean for six months. 
Marijuana is illegal under federal law.

Garon believes he got hepatitis by sharing needles with "speed 
freaks" as a teenager. In recent years, he said, pot has been the 
only drug he's used. In December, he was arrested for growing marijuana.

Garon, who has been hospitalized or in hospice care for two months 
straight, said he turned to the university hospital after Seattle's 
Harborview Medical Center told him he needed six months of abstinence.

The university also denied him but said it would reconsider if he 
enrolled in a 60-day drug-treatment program. Last week, at the urging 
of Garon's lawyer, the university's transplant team reconsidered 
anyway, but it stuck to its decision.

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

That's typically the case, said Peggy Stewart, a clinical social 
worker on the liver transplant team at UCLA 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, in Oregon and California, since the mid-to 
late 1990s, when states began adopting medical marijuana laws.

Many doctors agree that using marijuana -- smoking it, especially -- 
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.

Further complicating matters, Blumberg said, is that some insurers 
require proof of abstinence, such as drug tests, before they'll agree 
to pay for transplants.

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," Reyes said.

Dale Gieringer, state coordinator for the California chapter of 
NORML, the National Organization for the Reform of Marijuana Laws, 
scoffed at that notion.

"Everyone agrees that marijuana is the least habit-forming of all the 
recreational drugs, including alcohol," Gieringer said. "And unlike a 
lot of prescription medications, it's nontoxic to the liver."

Reyes and other UW officials declined to discuss Garon's case.

But Reyes said that in addition to medical concerns, transplant 
committees -- which often include surgeons, social workers and 
nutritionists -- must evaluate whether patients have the support and 
psychiatric health to cope with a complex post-operative regimen for 
the rest of their lives.

Garon, the lead singer for Nearly Dan, a Steely Dan cover-band, 
remains charged with manufacturing marijuana. He insists he was 
following the state law, which limits patients to a "60-day supply" 
but doesn't define that amount.

"He's just a fantastic musician, and he's a great guy," said his 
girlfriend, Leisa Bueno. "I wish there was something we could do 
legally. ... I'm going to miss him terribly if he passes." 
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