I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: News Articles => Topic started by: paddbear0000 on April 27, 2008, 11:17:00 AM
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Medical marijuana patients face transplant hurdles
By GENE JOHNSON
Associated Press Writer
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 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 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. This 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 weed. 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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On the Net:
United Nework for Organ Sharing: http://www.unos.org
Garon performing his song "Goodbye Baby": http://www.youtube.com/watch?vUJDihYn_fJA
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With all the people waiting in line for transplants that manage to live a healthy lifestyle, I can understand why people like this are rejected as
recipients. Too many risks. I know it sounds cold, but I say let someone else have the opportunity.
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Hmmm. . .I have friend on medical marijuana because of loss of appetite with his chemo treatments. It comes in a pill from the pharmacy- you don't have to grow your own!
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One of my young dialysis mates smokes it for nausea. He says nothing else works. I feel his pain, he goes 4.5 hrs. 4 days a week.
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When someone has chronic pain or nausea, depending on the cause, they still may require pain medication after a transplant. Since NSAIDS are not allowed, that leaves narcotics or marijuana (for severe pain.) The chance of acquiring "aspergillosis, a frequently fatal infection" from marijuana is a risk not worth taking. I guess a patient would be better off taking their chances with prescription pain relievers (and risk dependency) or white knuckling it and trying to get by on Tylenol.
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Hmmm. . .I have friend on medical marijuana because of loss of appetite with his chemo treatments. It comes in a pill from the pharmacy- you don't have to grow your own!
Yes, the transplant team gave me that pill after my transplant to try to give me my appetite back. It's called marinol. I didn't know they gave it to me at first. My dad came in and was talking to me and I didn't know it. I asked when did you get here and he said he was there for thirty minutes talking to me. It was a weird feeling I had with it and the appetite didn't last long. With a higher dose, it made me sick.
As for the case about people who use the drug legally, tough call on that, but if they go thru the 60 day drug treatment program and can stay off it, then I do not see a problem. The people who use it illegally is an easier answer. Ones who use it illegally for me should be denied to have a transplant
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What is really going on here is bourgeois society finding ever new ways to punish people who live unconventionally or do things they don't like. To inflict a death sentence on someone because he smoked marijuana is cruel and absurd.
Dr. Henry Halsted, Professor of Surgery at Johns Hopkins University, inventor of the modern surgical glove and the intricate surgical procedure named after him (the Halsted Maneuver), confessed at the end of his long life that he had been a constant cocaine addict since his twenties (as was Sigmund Freud for a while too). Just because many recreational drugs are hated by conventional society does not mean they are hated by Mother Nature as well, and there are cases of people leading extremely long, healthy, intelligent, and productive lives on drugs. Marijuana should be no contraindication to a transplant.