Medical Marijuana Patients Face Transplant Hurdles

Medical Marijuana Patients Face Transplant Hurdles
Posted by CN Staff on April 26, 2008 at 09:37:58 PT
By Gene Johnson, AP State
Source: Associated Press
Seattle, WA -- Timothy Garon's face and arms are hauntingly skeletal, but the fluid building up in his abdomen makes the 56-year-old musician look 8 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 isn't getting a new liver. He's been refused a spot on the transplant list, largely because he has used marijuana, even though it was legally approved for medical reasons.
"He said I'm going to die with such conviction," said Garon, lying in his hospital bed a few minutes after a doctor told him the hospital transplant committee's decision Thursday. "I'm not angry, I'm not mad, I'm just confused."Because of the scarcity of donated organs, transplant committess like the one at the University of Washington Medical Center have tough standards for deciding who should get them. Does a candidate have other serious health problems? Will he religiously take anti-rejection medicines? Is there good family support? Is the candidate likely to drink or do drugs?Garon believes he got hepatitis by sharing needles with "speed freaks" as a teenager. In recent years, he says, pot has been the only drug he's used. In December, he was arrested for growing marijuana.His case poses a new ethical consideration for those allocating organs, one that could become more common as a dozen states now have medical marijuana laws: When dying patients need a transplant, should it be held against them if they've used dope with a doctor's blessing?"Most transplant centers struggle with issues of how to deal with people who are known to use marijuana, whether or not it's with a doctor's prescription," 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."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 re-apply if they stay clean for six months. Marijuana is illegal under federal law.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, Douglas Hiatt, 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, according to 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 so that everyone will know what the rules are," Stewart 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."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.Another Seattle-area patient, Jonathan Simchen, 33, of Fife, said he was rejected as a kidney-transplant candidate at Virginia Mason Hospital and told by UW that he will not be listed until he abstains from pot for six months. Simchen said he uses marijuana to control his blood pressure and to stimulate his appetite, which is disrupted by dialysis.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."You look at each person and determine what the significance is of whatever they're taking, and if there's a potential inappropriate use," she said.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, other doctors, billing experts, social workers, nutritionists, and psychiatrists - must evaluate whether patients have the support and psychiatric health to cope with a complex post-operative regimen for the rest of their lives."You're on a ton of medication ... making appointments, getting your labs done, being consistent with having that level of responsibility," Reyes said. "You can't do it by yourself. It's not like a hernia operation where you're miserable and you go home and sit on your couch and your girlfriend comes by with a bowl of soup."Garon, the lead singer for Nearly Dan, a Steely Dan cover-band, remains charged with manufaturing weed. He insists he was following the state law, which limits patients to a "60-day supply" but doesn't define that amount. Nothing in the police reports indicates otherwise.The transplant committee likely considered the possibility of future jail time in its analysis of his social stability, as well as that he was kicked out of his rental home in Mountlake Terrace.His girlfriend, Liesa Bueno, of Olympia, said Garon has not used other drugs or alcohol since he was diagnosed with hepatitis in 2001."He's just a fantastic musician, and he's a great guy," she said. "I wish there was something we could do legally. ... I'm going to miss him terribly if he passes."Source: Associated Press (Wire)Author: Gene Johnson, AP StatePublished: April 26, 2008Copyright: 2008 The Associated Press California NORML Medical Marijuana Archives
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Comment #8 posted by FoM on April 26, 2008 at 17:58:55 PT
Yes it would have been hard. He had a stroke but he appears to be getting a little more strength then he had. He is about 50 now. The liver failure happened a number of years ago. When they found out he had HepC they gave him the medicine they use on some people with HepC but they never told him he can never drink a beer or anything so he did. The combination of the medicine and the beer shut down his liver.
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Comment #7 posted by Hope on April 26, 2008 at 17:29:04 PT
I'm so glad your friend is ok.That could have been a story that would cause you too much pain to tell.I'm so thankful it wasn't.
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Comment #6 posted by john wayne on April 26, 2008 at 16:50:33 PT
pretzel logic
"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."And it's also a potential indicator of someone who's discerning enough not to actively harm their own liver. 
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Comment #5 posted by FoM on April 26, 2008 at 13:43:44 PT
Our friend is doing so well that the doctor started lowering the drugs that prevent rejection. The doctor told him to keep doing what he is doing. If he only knew.
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Comment #4 posted by Hope on April 26, 2008 at 13:25:38 PT
They're tragically ignorant.
"The concern is that patients who have been using it will not be able to stop..."
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Comment #3 posted by Hope on April 26, 2008 at 13:22:31 PT
I bet they don't have any problem with harvesting organs from healthy people who might have some bi-products from cannabis burning in their blood and organs.
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Comment #2 posted by FoM on April 26, 2008 at 13:02:49 PT
Related Picture From Above Article
Tim Garon lies in his hospital bed as his girlfriend, Leisa Bueno, leans over to give him a kiss while they wait to hear if he will be put on a transplant list to receive a new liver Thursday, April 24, 2008, in Seattle. Garon was refused a spot on the transplant list, largely because he has used marijuana, even though it was legally approved for medical reasons. ( AP Photo/Elaine Thompson ) Picture:
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Comment #1 posted by FoM on April 26, 2008 at 12:15:10 PT
We Have a Friend
He needed a liver transplant and was on the waiting list and one day when he went to the Doctor they let him know they found marijuana in his system and they would drop him off the transplant list if he came back positive again. He stopped smoking and became very nauseated. He didn't smoke except for one night as he got sicker. He was called to come in for the transplant and he got scared. He drank lots of water and hoped for the best. Maybe they didn't test him again because he received the transplant. I understand why a person that drinks alcohol would be bumped from the list because of liver damage but cannabis doesn't cause liver damage. It only helps with the severe nausea.
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