Bill Would Clear Way for Medical Marijuana Users to Receive Transplants

Andrew Kitchenman | February 7, 2013 | Health Care
Legislation in NJ seeks to prevent repeat of controversial cases at California hospital

Should users of medical marijuana be prevented from getting needed organ transplants?

Not according to a bill being considered by state legislators, which treats medical marijuana as no different from any other prescription drug.

Such patients would be treated the same way as those using other prescription drugs under a bill being considered by state legislators.

The measure, A-765, was prompted by a California case in which a medical marijuana user was denied an organ transplant.

While some doctors have raised concerns about the potential effects of marijuana for transplant recipients, others have said marijuana has been found to be medically necessary and shouldn’t be a barrier to a transplant.

The issue is further complicated by insurance procedures and federal law, which continues to classify marijuana as illegal.

Assemblyman Peter J. Barnes III (D-Middlesex) said he sponsored the bill after reading about the California case.

“If you’re a person who’s prescribed marijuana and you have an illness, it’s authorized, it’s legitimate, you shouldn’t be turned away for a transplant,” Barnes said. “Not for the reason of using the drug.”

The state’s first marijuana dispensary opened in December, three years after the Legislature passed legislation allowing doctors to prescribe marijuana.

Barnes said more and more people are coming to understand the benefits of marijuana use for patients with serious illnesses like cancer and multiple sclerosis.

The bill is receiving support from advocates for medical marijuana. Roseanne Scotti, New Jersey state director of the Drug Policy Alliance, said patients using medical marijuana should receive equal treatment.

“Denying them that transplant is flat-out discrimination and not based on any scientific evidence, so it just seems like a very commonsense bill to us,” she said.

The marijuana-use policies of some of the state’s organ-transplant centers were not immediately available. In at least one case, medical use of the drug shouldn’t be an issue. At the University of Medicine & Dentistry of New Jersey’s University Hospital in Newark, medical marijuana use doesn’t block patients from receiving liver transplants.

“Medical marijuana is not a contra-indication for liver transplantation,” hospital spokeswoman Stacie J. Newton said. “If you are a user of marijuana, that doesn’t eliminate you from being considered for liver transplantation.”

Different hospitals across the country have reached different conclusions in an area where there are no national guidelines, said Dr. Jeffrey Crippin, a past president of the American Society of Transplantation and the medical director of the liver transplant program at Barnes-Jewish Hospital in St. Louis.

“Medical-wise, honestly, I don’t think there are issues that I’m aware of that say that marijuana will cause some horrible medical problem” that would make patients less fit for transplants or cause damage, Crippin said.

However, many transplant programs are concerned about a separate issue for liver transplant recipients – whether they are using marijuana as a temporary substitute for liver-destroying alcohol use.

“If a patient says, ‘Doctor, I’m not drinking anymore but now I’m smoking a joint or two every day,’ that always raises a red flag,” Crippin said.

Crippin added that if a doctor found that marijuana was medically necessary, “I think that most solid organ transplant programs would not” hold that against a patient.

While Barnes did not identify yesterday which case in California prompted his initial concern, the cases that have received the most national attention were at Cedars-Sinai Medical Center in Los Angeles.

That hospital has refused transplants to a number of patients who use medical marijuana. In a statement, hospital officials cited concern about the mold aspergillus, which can grow on marijuana. This mold can lead to fatal infections for those with compromised immune systems, such as transplant patients who are taking immunosuppressant medications to prevent their bodies from rejecting the organs.

An article published in 2000 in the Journal of the American Medical Association found that the risk of aspergillus from marijuana smoking was “unclear.”

Katrina Bramstedt, a medical ethicist at Australia’s Bond University School of Medicine, wrote in an email that the issue is complex.

“One of the problems is ‘medical marijuana,’ while legal in some U.S. states, is still not legal from a federal perspective,” Bramstedt wrote. “In tangent with this, most insurance companies don’t recognize ‘medical marijuana’ use as ‘clinical,’ but rather it falls into the category of active substance use/abuse, so it automatically will disqualify benefit coverage.”

She pointed out that other states have had problems with patients receiving medical marijuana based on cursory reviews by doctors.

William Remak, a California resident and a board member for the National Association of Hepatitis Task Forces, said the medical effects of marijuana use on transplant recipients is in need of further study. A two-time liver transplant recipient, Remak said some people have violated the terms of agreements they signed promising not to use drugs like marijuana. This can result in fatal consequences.

“A person who doesn’t understand the consequences has put themselves in an almost suicidal situation,” said Remak, whose organization advocates for hepatitis patients in need of liver transplants.

Both Bramstedt and Remak pointed to dronabinol, a pill that includes the active ingredient of pot, as a potential solution that will avoid the potential pitfalls of the smokable plant. However, some marijuana users have said the pills are ineffective.

Barnes noted that his bill would treat the medically approved use of marijuana the same as that of prescription drugs. Therefore, if a doctor had a legitimate medical reason to block a transplant, he or she could continue to do so.

However, Barnes said that New Jersey shouldn’t be in the same position as other states where patients may be using marijuana for illegitimate reasons, since the New Jersey law has appropriate safeguards to prevent the over-prescription of the drug.

Barnes said the bill is another step in recognizing that marijuana can have legitimate uses for patients suffering from severe illnesses.

“There’s a certain duplicity that exists, or a lack of candor or a lack of intellectual honesty” that continues to occur among opponents of medical marijuana, said Barnes, who is also sponsoring a bill that would decriminalize possession of a small amount of marijuana. “I think that there is a bias almost on the part of some people who don’t understand why the (original) bill was passed and the types of uses for which it’s being put.”

The bill is scheduled for a hearing in the Assembly Health and Senior Services Committee today. The Senate version of the bill hasn’t yet been scheduled for a committee hearing.