Submitted by GAtherton on 24 February 2015
The offer of a transplanted organ to someone who is in desperate need is an offer to prolong their lives. Medical science has been making that offer for 60 years but there is a huge investment in time and money needed as well as an emotional cost for donor & their family. There are not usually enough donor organs to meet the need for severely sick people. Consequently judgments have to be made as to who will benefit from an organ transplant as not everyone who needs one can have one. The judgment is commonly made according to several criteria – the recipient must be in a position to take maximum benefit so must be in good health, they must be able to acquire all of the support they are going to need to see them through the operation and the rest of their lives, they must not be at risk of cutting short the benefits of their transplant by their own actions eg by smoking tobacco or be suffering from psychiatric illness.
This recent story identifies a difficult issue arising from the application of these criteria. Some people smoke marijuana to relieve pain while they are ill with painful illnesses such as cancer. They can now do so completely legally in many parts of the US HOWEVER they have apparently been denied a solid organ transplant because of the risk of inhaling Aspergillus from poorly dried/stored marijuana, presumably harking back to the days when marijuana was illegally produced in hidden facilities that were not subject to hygiene regulations. Such material is still presumably widely available.
The presence of Aspergillus in the airways of transplant recipients carries a high risk of the patient developing aspergillosis. Aspergillosis, particularly in the early stages of immunosuppression necessary for some transplants is very difficult to treat successfully and carries a high mortality rate (>60%). Surgeons must therefore take all measures necessary to avoid infection!
Hopefully legalisation will improve matters and we have already discussed labs springing up to test marijuana for moulds.
Norman B. Smith died in 2012 because he smoked marijuana. But it wasn’t the drug that killed him.
Smith was taken off the organ transplant list at Cedars-Sinai Medical Center in Los Angeles just weeks before he was to get a new liver because he used medical marijuana. He died within a year.
Last week, California State Assemblyman Marc Levine (D-San Rafael) introduced legislation that would make it illegal for doctors, hospitals or procurement organizations to deny a transplant “based solely” on an applicant being a legal pot smoker.
“Arcane public health policies view medical cannabis patients as drug abusers,” Levine said in a statement. “As a result, too often, patients are denied a life-saving organ transplant solely because they are prescribed medical cannabis.” Arizona, Delaware, Illinois, Minnesota, New Hampshire, and Washington already have similar laws.
Smith, who was diagnosed with inoperable liver cancer, smoked marijuana with the approval of his oncologist at Cedars to ease the side effects of chemotherapy. Before he died, Smith said he hoped publicity surrounding his plight would get the law changed.
But he lived long enough to see Cedars deny a kidney transplant to Toni Trujillo for marijuana use after she had been on the list for six years. Trujillo traveled to California from Pennsylvania for specialized treatment at the medical center. She had been in the state for two years when she was notified by phone that she was being delisted for abusing drugs.
Both Smith and Trujillo say they were told by the hospital that a primary reason for denial was the risk of infection caused by aspergillosis, a genus of common molds frequently seen growing on plants, trees and food. Marijuana dispensaries regularly test for the mold.
While the fungus is considered a threat to people with suppressed immune function and a serious problem for people following transplants, the Centers for Disease Control and Prevention (CDC) points out that people are exposed to it every day in the air they breathe.
The California Medical Association (CMA) voted unanimously (pdf) last December to oppose using medical marijuana as a criterion for selecting organ transplant candidates. The resolution cited the drug’s therapeutic “effects on cancer, appetite, pain control, seizure disorder, and glaucom.” The CMA has not taken a position on the proposed law.
.–Ken Broder
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