In 2023, Kentucky became the latest state to pass a law banning organ transplants from being denied to patients based solely on marijuana use. This law is scheduled to come into effect on January 1, 2025. Over the past 11 years, 21 other states have enacted similar measures.
These laws go too far into medical decision-making, but they are part of a growing trend. As cannabis use becomes increasingly prevalent in American society, with 61 million Americans expected to smoke, vape, or otherwise consume marijuana by 2023, state governments have historically been He takes the lead in defending the rights of cannabis users, including the right to medical care. Organ transplants were refused.
At the same time, the Society for Transplant Medicine, which sets guidelines for transplant medicine, took over setting standardized directives on cannabis use, allowing individual programs to create their own rules. Some programs have taken a hardline approach by adopting a zero-tolerance policy toward marijuana. Other programs were more lenient, taking a kind of “don't ask, don't tell” stance. Still others have settled somewhere in between, allowing marijuana users to list after six months of abstinence — even those that have passed laws banning such restrictions. There is no consensus on this issue in the porting community.
Diversity of approaches creates disparity. For example, a cannabis user with sufficient resources could move to a community where the program allows transplant registration despite drug use. This kind of “program shopping” gives wealthy patients the benefit of greater access to life-saving organ transplants than ever before.
We need a standardized approach to ensuring transplant eligibility in a large and growing cannabis-using population. Donor organs are national assets. This means that national guidelines, rather than messy (and often vague) institutional policies, are needed to ensure that organs are distributed equitably and without unfairly denying treatment to those who need it most. that it is essential.
Why the FDA has a hard time properly regulating cannabis
When we were in medical school about 25 years ago, marijuana use was largely prohibited by transplant centers. Then, as now, the supply of donor organs did not meet society's demands, and their proper management was an ethical responsibility that the program took very seriously.
Despite advances in organ harvest in recent years and an increase in the number of donor organs (in part due to deaths from opioids), approximately 100,000 Americans are currently on waiting lists for organ transplants, and approximately 6,000 more each year. died without being transplanted.
If cannabis is known to negatively impact transplant outcomes, it would make sense for a program to ban its use. However, hard data on the health effects of cannabis are limited. Part of the reason is that marijuana is still classified by the federal government as a Schedule I drug, the most restrictive drug.
We know that vaping and smoking marijuana is associated with fungal infections in transplant patients. Additionally, cannabis can complicate the immune system suppression that these patients require to prevent organ rejection. There is also anecdotal evidence that patients who use cannabis may be less compliant with complex medication regimens.
Still, most of these studies are small and susceptible to bias, making it difficult to draw sound conclusions from them. Carefully designed studies on cannabis are needed to determine whether it can damage transplanted organs or worsen overall survival for patients.
Until then, the best data we have suggests that “cannabis use disorder'' is characterized by occasional cannabis use and mental and physical addiction, and can affect three in 10 cannabis users. ” suggests that it is necessary to distinguish between Patients with cannabis use disorder (near-daily or near-daily use) have much worse outcomes after kidney transplant, including higher rates of organ failure and mortality. 1st year after transplant.
Meanwhile, a 2016 study of kidney transplants found no difference in one-year patient or organ survival between recreational marijuana users, most of whom were not daily users, and non-users. A 2019 study of liver transplants also found that pre-transplant cannabis use had no negative impact on post-transplant outcomes, including five-year survival.
However, pre-transplant cannabis use disorder is not necessarily associated with adverse outcomes, suggesting that pre-transplant addiction treatment may reduce its harms.
All this suggests a national policy framework.
To defend “Kali’s sobriety”
First, denying organ transplants to all cannabis users is unnecessarily restrictive. Marijuana users are disproportionately black, and black patients have historically been underrepresented on transplant lists, potentially deepening historical inequalities.
Rather, guidelines need to distinguish between occasional users, who make up the majority of the cannabis-using population, and those with full-blown dependence. Occasional users should remain eligible for transplantation (though of course there is little medical benefit from recreational use in this population and should be encouraged to discontinue use).
Meanwhile, people with marijuana use disorders should not be eligible for organ transplants until they have undergone addiction counseling and rehabilitation, despite a law like the one about to be enacted in Kentucky. This will naturally require additional resources, as only about one-third of transplant centers in the United States currently offer drug addiction services.
At the same time, further research is needed on the health effects of cannabis in both transplant and non-transplant settings. The Biden administration is considering ending marijuana's Schedule I drug status. Doing so will free up research funds. Only with rigorous research on cannabis can we create the transparent, evidence-based standards needed to ensure fair organ allocation and optimal outcomes for all transplant patients.
Sandeep Jauhar, a cardiologist at Northwell Health in New York, is the author, most recently, of “My Father's Brain: Life in the Shadow of Alzheimer's.'' Maria Avila is the medical director of the Heart Transplant and Mechanical Circulatory Support Program at Northwell Health's North Shore University Hospital.
