Denied a Liver Transplant for Using Medical Marijuana, and Dying for It --

[xchrom]

http://www.alternet.org/drugs/denied-liver-transplant-using-medical-marijuana-and-dying-it-heartlessness-prohibition

Denied a Liver Transplant for Using Medical Marijuana, and Dying for It -- The Heartlessness of Prohibition



After being diagnosed with liver cancer in 2009, Norman B. Smith applied to the liver transplant list at Cedar-Sinai hospital. While waiting for a transplant, Mr. Smith underwent chemotherapy in an attempt to destroy the cancer eating away at his liver. This caused severe side-effects, common to many cancer patients. In an attempt to curb the pain, and on the recommendation of his oncologist, Mr. Smith began using medical marijuana. Cannabis has become increasingly common as a medicine of choice for patients undergoing chemotherapy, since it increases appetite and reduces pain—minimizing the chance of a patient developing cancer related wasting syndrome. Finally, in September of 2010, Mr. Smith was notified that he was eligible for a liver transplant and was placed on the liver transplant list. Mr. Smith continued his treatment and submitted to drug testing per the hospital's transplant list policy. After testing positive for THC (one of the active chemicals in marijuana), Mr. Smith was taken off the transplant list and denied a life saving procedure. Mr. Smith died because of this. It did not matter to the hospital that Mr. Smith's marijuana use was non-recreational, and was approved by his oncologist as a way to treat his chemotherapy side effects.

This story is a more common than one might think. While working at NORML I received a call from a 19 year-old medical marijuana patient who had a rare liver cancer. This patient tried everything to control the pain and nausea that plagued her everyday. Pills, healthy foods, acupuncture. . . nothing worked. In fact, many of the prescription drugs given to her by her doctor either worsened her nausea or caused other severe side-effects. Finally, she tried medical marijuana, which her oncologist said might be a good option if she could find a reliable source. She tried it, and it worked. After hearing about Mr. Smith, she became terrified that her marijuana use might jeopardize her chances of getting a new liver. How could this be possible? "I want my liver transplant, but I can't imagine living without my medicine, it would be too painful". Unfortunately, due to patient confidentiality laws, it is impossible to know how many people like Mr. Smith there are. But the number will continue to grow as marijuana continues to become an accepted treatment for cancer related pain and nausea. These are the human costs of the war on drugs.

Why do hospitals remove medical marijuana patients from their transplant list? One possibility is fear and ignorance. Cedar-Sinai claims that they remove marijuana users from transplant lists for two main reasons, that marijuana use may indicate a substance abuse problem (but taking high-powered and addictive pharmaceuticals does not?) and that marijuana may increase a user's chance of becoming infected with the aspergillus fungus, which may threaten the well-being of the transplanted organ. This theory is bunk and based on speculation, and a recent study featured in the American Journal of Tranplantation found that marijuana users are just as successful after a transplant as non-marijuana users. Another possibility is that hospitals are beholden to pharmaceutical companies who peddle dangerous drugs when there is a safe and affordable alternative; and marijuana remains illegal under federal law.

[Ms. Toad]

1. There are fewer livers available than there are people who need them.

That means they have to be very careful about selecting who will receive them.

One of the selection factors is the proven ability to be compliant with medical protocols, because the post transplant regimen to protect the new liver (that lasts the rest of the recipient's life) is very challenging and failure to follow it means rejection of the liver (i.e. the liver would have been wasted. Receiving a liver also means that your hepatologist becomes - essentially - your primary care doc. Everything you do medically has to be run past that doc & as someone on the transplant list this person probably either didn't do that or didn't follow his/her advice (either would be reason to pull him off the transplant list).

There is a good discussion to be had about whether the prohibition on medical marijuana is appropriate - but as long as the rule is in place, if you want to remain on the transplant list you have to follow it or formally get an exception from the list makers in advance of using it. This person didn't do that.

My daughter will almost certainly need a liver transplant - and even though she is not listed yet, everything she does goes through her hepatologist now, and when she disagrees with his medical treatment, or wants to try a different treatment, she knows that she has to convince him and get him on board because proven ability to follow medical advice is a critical (and appropriate) criteria for being one of the few to receive the gift of life. It stinks that there are too few livers - but removal from the list for failure to be compliant with medical protocol (as dictated by the transplant docs) is one of the good selection factors because it is a good predictor of whether the recipient will be able to protect that gift.