Grey Areas In Marijuana Laws Persist As Patients Are Denied Organ Transplants
(MintPress) – A woman in California claims she was denied a kidney transplant after it was found that she had legally been using medical marijuana, with the hospital saying that the marijuana usage increased her risk of infection after the surgery, according to Raw Story. In 2011, Cedars-Sinai Medical Center also denied a liver transplant to a man after his doctor, who worked at the Cedars-Sinai facility, prescribed him medical marijuana to help him cope with his chemotherapy.
Toni Trujillo said she was recommended medical marijuana by an independent doctor in 2010 to combat a disorder she was originally diagnosed with in her youth that caused inflammation in her kidneys. Trujillo said doctors never led her to believe that the marijuana usage would hamper her risks of undergoing her second kidney transplant since 1991.
“I was under the impression that it was safe and legal and allowed,” Trujillo said. “Then when I found out that it’s not, it was rather disappointing that they wanted it just eliminated and [have me] take prescription medication to help with the problems that marijuana helped out with… It helps my appetite and my sleep. I felt like it was working for me.”
The hospital told Trujillo that she must participate in substance abuse counseling for six months and be subjected to random drug screenings. After six months, she would be allowed back on the transplant list, but she would start her wait over at the bottom of list.
Joe Elford, chief counsel for Americans for Safe Access (ASA), a patient advocacy group working on behalf of Trujillo, told ENews Park Forest that Cedars-Sinai knew of Trujillo’s medical marijuana usage the past two years when she initially went to the hospital for her kidney treatments. She told ASA that the hospital provided no pushback against the marijuana usage when she told them it was being used as an appetite stimulant in order to increase her protein levels.
“Denying necessary transplants to medical marijuana patients is the worst kind of discrimination,” Elford said. “Cedars-Sinai would not be breaking any laws, federal or otherwise, by granting Toni Trujillo a kidney transplant, and it’s certainly the ethical thing to do.”
Trujillo, 40, was told that her marijuana usage would increase her risk of infection from aspergillosis, a common mold found on plants, trees and food. The Center of Disease Control (CDC) says that “most people breathe in aspergillus spores every day without being affected.” And scientific studies have showed no evidence of a link between medical marijuana usage and an increased risk of aspergillosis in organ transplants.
Allen St. Pierre, executive director for the National Organization for the Reform of Marijuana Laws (NORML), a nonprofit lobbying organization, said in an interview with MintPress that his organization has been aware of nearly a dozen cases where patients have been removed from organ donor lists because of medical marijuana use that was oftentimes prescribed by another doctor.
“This is a terrible thing that has been evolving over the past four or five years and there are so many examples where medical marijuana falls into the gray area of the law,” St. Pierre said.
St. Pierre said that in all of the cases he has encountered, not one doctor explained the potential consequences of marijuana use during the transplant process because medical marijuana falls into such a gray area of law, allowing it to be ruled on subjectively by health care professions. St. Pierre said that withholding that kind of information should make that particular doctor accountable for the patient’s removal from the donor list.
“This whole thing sets up a secondary discussion of serious intellectual liability where a doctor would recommend to somebody to use medical marijuana because, on one level, it could be therapeutic and healthy in the short term, but that recommendation could one day be a major negative health consequence of being denied an organ transplant,” St. Pierre said.
Unsubstantiated medical claims
The CDC notes that organ transplant patients are already at an increased risk of aspergillus infections simply from the surgery alone and that their immune systems are already compromised from the medication regimen they are put through to reduce the risk of organ rejection.
“Invasive aspergillosis generally affects people who have weakened immune systems, such as people who have had a bone marrow transplant or solid organ transplant, people who are taking high doses of corticosteroids, and people who are getting chemotherapy for cancer,” the CDC website says.
Dr. Hassan Ibrahim, medical director of the kidney transplant program at the University of Minnesota, one of the country’s premier transplant facilities, told MintPress he has never heard of marijuana being used as a deterrent for a potential organ recipient or its adverse medical effects in the organ transplant process.
“There’s no evidence that marijuana would affect kidney function in any adverse way,” Ibrahim said. He noted that the university had never turned down a patient simply because they tested positive for marijuana. “I have never heard of the association of marijuana and aspergillosis. It’s unfounded.”
A 2010 study published by the Infectious Diseases Society of America looking at the prognostic factors of aspergillosis found that the death rate of hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients after aspergillosis was significantly high, but did not note that marijuana contributed to an increased likelihood of contracting or exacerbating the condition. Slightly more than 34 percent of the subjects tested who had gone through an organ transplant and contracted aspergillus died before the study was complete.
“There are multiple variables associated with survival in transplant patients with (invasive aspergillosis),” the study concluded. “Understanding these prognostic factors may assist in the development of treatment algorithms and clinical trials.”
Last November, it was reported that 63-year-old Norman Smith was denied a liver transplant at Cedars-Sinai as well after testing positive for marijuana use. Smith, who was diagnosed with inoperable liver cancer, had his medical marijuana usage approved by his oncologist, who also worked at Cedars-Sinai, as a means to deal with pain and discomfort caused by chemotherapy and an unrelated back injury.
Smith was provided with the same stipulations as Trujillo: Removal from the organ recipient list and six months of substance abuse counseling. Elford, with the ASA, wrote to Cedars-Sinai to encourage the hospital to change its eligibility policy to include those that legally purchase medical marijuana from a recognized dispensary. Elford wrote that the hospital has no grounds to put patients through treatment programs for complying with the law.
“While your liver transplant policies are likely motivated by the best intentions, the decision to deny Mr. Smith eligibility for a liver transplant based solely on his compliance with California law and the advice of his physician is extremely misguided and may prove fatal,” Elford wrote.
The practice of removing a patient from the transplant list has already proven fatal. In 2008, Timothy Garon, 56, died of advanced hepatitis C after being denied a liver transplant for testing positive for marijuana. Garon’s physician, Dr. Brad Roter, prescribed and authorized Garon to use the marijuana medicinally and said he had no idea it would become such a roadblock for Garon when it came to him receiving an organ.
Garon lived in Washington state, where medical marijuana is legal, yet his request for appeals of the decision came back with various hospitals in the state denying him the transplant. An Associated Press reporter who spent time with Garon during the appeal process and prior to his death said Garon died without receiving an answer to his question.
“He said I’m going to die with such conviction,” the reporter said. “I’m not angry, I’m not mad, I’m just confused.”
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