Legalizing marijuana is a hot topic in the United States. For Timothy Garon, age 56, it was a deadly one. The Washington state native and musician believed he contracted hepatitis C (HCV) from a dirty needle during his “speed freak” days of using street drugs as a teenager. Over the years, advanced HCV ravaged his liver, compelling him to join the long list of those needing liver transplants. This is a common scenario for people with advanced HCV. According to the CDC, 75 to 85 of every 100 infected persons with HCV might develop long-term infection, while 1 to 5 might die from the consequences of long-term infection (liver cancer or cirrhosis). More so, HCV is the leading cause for liver transplants[1]. After attempts to receive the organ transplant, Garon was repeatedly denied a new liver. Why?
Mary Jane, weed, fatty, dubie, laughing grass—whatever you want to call it. ‘Marijuana abstinence’ better be your motto, if you’re hoping to receive an organ transplant anytime soon. Due to the intense pain associated with HCV, Dr. Brad Roter prescribed medical cannabis, or marijuana, to lessen Garon’s nausea and abdominal pain as well as increase his appetite. Although medical marijuana was authorized under Washington state law in 1998[2], the street drug remains illegal on the federal level, and many organ transplant committees and individual hospitals who develop criteria for organ recipients view those who use the substance as ineligible[3].
This poses a complicated ethical question. Should prescribed medical marijuana users be denied life-saving organ transplants?
In retrospect, Dr. Brad Roter admitted he did not know it would be such a hurdle if Garon were to need a transplant[4]. To further confuse the situation, the UW Medical Center released the following statement, "Although medical marijuana may be an issue in rare cases, it is never the sole determinant in arriving at medical decisions about candidates for organ transplants, and whether a patient is listed. Patients with a reasonable chance of survival and a good outcome, given a variety of factors, are listed[4]." According to Garon’s girlfriend, Leisa Bueno, Garon had been drug free since 2001, when he was diagnosed with HCV. Since that time, Garon grew his own marijuana for medical purposes, and was even arrested for doing so in December of 2007[3].
As of April 25, 2008, in Washington State alone, there were over 200 registrants on the waiting list for a liver and only eight donors[5]. Nationwide statistics report nearly 17,000 registrants in line for a liver transplant and only 539 deceased donors[5]. Those are tough numbers to swallow whether or not you're high on the dope smoke.
Although criteria for candidacy on an organ waiting list is ultimately determined by organ transplant committees and individual hospitals (which often include surgeons, social workers, and nutritionists), the medical community generally accepts a fairly new standard called the Model for End-Stage Liver Disease (MELD). The formation of MELD has led to startling improvements in the determination process, including a decreased mortality rate and waiting time[6]. According to Mary T. Austin, MD, MPH, from Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues, “in 1999, the [Institute of Medicine; IOM] deemed that waiting time was a poor indicator of medical urgency and that rates of transplantation, illness severity, and waiting list mortality were much more meaningful. The IOM recommended that allocation of deceased donor livers could be improved by instituting a mechanism that favored disease severity and deemphasized patient waiting time.... The [MELD] was identified as potentially meeting these requirements[7]."
One of the non-disease-specific criteria for placement on the liver transplant waiting list is six months abstinence from alcohol and illicit drugs[8]. Additional considerations are taken into account: Does the recipient have other serious health issues? What are the chances they will return to abusing illicit drugs or alcohol after receiving a new liver? Where “prescribed marijuana” fits into this equation is uncertain. Dr. Robert Sade, Director of the Institute of Human Values in Health Care at the Medical University of South Carolina said, "Marijuana, unlike alcohol, has no direct effect on the liver. It is, however, a concern ... in that it's a potential indicator of an addictive personality[4]."
Two months after Garon began hospice, one of his doctors refused to put in his paperwork for transplant candidacy until he discontinued marijuana usage for six months. Then, understanding a six-month time span might outlast Garon, the hospital agreed to reconsider his case if he completed a 60-day drug-treatment program. Unfortunately, Garon never got the chance. His HCV was too far advanced. The hospital denied his placement on the list again, and he died one week later.
What does this mean for future transplant candidates? Will they be penalized for heeding their doctor’s suggestion to use marijuana medicinally? Should doctors fear the consequences of prescribing marijuana to patients, even when nothing else works to alleviate pain? Do doctors realize prescribing marijuana will nip their patients’ chances at organ donation in the bud? There needs to be formalized national criteria to determine the eligibility requirements; one that thoroughly addresses prescribed marijuana. These questions must be answered before the next victim of miscommunication falls prey to death by dubie.
Mary Jane, weed, fatty, dubie, laughing grass—whatever you want to call it. ‘Marijuana abstinence’ better be your motto, if you’re hoping to receive an organ transplant anytime soon. Due to the intense pain associated with HCV, Dr. Brad Roter prescribed medical cannabis, or marijuana, to lessen Garon’s nausea and abdominal pain as well as increase his appetite. Although medical marijuana was authorized under Washington state law in 1998[2], the street drug remains illegal on the federal level, and many organ transplant committees and individual hospitals who develop criteria for organ recipients view those who use the substance as ineligible[3].
This poses a complicated ethical question. Should prescribed medical marijuana users be denied life-saving organ transplants?
In retrospect, Dr. Brad Roter admitted he did not know it would be such a hurdle if Garon were to need a transplant[4]. To further confuse the situation, the UW Medical Center released the following statement, "Although medical marijuana may be an issue in rare cases, it is never the sole determinant in arriving at medical decisions about candidates for organ transplants, and whether a patient is listed. Patients with a reasonable chance of survival and a good outcome, given a variety of factors, are listed[4]." According to Garon’s girlfriend, Leisa Bueno, Garon had been drug free since 2001, when he was diagnosed with HCV. Since that time, Garon grew his own marijuana for medical purposes, and was even arrested for doing so in December of 2007[3].
As of April 25, 2008, in Washington State alone, there were over 200 registrants on the waiting list for a liver and only eight donors[5]. Nationwide statistics report nearly 17,000 registrants in line for a liver transplant and only 539 deceased donors[5]. Those are tough numbers to swallow whether or not you're high on the dope smoke.
Although criteria for candidacy on an organ waiting list is ultimately determined by organ transplant committees and individual hospitals (which often include surgeons, social workers, and nutritionists), the medical community generally accepts a fairly new standard called the Model for End-Stage Liver Disease (MELD). The formation of MELD has led to startling improvements in the determination process, including a decreased mortality rate and waiting time[6]. According to Mary T. Austin, MD, MPH, from Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues, “in 1999, the [Institute of Medicine; IOM] deemed that waiting time was a poor indicator of medical urgency and that rates of transplantation, illness severity, and waiting list mortality were much more meaningful. The IOM recommended that allocation of deceased donor livers could be improved by instituting a mechanism that favored disease severity and deemphasized patient waiting time.... The [MELD] was identified as potentially meeting these requirements[7]."
One of the non-disease-specific criteria for placement on the liver transplant waiting list is six months abstinence from alcohol and illicit drugs[8]. Additional considerations are taken into account: Does the recipient have other serious health issues? What are the chances they will return to abusing illicit drugs or alcohol after receiving a new liver? Where “prescribed marijuana” fits into this equation is uncertain. Dr. Robert Sade, Director of the Institute of Human Values in Health Care at the Medical University of South Carolina said, "Marijuana, unlike alcohol, has no direct effect on the liver. It is, however, a concern ... in that it's a potential indicator of an addictive personality[4]."
Two months after Garon began hospice, one of his doctors refused to put in his paperwork for transplant candidacy until he discontinued marijuana usage for six months. Then, understanding a six-month time span might outlast Garon, the hospital agreed to reconsider his case if he completed a 60-day drug-treatment program. Unfortunately, Garon never got the chance. His HCV was too far advanced. The hospital denied his placement on the list again, and he died one week later.
What does this mean for future transplant candidates? Will they be penalized for heeding their doctor’s suggestion to use marijuana medicinally? Should doctors fear the consequences of prescribing marijuana to patients, even when nothing else works to alleviate pain? Do doctors realize prescribing marijuana will nip their patients’ chances at organ donation in the bud? There needs to be formalized national criteria to determine the eligibility requirements; one that thoroughly addresses prescribed marijuana. These questions must be answered before the next victim of miscommunication falls prey to death by dubie.
[1] http://www.cdc.gov/NCIDOD/DISEASES/HEPATITIS/c/faq.htm#1a
[2] http://www.aclu-wa.org/detail.cfm?id=182
[3] http://ap.google.com/article/ALeqM5iiNTqWskznUXcmUi8fblN69gxNNAD90DG7400
[4] http://seattletimes.nwsource.com/html/health/2004389825_liver03m.html
[5] http://www.optn.org/latestData/rptData.asp
[6] Arch Surg. 2007; 142(11):1079–1085.
[7] http://www.medscape.com/viewarticle/566277
[8] http://www.ncbi.nlm.nih.gov/pubmed/9404965
2 comments:
Em,
Love your writings!!! You are SO SMART!!!!
Love,
Peggies
Bioethics is the investigation of the moral issues emerging from progress in science and medication. It is likewise good discernment as it identifies with clinical approach and practice. It incorporates the investigation of qualities relating to essential consideration and different parts of medication.
is used in the treatment of Migraine. May be taken with or without food.
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