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Pot eased suffering, may have cost his life (bigaltherealone)
Posted: 3:50:28 pm on 5/3/2008 Modified: Never
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Courtesy of Seattlepi.com
Legal medical marijuana use bars transplant
The death this week of a musician who was three times denied a liver transplant highlights a new ethical concern: When dying patients need a transplant, should it be held against them if they've used marijuana with a doctor's blessing?
Timothy Garon, 56, died Thursday at Bailey-Boushay House. He was the lead singer for Nearly Dan, a Steely Dan cover-band.
His lawyer, Douglas Hiatt, said that although no one told him why Garon was turned down for a transplant, he suspects it was because he used marijuana with medical approval, as allowed under state law, to ease the symptoms of advanced hepatitis C.
Garon died a week after a University of Washington Medical Center committee had for the second time denied him a spot on the liver transplant list. Harborview Medical Center previously turned him down. No reasons were given for the denials, Hiatt said.
Harborview said he would be considered if he avoided pot for six months, and the UW Medical Center offered to reconsider if he enrolled in a 60-day drug treatment program, but doctors said his liver disease was too advanced for him to last that long, Hiatt said. The university hospital committee agreed to reconsider anyway, then denied him again.
"When a doctor authorizes medical marijuana, it's like a prescription," Hiatt said. "Telling a dying guy in his shape to wait 60 days is insulting and sickening in my opinion."
Medical officials around the country have been wrestling with the issue.
"Most transplant centers struggle with issues of how to deal with people who are known to use marijuana, whether or not it's with a doctor's prescription," said Dr. Robert Sade, director of the Institute of Human Values in Health Care at the Medical University of South Carolina. "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."
In a statement, officials from the University of Washington Medical Center said while they couldn't speak specifically about Garon's case, medical marijuana is never the sole determinant when making decisions about candidates for organ transplants, and whether a patient is listed.
"UW Medical Center follows an extensive evaluation process to determine whether organ transplant candidates should be listed. Patients with a reasonable chance of survival and a good outcome, given a variety of factors, are listed," according to the statement.
"Currently, in a given year, there are approximately 98,000 patients waiting for organs in the U.S. and only 6,000 donors available," the statement continued. "Because of this scarcity of organs, the listing process is often rigorous. Those patients who have done -- and continue to do -- everything they need to ensure a healthy lifestyle pre- and post-transplant will have the best chance of a good outcome."
In addition to health care issues, the UW committee "looks at a number of other issues, including behavioral concerns such as a history of substance abuse or dependency. If such a history exists, then the Committee looks at the period of abstinence the candidate has demonstrated to date, efforts made to maintain this abstinence, and the potential to abuse again. The Committee also factors in the patient's long-term history of social stability and ongoing medical compliance, as these are the best predictors to maintain graft survival following transplant," according to the statement. .
Garon believes he contracted hepatitis C by sharing needles with "speed freaks" as a teenager. In recent years, he said shortly before his death, pot has been the only drug he's used. In December, he was arrested for growing marijuana.
The Virginia-based United Network for Organ Sharing, which oversees the nation's transplant system, leaves it to individual hospitals to develop criteria for transplant candidates. At some, people who use "illicit substances" -- including medical marijuana, even in states that allow it -- are automatically rejected. At others, such as the UCLA Medical Center, patients are given a chance to reapply if they stay clean for six months. Marijuana is illegal under federal law.
Dr. Brad Roter, the Seattle physician who authorized Garon's pot use for nausea, abdominal pain and to stimulate his appetite, said he did not know it could be a factor if Garon were to need a transplant. That's typically the case, according to Peggy Stewart, a clinical social worker on the liver transplant team at UCLA who has researched the issue.
"There needs to be some kind of national eligibility criteria so that everyone will know what the rules are," Stewart said. The patients "are trusting their physician to do the right thing. The physician prescribes marijuana, they take the marijuana, and they are shocked that this is now the end result."
Many doctors agree that using marijuana -- smoking it, especially -- is out of the question post-transplant. The drugs patients take to help their bodies accept a new organ increase the risk of aspergillosis, a frequently fatal infection caused by a common mold found in marijuana and tobacco.
But there's little information on whether using marijuana is a problem before the transplant, said Dr. Emily Blumberg, an infectious disease specialist who works with transplant patients at the University of Pennsylvania Hospital.
Further complicating matters, Blumberg said, is that some insurers require proof of abstinence, such as drug tests, before they'll agree to pay for transplants.
"You look at each person and determine what the significance is of whatever they're taking, and if there's a potential inappropriate use," she said.
Dr. Jorge Reyes, a liver transplant surgeon at the UW Medical Center, said that while medical marijuana use isn't in itself a sign of substance abuse, it must be evaluated in the context of each patient.
"The concern is that patients who have been using it will not be able to stop," Reyes said.
Dale Gieringer, state coordinator for the California chapter of NORML, the National Organization for the Reform of Marijuana Laws, scoffed at that notion.
"Everyone agrees that marijuana is the least habit-forming of all the recreational drugs, including alcohol," Gieringer said. "And unlike a lot of prescription medications, it's nontoxic to the liver."
Big Al - Support Advisory for www.MensForte.com
(Email your questions to me at bigal@mensforte.com)
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