Deny Organ Transplants to Marijuana Users?

Arthur L. Caplan, PhD


September 23, 2013

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Hi. I'm Art Caplan at the NYU Langone Medical Center in New York City, and I head the Division of Medical Ethics. Should somebody who smokes marijuana be eligible to get an organ transplant? You might think that this is a silly question, but it isn't. In fact, nearly every transplant center in the United States says that if you are abusing a drug -- alcohol, cocaine, or heroin -- you will not be considered for a transplant. For a long time, marijuana has been listed right beside the rest of those drugs as something that is both addictive and criminal to use. Clearly, we have been shifting our policy in the United States, with many states permitting the use of marijuana for medical purposes. Some states allow recreational use without penalty. However, a number of transplant centers around the United States continue to exclude people who have shown 2 positive tests in a row over a period of months for the use of marijuana.

What is the medical reason? It is partly physiological and partly psychological. Marijuana has been shown to damage the liver. It causes problems for people who already have fatty livers. If you need a liver transplant, it may accelerate your need if your liver is already starting to go, and it can damage the new liver. If the livers come from older donors, which they often do, there is some evidence that marijuana use can weaken the ability of the liver to function well. In terms of psychology, there is a fear that if you smoke a lot of marijuana you won't be able to be compliant with the post-transplant regimen. You won't take your drugs properly, you won't be able to follow instructions well, and your memory itself may be impaired. I am not going to say that there is a huge amount of evidence for that particular worry, but it is a worry that transplant teams talk about, that a heavy marijuana user may be someone who isn't likely to be able to comply well post-transplant.

I said that the test for marijuana exclusion for transplant is 2 positive tests in a row over a couple of months. That doesn't mean that you are a heavy user. You might just be a recreational user. And even if you are a heavy user, what if you are using it with approval in a state that allows the use of medical marijuana? Should that exclude you as well?

I believe that if society is becoming more accepting of marijuana users, the field of transplant is not going to be able to exclude people who use marijuana for very long. Forty percent of the population admits to marijuana use. That number is even higher among younger people. If you start saying that they can't get a transplant, public support for transplant may be threatened. That is, people might say that if you exclude marijuana users, they are not going to be organ donors. I don't think the medical facts justify excluding people who use marijuana unless they are heavy, heavy users. That would have to be established by some means of testing or behavioral narratives, but it isn't just "marijuana use." Similarly, compliance doesn't seem to be a big enough problem for the recreational or occasional user, so I think it is time that we change the policy. I think transplant centers should not routinely exclude people because they use marijuana. For heavy, heavy, heavy users, maybe. For recreational users, those who use it for medical purposes, or the occasional user, I don't think so. If we don't make that change, we risk alienating a public that is increasingly accepting the use of marijuana for recreational purposes and accepting the idea that marijuana users shouldn't be discriminated against.

I'm Art Caplan at the NYU Langone Medical Center. Thanks for watching.


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