Transplantation and Marijuana Use

American Journal of Transplantation. 2016;16(1):1-2. 

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Screening

One of the calls to Dr. Danovitch was from Douglas J. Norman, MD, director of transplant medicine at Oregon Health and Science University (OHSU) in Portland. Dr. Norman also talked with transplant professionals at the University of California, San Francisco (UCSF) and three programs in Seattle. He says that while UCLA and UCSF screen candidates carefully, they do not attempt to stop people from smoking marijuana. "They pointed out that with patients who use the drug, it is not reasonable to continue to screen forever and expect different results," he says. In Seattle, he says, two out of three programs do not allow transplants to patients who smoke marijuana, even after Washington passed a law legalizing recreational use of the drug.

OHSU tries to identify addicted patients via a screening that must be negative of cannabis use for three consecutive months prior to a transplant. After that, "we don't ask or screen," says Dr. Norman, adding that their major concern is infectious fungal complications from smoking. The OHSU team also worries about the interaction of marijuana with immunosuppression therapy. Dr. Norman notes that animal studies have indicated that cannabis interferes with major enzymes that metabolize drugs like tacrolimus and cyclosporine.

Matthew J. Ellis, MD, medical director of kidney and pancreas transplantation at Duke Medicine in Durham, N.C., says he and colleagues at his institution don't want to get into the business of whether or not marijuana should be legal. "We want to know how and why the patients use marijuana," he says, adding that Duke is concerned about those who use cannabis as a coping mechanism for mental health or stress, versus those who use it just for fun. Depending on results from a complete evaluation of the patient, any type of marijuana use may contribute to a denial of transplantation, he says.

In discussions with referring physicians in North Carolina, Dr. Ellis says he found an even split among the group on whether a person should be able to smoke marijuana—or even cigarettes—and receive a transplant. "It's clear to me that there is no consensus on this; we are unlikely to make everyone happy," he adds.

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