Transplantation and Marijuana Use

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

In This Article

Known Versus Unsubstantiated Risks

Kenneth Newell, MD, PhD, professor of surgery in the division of transplantation and vice chair for academic affairs at Emory University in Atlanta, notes that, years ago, he believed that anybody who used marijuana should not receive a transplant simply because the drug was illegal. "Since then, I've thought about it a little differently," he says. "There are people who use all sorts of prescription medications in ways that harm them. What I've tried to do over the years is ask if marijuana use is negatively impacting the patient's life and how it influences behavior. Is the person in a stable relationship; have they held the same job; have they been free of illegal actions? As long as the medical marijuana use is legal and there is not a record of harm to your life, health or social functioning, I think it's hard to deny people access to a life-sustaining therapy."

Itai Danovitch, MD, chair of the department of psychiatry and behavioral neurosciences at Cedars-Sinai Medical Center in Los Angeles and president of the California Society of Addiction Medicine, says that the use of illegal substances is usually looked upon as a risk factor for transplant. "The question is, what level of risk does that substance impart on an individual who is going to have a transplant, and how should the transplant service adjudicate that information in determining a person's eligibility to have a transplant," he says. "That issue is particularly highlighted with marijuana, because while it is a substance of abuse and it is possible to be addicted to marijuana, there is very little evidence that use of marijuana predicts worse transplant outcomes."

He notes that approximately 9% of people who smoke cannabis develop a marijuana-use disorder, meaning that the majority don't. Even for those recreational users who develop some problems, "the severity is much milder than with other forms of substance abuse such as alcohol or cocaine," he says. "What is important is for providers to distinguish between the known risks associated with a particular behavior and the presumed, unsubstantiated risks. Where providers need to be really careful, especially around stigmatized behaviors with substances, is that they don't let bias and stigma drive those critical decisions."

According to a national survey released by Gallup in October 2015, a majority of Americans (58%) continue to say marijuana use should be legal in the United States.

"Marijuana is just the tip of the iceberg as it relates to substance abuse and mental health issues that our patients have," Dr. Ellis adds. "We take care of patients with chronic illness. I think our community needs to be open minded to the possibility that a transplant and marijuana can coexist." But, he advises being careful with these patients, as the marijuana use may be masking something else that should be addressed.