Kidney Transplants and Cannabis

The New York Times recently reported that the national transplant list now contains more than 100,000 people waiting for kidneys. They noted that although the need for such donations has increased, the number of donations has stayed the same. The author points out the cruelty in denying organs to sick people and concludes that paying donors would help remedy the situation.

But, there is another group of sick people who are cruelly denied transplants, people who are in fact not even allowed on a transplant list: people who use marijuana.

This is the rule in the VA system, as well as the majority of transplant programs. Fortunately, that rule appears to be changing, along with the passage of medical marijuana laws around the U.S. Some transplant centers, such as Oregon Health Science University, have modified their criteria related to cannabis use.

According to an Oregonian report in 2012, if an otherwise qualified candidate has a single negative screen for marijuana, he or she would be allowed on the waiting list. However, patients who don’t want to be disqualified from obtaining a transplant would be prudent not to use even medical marijuana, other than topically, since what is really being said is that two positive screens will eliminate them as candidates.

Why would someone with end stage renal disease (ESRD) use marijuana?

Some of the symptoms of ESRD are specifically addressed by medical marijuana laws and are known to be successfully treated with cannabis. These include appetite loss, weight loss, nausea and vomiting, headaches and sleep problems. Most physicians acknowledge that cannabis can improve appetite, thereby helping to prevent weight loss. The same is true for nausea and vomiting. Cannabis also can help decrease pain, prevent insomnia and even improve one’s attitude—a helpful effect for someone with a chronic illness.

How could marijuana be harmful to a patient with ESRD?

In a case report in the journal Transplant, one individual who smoked marijuana developed invasive pulmonary aspergillosis (a lung infection caused by the fungus aspergillus) after a kidney transplant. The authors recommended that patients be prohibited from using marijuana during periods of high steroid use, but that begs the question of whether there is any harm in post-transplant patients using cannabis orally.

Another study showed that patients with chronic Hepatitis C were more prone to develop fatty liver with daily cannabis smoking. Again, this is a small group — not kidney transplant patients— and the risk was found only with dailycannabis smoking, not with other methods.

The use of marijuana  as a singular criterion for denial of a transplant is not justified by any sort of medical rationale. It is not known yet whether use or overuse of cannabis increases risks with a kidney transplant the way that tobacco abuse or obesity do, yet these conditions are not absolute disqualifiers.

Do you know someone who has been disqualified from a transplant or other medical necessity because of cannabis use? Tell us in the comments below.