Weeding Out the Truth About Marijuana and Organ Transplants

 Katie Bloomer 

Professor Horgan

HST 401

13 December 2022

Weeding Out the Truth About Marijuana and Organ Transplants 

Organ donation is becoming more common as medicine advances. The transplant waiting list was created to manage the growing demand for organ transplants. This list uses a variety of factors to rank transplant candidates in terms of priority receiving their needed organs. One of the factors is the medication the patient has been using prior to their placement on the list. Currently, medical marijuana is one of the medications that is being considered. With many states legalizing medical and even recreational cannabis, it is being substituted for many previous methods of pain management. Despite the recent legalizations of marijuana, many doctors hesitate to prescribe the drug, leading to questions about the dangers of marijuana on the user. There is an ongoing debate regarding the effects of medical marijuana on an organ recipient which produces the question: To what extent should medical marijuana usage affect placement on the transplant waiting list?

The physical health of a recipient is a significant factor for placement. A recipient must be strong enough to survive the transplant surgery. Although the intensity of the surgery varies depending on the organ and condition of the patient, all organ transplant surgeries are difficult on the body. A candidate for transplantation must go through a “...dental exam, chest x-ray, cardiac work-up, pulmonary work-up, infectious disease testing, cancer screening, [and] gender-specific testing…” (“What Every Patient Needs to Know.”) in order to best ensure their ability to survive a transplant. The patients must be in poor health so they need the transplant more than other people. According to the American Transplant Foundation, almost 114,000 people in the United States are currently waiting for an organ transplant (“Facts and Myths about Transplant.”). This means that the need for organs will not be met instantaneously and some candidates will be forced to wait. The organ shortage leaves many without lifesaving organs and “17 people die each day waiting for an organ transplant” (“Organ Donation Statistics.”). In order to reduce the number of deaths, the people who are in more urgent need receive priority. 

The mental health of a recipient is another factor strongly considered during the placement process. Transplantation can have a negative psychological effect on recipients and can be amplified by the side effects of transplant medications. The development of anxiety following a transplant is typical. “Often, before surgery, patients are in denial with regard to the rigors and stressors they will face after-transplant. These issues become reality immediately when they are called in for surgery...” (“Mental Health Services.”). Additional anxiety can arise due to fear of rejection, complications, and reactions to medication. Depression is another potential response to the trauma of surgery. “...Depression seems to be prevalent in approximately 30% of [transplant] patients” (Schulz). This can lead to a lack of postoperative care and eventually rejection. A positive attitude and desire to get better is necessary to pass the psychological evaluation. There will inevitably be challenges during the recovery process, so a patient must begin in a good frame of mind so they are strong even during times of mental fatigue. 

The aftercare capabilities of the patient and designated caregiver impact the ability to join the transplant waiting list. The recipient must deal with their wound care, medications, and therapy. Although a caregiver will assist the recipient with these tasks immediately following the transplant, the patient must be able to manage their own long-term care. Typical aftercare involves inpatient and outpatient treatments of physical therapy, occupational therapy, and speech therapy along with a general visiting nurse. There are also more frequent doctor visits, specialists, and even equipment needed for self checkups.

As the debate surrounding marijuana use advances, laws are being created by states to assert their position on the issue. The Medical Cannabis Organ Transplant Act is a California law that “...prohibits transplant centers from denying transplantation to medical marijuana users solely based on their use of the drug” (Pondrom). This law claims that denying access to a life saving transplant strictly due to a prescribed medication is unethical. Marijuana is no longer illegal and therefore should not be treated differently from other prescription drugs. Numerous other states, including Arizona, Arkansas, Delaware, Hawaii, Illinois, Minnesota, and New Hampshire, have laws that state “a registered qualifying patient's authorized use of marijuana must be considered the equivalent of the use of any other medication under the direction of a physician and does not constitute the use of an illicit substance or otherwise disqualify a registered qualifying patient from medical care”. 

Although some states are beginning to create laws that protect marjuana users' right to a transplant, this is not the case everywhere. Riley Hancey, a 19 year old in need of a double lung transplant, was denied because of a positive test for THC. His father explained that Riley only had one single recent case of marijuana use that took place during a night out with friends. Although it was an isolated case of marijuana use, Riley was forced to travel to a different hospital in order to receive the lifesaving transplant. This is just one example of the inconsistencies regarding marijuana use and organ transplants as each state and even hospital creates their own rules. 

Those who believe marijuana use should have an impact on placement state that there are many side effects of smoking marijuana that are generally considered negative, regardless of whether the user is also a transplant recipient. “chronic use of marijuana results in epithelial damage to the trachea and major bronchi, and decreased diameter of the bronchial airways” (Hubbard). These effects can result in limited lung capacity and potentially the need for oxygen. If the damage is severe then surgery may be necessary to repair the airway. Additionally, “...marijuana can increase heart rate (a dose-dependent tachycardia), increases cardiac output by as much as 30 percent, alters blood pressure, increases myocardial demand, decreases myocardial oxygen and increases angina” (Hubbard). These side effects would all prevent a potential recipient from being added to the transplant waiting list. The only way to deal with the side effects are to take additional medications and participate in further treatments. 

Despite the potential side effects, marijuana can be beneficial regardless of whether the user is also a transplant recipient. “Cannabinoids such as THC… suppress the production of inflammatory Th1 cytokines while promoting Th2 cytokines” (Nagarkatti). Th1 cytokines create inflammation while Th2 cytokines supply an anti-inflammatory response. Therefore, THC can act as an anti-inflammatory and relieve the inflammation that can occur due to immunosuppressants or other medications after transplantation. “...tetrahydrocannabinol  are also responsible for the antiemetic, analgesic, appetite-stimulating, and antianxiety or sedative effects of marijuana” (Kane). An antiemetic is a medication that treats nausea and vomiting while an analgesic is a general painkiller. The combination of these makes marijuana a multipurpose drug that combats many of the complications involved with organ transplants and recovery. 

Some studies show people who are on immunosuppressants are not impacted by the use of marijuana. Research was published in the Clinical Kidney Journal concerning the impacts of marijuana on kidney transplant recipients. There was no difference in long term kidney function between the two groups. The study concluded that marijuana does not impact the effectiveness of organs. (Jaeger) A study focused on the impacts of marijuana on liver transplant recipients, “...did not find clear evidence of harm associated with historical marijuana use…” (Kotwani). This discovery would indicate that marijuana should not be a factor in deciding placement because it does not appear to shorten survival rates. 

Other evidence concludes that people who use immunosuppressants are negatively impacted by the use of marijuana. According to research done at Oregon Health and Science University (OHSU), “Dr. Norman [the director of transplant medicine at OHSU] notes that animal studies have indicated that cannabis interferes with major enzymes that metabolize drugs like tacrolimus and cyclosporine” (Pondrom). Tacrolimus and cyclosporine are both immunosuppressants commonly used after kidney transplants. “Calcineurin inhibitors (CNIs) are the cornerstone of immunosuppression for kidney transplantation. Cyclosporine and tacrolimus are the most commonly used CNIs in renal transplant recipients during the past 20 years” (“Systematic Review of Calcineurin Inhibitors for Kidney Transplant.”). If patients can not take CNIs, they must resort to other medications that are less effective. Given the limits that marijuana puts on crucial anti-rejection medications, it should be considered that patients are more likely to experience rejection from not taking the ideal medication. In terms of smoking marijuana “...various microorganisms are carried on its leaves and flowers which when inhaled could expose the user, in particular immunocompromised patients, to the risk of opportunistic lung infections, primarily from inhaled molds…” (Ruchlemer). A person who uses immunosuppressants is likely not going to be able to fight off an infection. 

In many ways, marijuana usage negatively impacts the ability of the caretaker to assist the recipient. In a study using marijuana “The low dose produced generalized impairment of all mental processes…the high dose resulted in more extensive impairment…” (Klonoff). These impairments complicate the caretaker process. A “... 1968 report of Weil, Zinberg and Nelsen which concluded that sustained attention was not affected by marijuana usage; general alertness, muscular coordination and attention decreased at both dose levels” (Klonoff). These side effects cause difficulty for the caretaker. “Caldwell, Myers and Domino found that marijuana minimally affected sensory acuity” (Klonoff). Acuity is a person’s level of perception. Patients who have even slightly decreased use of their senses would be more difficult to care for than a person who is fully aware of their surroundings. 

Despite the negative effects previously mentioned, marijuana usage can also positively impact the ability of the caretaker to assist the recipient. The antianxiety and sedative effects of marijuana make the job of the caretaker easier. Reducing anxiety also reduces difficulty sleeping, extreme worry, trouble concentrating, and tiredness. (“Anxiety Disorders.”). Reducing the number of medications needed makes it easier for the caretaker to keep track and is healthier for the recipient by reducing the interactions involved.

There is no clear answer to the role that marijuana should play in organ transplants. It will continue to be debated in the medical community for the foreseeable future due to the many unknowns involving both marijuana and transplantation. Despite the potential risks that cannabis use could contribute to transplants, the dangers are not serious enough to make medical marijuana usage a factor in determining placement on the transplant waiting list. The use of marijuana as a factor should continue to be reconsidered as our knowledge of cannabis and transplants improve.

Bibliography

“AB-258 Organ Transplants: Medical Marijuana: Qualified Patients.” California 

Legislative Information, 2015, leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB258.

“Anxiety Disorders.” Mayo Clinic, Mayo Foundation for Medical Education and 

Research, 4 May 2018, 

www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961\.

Austin, Kat. “How Much Does Weed Cost? Cannabis Pricing Guide 2020.” Save On 

Cannabis - Cannabis Coupons and CBD Coupon Codes, 8 Dec. 2020, saveoncannabis.com/weed-price-guide/.

“Facts and Myths about Transplant.” American Transplant Foundation, 21 Mar. 2019, 

www.americantransplantfoundation.org/about-transplant/facts-and-myths/.

Howard, Richard J., and Danielle L. Cornell. “Ethical Issues in Organ Procurement and 

Transplantation.” IntechOpen, IntechOpen, 29 Dec. 2016, www.intechopen.com/books/bioethics-medical-ethical-and-legal-perspectives/ethical-issues-in-organ-procurement-and-transplantation.

“How Hard Is It to Get a Medical Card?: Green Health Docs.” Green Health Docs - 

Medical Marijuana Card Doctors, 21 Sept. 2020, 

greenhealthdocs.com/how-hard-is-it-to-get-a-medical-card/.

Hubbard, John  R., et al. “Marijuana: Medical Implications.” AFP , 1 Dec. 1999. 

AAFP, www.aafp.org/afp/1999/1201/p2583.html.

James, Alexandra, and Roslyn B. Mannon. “The Cost of Transplant 

Immunosuppressant Therapy: Is This Sustainable?” Current Transplantation Reports, vol. 2, no. 2, 28 Mar. 2015, pp. 113–121. National Center for Biotechnology Information, doi:10.1007/s40472-015-0052-y.

Jaeger, Kyle. “Marijuana Use Doesn't Affect Outcome Of Kidney Transplants, Study 

Finds.” Marijuana Moment, 15 Nov. 2018, www.marijuanamoment.net/marijuana-use-doesnt-affect-outcome-of-kidney-transplants-study-finds/.

Joy, Janet E., et al. National Academy Press, 2018, pp. 1–170, Marijuana and Medicine: 

Assessing the Science Base, komornlaw.com/wp-content/uploads/2018/01/39-1999-IOM_Report.pdf.

Kane, Brigid. “Medical Marijuana: The Continuing Story.” Annals of Internal Medicine, 

vol. 134, no. 12, 19 June 2001. Annals of Internal Medicine, doi:10.7326/0003-4819-134-12-200106190-00035.

Klonoff, Harry, et al. “Neuropsychological Effects of Marijuana.” National Center for 

Biotechnology Information, 20 Jan. 1973, www.ncbi.nlm.nih.gov/pmc/articles/PMC1941135/.

Kotwani, Prashant, et al. “History of Marijuana Use Does Not Affect Outcomes on the 

Liver Transplant Waitlist.” Journal of Hepatology, vol. 66, no. 1, May 2018. National Center for Biotechnology Information, doi:10.1016/s0168-8278(17)30681-5.

Kuhl, Laura. “How Do I Obtain a Medical Marijuana Card in My State?” PotNetwork, 2 

July 2019, www.potnetwork.com/news/how-do-i-obtain-medical-marijuana-card-my-state.

“Mental Health Services.” Stanford Health Care (SHC) - Stanford Medical Center, 

stanfordhealthcare.org/medical-clinics/transplant-program/mental-health-services

.html.

Nagarkatti, Mitzi, et al. “Do Cannabinoids Have a Therapeutic Role in Transplantation?” 

Trends in Pharmacological Sciences, vol. 31, no. 8, 28 June 2010, pp. 345–350. National Center for Biotechnology Information, doi:10.1016/j.tips.2010.05.006.

“Organ Donation Statistics.” Organ Donor, 28 Sept. 2020, 

www.organdonor.gov/statistics-stories/statistics.html.

“Organ Procurement and Transplantation Network.” OPTN, 2010, 

optn.transplant.hrsa.gov/resources/ethics/ethical-principles-in-the-allocation-of-human-organs/.

Pondrom, Sue. “Transplantation and Marijuana Use.” American Journal of 

Transplantation, vol. 16, no. 1, 2015, pp. 1–2. Wiley Online Library, doi:10.1111/ajt.13679.

Ruchlemer, Rosa, et al. “Inhaled Medicinal Cannabis and the Immunocompromised 

Patient.” Supportive Care in Cancer, vol. 23, no. 3, 2014, pp. 819–822. Springer Link, doi:10.1007/s00520-014-2429-3.

Schulz, Karl-Heinz, and Sylvia Kroencke. “Psychosocial Challenges before and after 

Organ Transplantation.” Transplant Research and Risk Management, vol. 7, 4 Aug. 2015. DovePress, doi:10.2147/trrm.s53107. 

Schwartz, Robert. “Legalize marijuana without the smoke.” 

“Systematic Review of Calcineurin Inhibitors for Kidney Transplant.” Effective Health 

Care Program, 14 Oct. 2014, effectivehealthcare.ahrq.gov/products/calcineurin-inhibitor/research-protocol.

Ticehurst, Erin. “What Over-the-Counter (OTC) Medications Are Safe for Liver 

Transplant Recipients? – Penn Medicine.” Penn Medicine, 3 Aug. 2011, www.pennmedicine.org/updates/blogs/transplant-update/2011/august/otc-medicines-safe-for-liver-transplant.

“What Every Patient Needs to Know.” United Network for Organ Sharing, 2019.