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The death this week of a musician who said he was denied a liver
transplant because of his medical-marijuana use has highlighted a new
ethical consideration: Should pot use with a doctor's blessing be held
against a dying patient who needs an organ transplant?
Timothy Garon, 56, used marijuana to ease the symptoms of advanced
hepatitis C. Dr. Brad Roter, the physician who authorized Garon to
smoke pot to alleviate nausea and abdominal pain and to stimulate his
appetite — a use authorized under a Washington state law approved by
voters in 1998 — said he had not known it would be such a hurdle if
Garon were to need a transplant.
Garon died Thursday, one week after he said he learned from his
doctor that a University of Washington Medical Center committee had
again denied him a spot on the liver-transplant list.
"He said I'm going to die, with such conviction," Garon said then. "I'm not angry, I'm not mad, I'm just confused."
His death at Bailey-Boushay House, an intensive-care nursing center,
was confirmed Friday by his lawyer, Douglas Hiatt, and Alisha Mark, a
spokeswoman for Virginia Mason Medical Center, which operates
Bailey-Boushay.
Garon, lead singer for Nearly Dan, a Steely Dan cover band, believed
he contracted hepatitis by sharing needles with "speed freaks" as a
teenager. In recent years, he said, pot had been the only drug he'd
used. In December, he was arrested for growing marijuana.
The UW Medical Center declined to talk about Garon's case
specifically, but released a statement saying: "Although medical
marijuana may be an issue in rare cases, it is never the sole
determinant in arriving at medical decisions about candidates for organ
transplants, and whether a patient is listed. Patients with a
reasonable chance of survival and a good outcome, given a variety of
factors, are listed."
The statement also noted that there are about 98,000 patients
waiting for organs in the United States and only 6,000 donors available.
Hiatt said Friday that UW was being "completely disingenuous" about
the transplant denial: "They denied him because of medical-marijuana
use," he said. "They have a shortage of organs, and they're using moral
judgments to decide who gets one."
Garon had been in the hospice for two months. His doctor at
Harborview Medical Center told him she wouldn't put in his paperwork
for transplant consideration at UW until he avoided pot for six months,
Hiatt said. The university soon offered to reconsider if he enrolled in
a 60-day drug-treatment program, but his liver disease was too advanced
by then for him to last that long, doctors told him. The
university-hospital committee agreed to reconsider its decision, then
denied him again.
Because of the scarcity of donated organs, transplant committees
such as the one at the UW Medical Center have tough standards for
deciding who should get them. Does a candidate have other serious
health problems? Will he or she religiously take anti-rejection
medicines? Is there good family support? Is the candidate likely to
drink or do drugs? And what about medical marijuana authorized by a
doctor?
"Most transplant centers struggle with issues of how to deal with
people who are known to use marijuana, whether or not it's with a
doctor's prescription," said Dr. Robert Sade, director of the Institute
of Human Values in Health Care at the Medical University of South
Carolina. "Marijuana, unlike alcohol, has no direct effect on the
liver. It is, however, a concern ... in that it's a potential indicator
of an addictive personality."
Garon's girlfriend, Leisa Bueno, of Olympia, said Garon had not used
other drugs or alcohol since he was diagnosed with hepatitis in 2001.
The Virginia-based United Network for Organ Sharing, which oversees
the nation's transplant system, leaves it to individual hospitals to
develop criteria for transplant candidates. At some, people who use
"illicit substances" — including medical marijuana, even in states that
allow it — are rejected automatically.
At others, such as the UCLA Medical Center, patients are given a
chance to reapply if they stay clean for six months. Marijuana use is
illegal under federal law.
Typically, doctors don't realize that authorizing marijuana use for
nausea or other disease complications may jeopardize their patient's
chance for a transplant, said Peggy Stewart, a clinical social worker
on the liver-transplant team at UCLA who has researched the issue.
"There needs to be some kind of national eligibility criteria so that everyone will know what the rules are," Stewart said.
The patients "are trusting their physician to do the right thing.
The physician prescribes marijuana, they take the marijuana, and they
are shocked that this is now the end result."
No one tracks how many patients are denied transplants over
medical-marijuana use. Pro-marijuana groups have cited a handful of
cases, including at least two patient deaths, in Oregon and California,
since the mid- to late 1990s, when states began adopting
medical-marijuana laws.
Another Seattle-area patient, Jonathan Simchen, 33, of Fife, Pierce
County, said he was rejected as a kidney-transplant candidate at
Virginia Mason and told by the UW that he will not be listed until he
abstains from pot for six months.
Simchen said he uses marijuana to control his blood pressure and to stimulate his appetite, which is disrupted by dialysis.
Many doctors agree that using marijuana — smoking it, especially —
is out of the question post-transplant. The drugs patients take to help
their bodies accept a new organ increase the risk of aspergillosis, a
frequently fatal infection caused by a common mold found in marijuana
and tobacco.
http://seattletimes.nwsource.com/html/health/2004389825_liver03m.html
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