Marijuana restrictions eased for organ transplant candidates at OHSU and Portland VA

OHSU Hospital has quietly eased restrictions on pot use among people seeking organ transplants, a shift driven in part by the rising number of medical marijuana patients in Oregon.

The hospital in the past year has revisited its long-standing policy that required six months of negative drug screens and even the possibility of drug rehabilitation for marijuana users before patients could be waitlisted for a liver transplant. The revised policy allows marijuana users who meet all other criteria to be waitlisted for liver transplants if a single screen turns up negative. 

The new approach also applies to OHSU's kidney, pancreas and heart transplant programs, but most of the discussion has focused on liver patients, among whom substance abuse and marijuana use are common.

"It's been more in the conversation than ever before," said Mike Seely, OHSU's administrator for transplant services. "It's been our responsibility to see what's reasonable."

Only OHSU, home to the state's largest transplant programs and one of the country's oldest programs, and the Portland Veterans Affairs Medical Center perform liver transplants in Oregon.  The new policy applies to both facilities, which share a team of liver specialists and surgeons. Surgeons on the team performed 60 liver transplants last year, and OHSU typically performs 20 heart, 100 kidney and eight to 14 pancreas transplants annually.

Nationwide, transplant programs routinely screen potential organ recipients for substance abuse to ensure that organs, an extremely scarce resource, go to those who will benefit most. Substance abuse is a major concern for transplant doctors, who say it can complicate a patient's recovery.

OHSU's revised stance isn't an embrace of marijuana or even a statement about its medicinal value, hospital officials said. After being waitlisted and after surgery, patients are still told not to use marijuana, tobacco, alcohol or illicit substances.

Marijuana advocates say access to organ transplant programs is an ongoing problem for medical marijuana patients nationwide. Some transplant programs require many months of clean drug screens before a patient can be considered for placement on a transplant list.

Kris Hermes, spokesman for Americans for Safe Access, the country's largest medical marijuana advocacy group, said some transplant programs require marijuana users to submit to random drug tests and undergo rehab. And even if they make it onto a waiting list, patients have been kicked off after subsequent tests show they've used marijuana, he said.

Still, Hermes said he's encouraged by OHSU's policy shift. "It's definitely a ray of hope," he said.

Patients' past marijuana use often arises during the OHSU liver transplant team's weekly meetings to evaluate potential organ recipients, said Dr. Willscott Naugler, a liver specialist and medical director for the liver transplant program at OHSU.

Previously OHSU liver transplant specialists viewed marijuana no differently than heroin or other street drugs, a perspective in step with the American Medical Association, which officially labels pot a "dangerous drug." OHSU doctors say they still won't place people on the transplant list if they're "in the midst of substance abuse." Heroin users or active alcoholics, for instance, must be sober for at least six months. They also have to demonstrate that they've taken steps to prevent relapse.

"The old policy was that marijuana fell into that category," he said.

Doctors decided to revisit the policy after seeing potential transplant candidates who were medical marijuana patients with no obvious addiction problems.

"If you had a beer last weekend, no one would say you are an alcoholic," said Naugler, who helped write the new policy. "You might be. But it doesn't mean you are. We have taken the same approach to marijuana. If you had it last weekend, you may not have an abuse problem."

In Oregon, 137 people are on the waiting list for a new liver, according to the United Network for Organ Sharing, which manages the country's organ transplant system. Nationwide, 16,011 patients are on the liver transplant list. The agency says 92,853 patients in the country are on the kidney waiting list.

No federal guidelines or national standards apply to medical marijuana and the organ transplant screening process, but national transplant experts say the issue is a persistent and potentially tricky one.

"We need to be very careful," said Dr. David J. Reich, chair of the liver transplant and surgery committee for the American Association for the Study of Liver Diseases and chief of organ transplantation at Philadelphia's Hahnemann University Hospital. "There is a shortage of organs. It's not acceptable to get it wrong, and there is not a lot of evidence with regard to marijuana.

"It's definitely a politicized, controversial issue," he added.

Reich said a recent study of liver transplant patients showed carefully screened patients who had used marijuana before the procedure had "excellent" outcomes.

Jim Klahr, a 60-year-old liver patient, said OHSU's policy is a "baby step" in the right direction but doesn't change much for him.

Klahr, who lives in Brookings, is a longtime marijuana activist and Oregon medical marijuana cardholder. He even grows marijuana that he gives to other medical marijuana patients. But he hasn't used pot since he landed on OHSU's liver transplant list nine years ago. At least twice a year he undergoes testing to make sure he hasn't consumed marijuana.

As far as Klahr is concerned, pot is still off-limits even under the new policy.

"It leads to the same place," he said. "New people and myself cannot use it without the fear of being taken off the program."