Organs are a rare commodity across the world. Every year in the United States alone, over 100,000 people need an organ transplant to survive, but only about 1 in 10 of them will receive one in time. Every day, 13 people on the list will die waiting. So who should get them? For what reasons should we deprive someone of an organ?
Choosing an organ recipient is a complicated task. The United Network for Organ Sharing, a nonprofit, independent organization, oversees the transplant network and helps define big-picture recommendations on who should be placed on the transplant list. But many policies and procedures leading to actual transplants are left up to the transplant center in which they’re performed.
Who gets one of the few organs available has always been a controversial topic, but recently it has become even more so with the statewide legalization of cannabis. Cannabis, while federally illegal, has been spreading across the nation, with 40 states allowing it for medicinal purposes and almost half making it legal recreationally.
But this domino effect of legalization has not translated to transplant policy. As of right now, a transplant center in the majority of states can decide not to give a transplant to someone on the list solely because of their cannabis use, even if the state they live in says it can be prescribed for medical conditions. And drug testing is required for many transplants, with patients needing to show that they’ve been abstinent from drugs for six months.
And transplant centers have made it clear that the legal status of cannabis matters. Although 68 percent of transplant providers said they would allow listing a patient on the registry if they used medical cannabis, this dropped to less than one out of three (27.5 percent) listing a patient if they used it for recreational purposes. Some centers outright ban cannabis use in any form.
Guidelines have been suggested by many, but as of right now, there is no clear law. States have filled in the gaps, with 22 states creating laws to prevent cannabis use from being the sole reason for a denial. But that still leaves patients in the other states in a place of legal limbo, allowing for both the prescription of cannabis but also the denial of medical care because of it.
Those on the hardline denial of organs to cannabis users worry about the long-term effects of drug use on organs. Given that organs are precious resources, they argue that we should be giving them to people with the highest chance of success.
But proponents of the bills protecting cannabis users cite literature stating that cannabis use does not decrease survival rates for many organ transplants, including liver, heart, kidney, and lung. And other concerns, including infection risk in cannabis users and unwillingness to adhere to treatments, have not been borne out in the science either.
The science does not seem to support the idea that cannabis users are worse transplant recipients than nonusers, leading many to claim that the denial of users for placement on the list or receipt of an organ is just lethal bias.
As the call reaches a fever pitch for official guidelines on this topic, patients remain in limbo, potentially being denied a life-saving treatment in some states while being approved in others. And everyone, including doctors, philosophers, and neuroscientists, is weighing in on this charged topic.
Cannabis legalization has spread across the country far faster than our ability to create guidelines for every ethical conundrum that it causes. And the patients and physicians are the ones struggling with the consequences.
