PATIENTS USING MEDICAL MARIJUANA CAN BE DENIED TRANSPLANTS

SEATTLE -- Timothy Garon's face and arms are hauntingly skeletal, but
the fluid building up in his abdomen makes the 56-year-old musician
look eight months pregnant.

His liver, ravaged by hepatitis C, is failing. Without a new one, his
doctors tell him, he will be dead in days.

But Garon's been refused a spot on the transplant list, largely
because he has used marijuana, even though it was legally approved
for medical reasons.

"I'm not angry, I'm not mad, I'm just confused," said Garon, lying in
his hospital bed a few minutes after a doctor told him the hospital
transplant committee's decision Thursday.

With the scarcity of donated organs, transplant committees like the
one at the University of Washington Medical Center use tough
standards, including whether the candidate has other serious health
problems or is likely to drink or do drugs.

And with cases like Garon's, they also have to consider -- as a dozen
states now have medical marijuana laws -- if using dope with a
doctor's blessing should be held against a dying patient in need of a
transplant.

Most transplant centers struggle with how to deal with people who
have used marijuana, 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," Sade said.

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 automatically
rejected. At others, such as the UCLA Medical Center, patients are
given a chance to reapply if they stay clean for six months.
Marijuana is illegal under federal law.

Garon believes he got hepatitis by sharing needles with "speed
freaks" as a teenager. In recent years, he said, pot has been the
only drug he's used. In December, he was arrested for growing marijuana.

Garon, who has been hospitalized or in hospice care for two months
straight, said he turned to the university hospital after Seattle's
Harborview Medical Center told him he needed six months of abstinence.

The university also denied him but said it would reconsider if he
enrolled in a 60-day drug-treatment program. Last week, at the urging
of Garon's lawyer, the university's transplant team reconsidered
anyway, but it stuck to its decision.

Dr. Brad Roter, the Seattle physician who authorized Garon's pot use
for nausea, abdominal pain and to stimulate his appetite, said he did
not know it would be such a hurdle if Garon were to need a transplant.

That's typically the case, 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," she 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," she said.

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.

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.

But there's little information on whether using marijuana is a
problem before the transplant, said Dr. Emily Blumberg, an infectious
disease specialist who works with transplant patients at the
University of Pennsylvania Hospital.

Further complicating matters, Blumberg said, is that some insurers
require proof of abstinence, such as drug tests, before they'll agree
to pay for transplants.

Dr. Jorge Reyes, a liver transplant surgeon at the UW Medical Center,
said that while medical marijuana use isn't in itself a sign of
substance abuse, it must be evaluated in the context of each patient.

"The concern is that patients who have been using it will not be able
to stop," Reyes said.

Dale Gieringer, state coordinator for the California chapter of
NORML, the National Organization for the Reform of Marijuana Laws,
scoffed at that notion.

"Everyone agrees that marijuana is the least habit-forming of all the
recreational drugs, including alcohol," Gieringer said. "And unlike a
lot of prescription medications, it's nontoxic to the liver."

Reyes and other UW officials declined to discuss Garon's case.

But Reyes said that in addition to medical concerns, transplant
committees -- which often include surgeons, social workers and
nutritionists -- must evaluate whether patients have the support and
psychiatric health to cope with a complex post-operative regimen for
the rest of their lives.

Garon, the lead singer for Nearly Dan, a Steely Dan cover-band,
remains charged with manufacturing marijuana. He insists he was
following the state law, which limits patients to a "60-day supply"
but doesn't define that amount.

"He's just a fantastic musician, and he's a great guy," said his
girlfriend, Leisa Bueno. "I wish there was something we could do
legally. ... I'm going to miss him terribly if he passes."