POT EASED SUFFERING, MAY HAVE COST HIS LIFE

Legal Medical Marijuana Use Bars Transplant

The death this week of a musician who was three times denied a liver
transplant highlights a new ethical concern: When dying patients need
a transplant, should it be held against them if they've used marijuana
with a doctor's blessing?

Timothy Garon, 56, died Thursday at Bailey-Boushay House. He was the
lead singer for Nearly Dan, a Steely Dan cover-band.

His lawyer, Douglas Hiatt, said that although no one told him why
Garon was turned down for a transplant, he suspects it was because he
used marijuana with medical approval, as allowed under state law, to
ease the symptoms of advanced hepatitis C.

Garon died a week after a University of Washington Medical Center
committee had for the second time denied him a spot on the liver
transplant list. Harborview Medical Center previously turned him down.
No reasons were given for the denials, Hiatt said.

Harborview said he would be considered if he avoided pot for six
months, and the UW Medical Center offered to reconsider if he enrolled
in a 60-day drug treatment program, but doctors said his liver disease
was too advanced for him to last that long, Hiatt said. The university
hospital committee agreed to reconsider anyway, then denied him again.

"When a doctor authorizes medical marijuana, it's like a
prescription," Hiatt said. "Telling a dying guy in his shape to wait
60 days is insulting and sickening in my opinion." Medical officials
around the country have been wrestling with the issue.

"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."

In a statement, officials from the University of Washington Medical
Center said while they couldn't speak specifically about Garon's case,
medical marijuana is never the sole determinant when making decisions
about candidates for organ transplants, and whether a patient is listed.

"UW Medical Center follows an extensive evaluation process to
determine whether organ transplant candidates should be listed.
Patients with a reasonable chance of survival and a good outcome,
given a variety of factors, are listed," according to the statement.

"Currently, in a given year, there are approximately 98,000 patients
waiting for organs in the U.S. and only 6,000 donors available," the
statement continued. "Because of this scarcity of organs, the listing
process is often rigorous. Those patients who have done -- and
continue to do -- everything they need to ensure a healthy lifestyle
pre- and post-transplant will have the best chance of a good outcome."

In addition to health care issues, the UW committee "looks at a number
of other issues, including behavioral concerns such as a history of
substance abuse or dependency. If such a history exists, then the
Committee looks at the period of abstinence the candidate has
demonstrated to date, efforts made to maintain this abstinence, and
the potential to abuse again. The Committee also factors in the
patient's long-term history of social stability and ongoing medical
compliance, as these are the best predictors to maintain graft
survival following transplant," according to the statement.

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

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.

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 could be a factor if Garon were to need a transplant.
That's typically the case, according to 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."

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.

"You look at each person and determine what the significance is of
whatever they're taking, and if there's a potential inappropriate
use," she said.

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."