Marijuana Use and Organ Transplantation: a Review and Implications for Clinical Practice

Abstract

There is no consensus among experts regarding marijuana use in transplantation patients. There are extant case reports of post-transplant complications attributed to marijuana use including membranous glomerulonephritis, ventricular tachycardia, and tacrolimus toxicity. However, recent studies suggest that the overall survival rates in kidney, liver, lung, and heart transplant patients using marijuana are equivalent to non-users. Transplant teams should not de facto exclude marijuana users from transplant listing but instead holistically evaluate a patient's candidacy, integrating meaningful medical, psychiatric, and social variables into the complex decision-making process. Psychiatric providers can play a key role in this process. Appropriate stewardship over donor organs, a limited and precious resource, will require a balance of high-clinical standards with inclusive efforts to treat as many patients as possible.

Marijuana Consumption in Liver Transplant Recipients

“…With increasing legalization and utilization, more and more transplant centers are going to face the challenge of marijuana‐related issues in liver transplantation. Additionally, 7 US states (California, Delaware, Arizona, Illinois, Minnesota, Washington, and New Hampshire) recently introduced legislation explicitly banning denial of transplantation due to marijuana consumption . Thus, the purpose of this analysis was to assess the effect of marijuana and tobacco use on post–liver transplant outcomes.…”

Marijuana in pediatric and adult congenital heart disease heart transplant listing: A survey of provider practices and attitudes

“…Despite the considerable consternation among providers and professional societies, marijuana's impact on chronic medical disease and cardiac transplant is poorly understood . Marijuana is designated a schedule I drug (no currently accepted medical use and a high potential for abuse) by the United States Drug Enforcement Administration (DEA) which makes the systematic study of its safety and efficacy quite challenging.…”

“…Thus, even with increasing use in the general public and the medical field, opinions and guidelines regarding marijuana are currently based on small case series, individual case reports, and consensus opinion rather than high‐quality data. Despite the lack of outcome data, multiple states have passed legislation prohibiting transplant selection committees from denying transplant listing on the basis of medical marijuana use alone . Thus, clinical decision‐making may be limited in many cases due to legislative regulations.…”

Denying renal transplantation to an adolescent medical cannabis user: An ethical case study

“…Furthermore, a recent phase II clinical trial that examined the combination of CBD with standard therapies for GVHD prophylaxis showed a statistically significant decrease in GVHD rates in CBD users (HR 0.3, P = 0.0002) . The endocannabinoid system shows promise as a possible target for therapies to reduce the immune response, with particularly beneficial outcomes for transplant patients …”

“…As more patients adopt this unconventional therapy, healthcare providers will inevitably come across potential transplant recipients utilizing this therapeutic modality. Transplant providers, from multidisciplinary teams, are uniquely impacted by this changing environment . Providers are tasked with the decision to utilize a precious resource, taking into account an individual's long‐term risk.…”