By Hannah Rahim
Medical cannabis users in the U.S. face discrimination in seeking health care services, including restrictions against obtaining solid organ transplants.
Considering growing evidence that medical cannabis (which is legal in 38 states, 3 territories, and the District of Columbia) does not compromise post-transplant health outcomes, policymakers should rethink the use of cannabis consumption as a contraindicator to transplantation and should adopt legal protections to prevent undue discrimination towards medical cannabis users.
Concerns about cannabis and transplant outcomes
While transplant societies list drug abuse as a contraindication to solid organ transplantation, they do not offer conclusive recommendations surrounding the medical use of cannabis. The U.S. Organ Transplant and Procurement network defers the determination of transplant eligibility to each transplant center. Many transplant centers prevent cannabis users from receiving solid organ transplantation due to concerns regarding interactions between cannabis and immunosuppressant drugs used for transplants, treatment non-adherence, fungal infections, and neuropsychiatric effects.
However, recent research indicates that cannabis use does not actually foretell worse transplantation outcomes. For instance, a retrospective cohort study of 926 patients who underwent lung transplantation found no significant difference in post-operative complications or survival for cannabis users compared to non-users. Similarly, a retrospective case-control study of 211 patients who underwent liver transplantation found no significant difference in complications, readmission rates, medication non-compliance, or continued substance use between cannabis users and non-users. Also, a retrospective analysis of 316 liver transplant patients found no difference in complications between cannabis users and non-users. Although larger-scale studies are needed to validate these findings, these studies suggest that medical cannabis use should not be an absolute contraindication to solid organ transplantation. Research has also suggested that THC, a component of cannabis, might actually help to prevent transplant rejection.
Need for reform
Discriminating against medical cannabis users seeking organ transplantation without strong evidence of harm is particularly problematic because, for many patients, cannabis is the only medication that can alleviate their symptoms, thus they are not able to continue treatment without jeopardizing their transplant eligibility.
In addition, medical cannabis discrimination can exacerbate existing barriers in access to transplantation that disproportionately affect vulnerable populations, including racial and ethnic minorities and patients at a socioeconomic disadvantage. Because of inconsistent policies relating to cannabis use in transplant centers, clinical judgment may play a large role in determining the patients who are selected for transplants, which can introduce bias and discrimination.
Legal strategies to prevent discrimination
Further research on cannabis use and post-transplant health outcomes will be important to generate a stronger evidence base to inform transplant policies. While this research is being conducted, transplant centers should carry out holistic evaluations of candidacy instead of de facto excluding cannabis users from organ transplantation. Medical cannabis policies in transplantation may also vary based on the method of administration – for instance, the Canadian Cardiac Transplant Network recommends 6 months of abstinence from smoking, inhaling, or vaping before heart transplantation due to concerns about pulmonary infections, but states that non-inhalation cannabis is not a contraindication. Limiting restrictions to inhaled cannabis for organ transplant candidates can be a first step towards ensuring that those who use medical cannabis still have access to some form of treatment.
Thirteen states have enacted laws that prohibit the disqualification of a patient from organ transplantation solely because of their medical cannabis use, but more widespread adoption of such laws is essential to preventing discrimination.
At the federal level, protections against medical cannabis discrimination are not feasible because cannabis is classified as a Schedule I drug, meaning it has no currently accepted medical use and a high potential for abuse. However, considering President Biden’s request for cannabis scheduling to be reviewed, the drug might be descheduled, which could allow for federal anti-discrimination legislation. Other antidiscrimination legislation in the context of organ transplantation has been proposed, such as the Charlotte Woodward Organ Transplant Discrimination Prevention Act introduced in April 2023, which would prohibit discrimination in organ transplantation based on disability alone. Such legislation could form a model for antidiscrimination legislation for medical cannabis users in the organ transplant context.
Legislative solutions will be useful to standardize legal protections across transplant centers and ensure that medical cannabis users who seek organ transplantation are not unduly discriminated against.
