Medical marijuana is legal. So why are hospitals using it to justify denying transplants?
Sitting in the lobby of the University of Washington Medical Center on the UW campus, Jonathan Simchen pulls up his shirt to reveal three deep scars in his abdomen from a botched kidney operation that took place when he was 9 years old. Doctors in Colorado, where Simchen grew up, accidentally punctured his large intestine while attempting a biopsy on his kidney to determine why he was urinating blood—filling his body cavity with feces.
That was the first in a string of medical problems for Simchen, now 33, including diabetes and a recent kidney failure. Although Virginia Mason deemed Simchen qualified for a kidney transplant in 2007, the hospital removed him from the transplant list a few months later—when, he says, he expressed an interest in trying medical marijuana.
Then, less than a month after Virginia Mason turned Simchen down—and after he had received authorization to use medical marijuana—the UW refused him a transplant, too.
Simchen is not the first person to be denied a transplant because he uses medical marijuana, nor is he likely to be the last. Earlier this month, Timothy Garon, a 56-year-old Seattle musician with hepatitis C, died after the UW denied him a liver transplant for using medical marijuana. Garon's case received widespread attention after his story was picked up by the Associated Press and reprinted in newspapers across the country, putting the medical-marijuana transplant issue briefly in the national spotlight. Last year, an Oregon man who legally used medical marijuana sought help from a Seattle attorney after he was refused a heart transplant. Within a few months, he, too, was dead.
But Simchen is in a unique position: "He's the only guy I've found who isn't going to die while it takes years to litigate this," says Douglas Hiatt, the attorney who has provided legal counsel for all three men.
"I don't feel sick. I don't like to think I'm a sickly person," Simchen says, striding briskly across the UW campus. A member of the Puyallup tribe, he attends Highline Community College and speaks enthusiastically of his plans to become a history teacher and travel through Europe. However, his freedom is limited. Three days a week, Simchen must receive dialysis treatments, which consume more than 15 hours every week.
As a diabetic, Simchen must eat regularly to maintain his blood sugar. But dialysis makes him nauseated. That's why his doctor, Dr. Jason Ling, authorized using medical marijuana, which is known for stimulating the appetite. Dr. Ling did not respond to an e-mail requesting comment.
Such authorizations, while legal under Washington law since 1998, have given hospitals in the state cause to deny transplants to otherwise-qualified patients.
"People are following the law and they're getting screwed," says Lennon Garon, the son of liver patient Timothy Garon. "If alcohol was illegal and marijuana was legal, my dad would be alive."
According to statements from Virginia Mason and the UW, which won't discuss individual patients' cases, the main reason for denying transplants to marijuana smokers is the risk that the organ might be rejected. According to officials at both hospitals, a mold occasionally found in marijuana and tobacco, called aspergillus, could foster new infections in additional organs.
Because the hospitals treat medical marijuana as an addictive drug, they believe transplant patients may be unable to stop smoking pot after the transplant—allowing the harmful mold to destroy the new organ.
"For a lot of people, they can't just go cold turkey," says Virginia Mason spokeswoman Alisha Mark. However, Dr. Roger Roffman, a UW professor who has been studying marijuana dependence since the 1970s, rejects that claim, calling it a "serious... misread [of] science and what is known about control."
Yet another UW doctor argues that claims about the danger of aspergillus in marijuana are wildly overstated. "The argument that the transplant team is making... is not medically valid," says Dr. Greg Carter, a clinical professor in the Department of Rehabilitation. "There are only a few case reports [of aspergillus infection in transplant patients] and these are not considered of much [scientific] value."
After Virginia Mason removed him from the transplant list, Simchen says, a nurse there suggested he contact the University of Washington. However, when he got in touch with the UW's transplant division, he was again told he was ineligible because he had used medical marijuana. Both hospitals have justified the decision by explaining that organs are in scarce supply—roughly one organ is available for every 10 patients seeking a transplant—so the transplant teams must apply strict standards to determine which candidates are most likely to accept the organ.
In a statement similar to the one released after Garon's death, Clare Hagerty, a spokeswoman for the UW transplant division, wrote: "Although medical marijuana may be an issue in rare cases, it is never the sole determinant in arriving at medical decisions about candidates for organ transplants."
Hagerty says, "The committee looks at the period of abstinence a transplant candidate has demonstrated to date, efforts made to maintain this abstinence, and the potential to abuse again."
So does the UW transplant division distinguish between marijuana used under a physician's care and marijuana used for recreational purposes—or, for that matter, abuse of illegal narcotics? Hagerty's response: "No. UW Medical Center's policy does not allow our physicians to prescribe medical marijuana. We also discourage authorization of its use... Substance abuse includes drugs and alcohol."
Simchen says he is willing to quit smoking pot again to get the transplant. However, he adds, "If that's my only option, that breaks my heart. Medical marijuana gives me a better quality of life."
Hiatt, Simchen's attorney, says, "We're seeing the drug war spilling into transplant programs. I'd like to try to negotiate something with [the hospitals] and have them reevaluate the criteria and conduct a rigorous reappraisal of the transplant policies."
For his part, Simchen sees his transplant as an issue much larger than his own health. "At this point, I'm not just standing for myself. I'm standing for other patients who need a kidney transplant," he says. "If I can get it, everyone else can get it."