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

Ryan, Jennie; Noeder, Maia M.; Burke, C. Shawn; Stubblefield, Samuel C.; Sulieman, Salwa; Miller, Elaine Tilka

doi:10.1111/petr.13467

Cited by 13 publications

(12 citation statements)

References 55 publications

(99 reference statements)

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“…Past studies regarding ethics consultation for transplant candidates and recipients have focused on specific requests or challenging cases such as living organ donation from individuals with developmental delay (Spike 2001), novel organ transplant procedures such as face transplant or uterine transplant (Castlen and Cochrane 2019), withdrawing ECMO for patients who are awake and alert but who are not transplant candidates (DeMartino 2019), discussion of burdens and benefits of transplant in paediatric populations (Aulisio et al 2009), or candidacy denials because of illicit drug use (Ryan et al 2019). More commonly, ethics committees may function as a discussion forum for individual programmes when considering listing (or inactivation) policies (Thomas et al 2015).…”

Section: Discussionmentioning

confidence: 99%

Ethics Consultation for Adult Solid Organ Transplantation Candidates and Recipients: A Single Centre Experience

et al. 2021

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Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the northeastern United States. Of the 880 ethics consultations, sixty (6.8 per cent) involved solid organ transplant, thirty-nine (65.0 per cent) for candidates and twenty-one (35.0 per cent) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent , p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often Bioethical Inquiry

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Section: Discussionmentioning

confidence: 99%

Ethics Consultation for Adult Solid Organ Transplantation Candidates and Recipients: A Single Centre Experience

et al. 2021

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“…California, Washington, Illinois, Arizona, Delaware, and New Hampshire have expanded their medicinal cannabis bills to include antidiscriminatory sections, designed to protect medicinal cannabis patients. In all other states, a patient's medicinal cannabis use may be used to preclude them from employment and housing and can prohibit them from potential medical therapies and procedures, including organ transplantation (Ryan et al, 2019). These are all examples of health inequality between patients in various geographical locations.…”

Section: Patientsmentioning

confidence: 99%

Medicinal Cannabis: Policy, Patients, and Providers

Ryan

McCabe

Boyd

2021

Policy, Politics, & Nursing Practice

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Medicinal cannabis is legal in some form in 47 states, 3 United States territories, and the District of Columbia. An estimated three million Americans use cannabis for relief of a variety of illnesses, and this figure is expected to grow based on policy changes. However, cannabis remains illegal at the federal level as a Schedule I drug under the 1970 Controlled Substances Act. Schedule I classification of cannabis has impeded the advancement of research, leaving providers with little evidence-based information to educate their patients. Furthermore, the disparities in individual state laws create significant social and health inequities in gaining access to medicinal cannabis. Conflicting state and federal policies regarding medicinal cannabis create logistical and ethical dilemmas, and all U.S. stakeholders—patients, providers, and health delivery systems—may be impacted by conflicting federal and state policies. This brief addresses the impact of conflicting cannabis policies.

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“…48 There is no consensus among transplant professionals on the correct approach to adopt with transplant candidates who use cannabis. 49,50 Some transplant centers have a zero tolerance policy and refuse to list a patient with any current use of cannabis, and other centers deny access to transplantation for patients diagnosed with cannabis use disorder. 9,33,51,52 Also, in 2014, the International Lung and Heart Transplant Society viewed SUD, including cannabis use disorder, as an absolute contraindication to lung transplantation.…”

Section: Dsm-5 Criteria For Substance Use Disorder Amentioning

confidence: 99%

Canadian Society of Transplantation White Paper: Ethical and Legal Considerations for Alcohol and Cannabis Use in Solid Organ Listing and Allocation

et al. 2021

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Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue. Until recently, patients in Canada with alcohol-associated liver disease were required to demonstrate abstinence for 6 mo to receive a liver transplant. There is no equivalent rule that is applied consistently for cannabis use. There is some evidence that alcohol and cannabis use disorder pretransplant could be associated with worse outcomes posttransplantation. However, early liver transplantation for patients with alcohol-associated liver disease in France and in the United States has led to challenges of the 6-mo abstinence rule in Canada in the media. It has also resulted in several legal challenges arguing that the rule violates human rights laws regarding discrimination in the provision of medical services and that the rule is also unconstitutional (this challenge is still before the court). Recent legalization of cannabis use for adults in Canada has led to questions about the appropriateness of limiting transplant access based on cannabis use. The ethics committee of the Canadian Society of Transplantation was asked to provide an ethical analysis of cannabis and alcohol abstinence policies. Our conclusions were as follows: neither cannabis use nor the 6-mo abstinence rule for alcohol use should be an absolute contraindication to transplantation, and transplant could be offered to selected patients, further research should be conducted to ensure evidence-based policies; and the transplant community has a duty not to perpetuate stigma associated with alcohol and cannabis use disorders.

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

Cited by 13 publications

References 55 publications

Ethics Consultation for Adult Solid Organ Transplantation Candidates and Recipients: A Single Centre Experience

Ethics Consultation for Adult Solid Organ Transplantation Candidates and Recipients: A Single Centre Experience

Medicinal Cannabis: Policy, Patients, and Providers

Canadian Society of Transplantation White Paper: Ethical and Legal Considerations for Alcohol and Cannabis Use in Solid Organ Listing and Allocation

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