It’s a more complicated question than you might think
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In 2023, Kentucky became the latest state to pass legislation ensuring that cannabis users cannot be denied organ transplants solely due to their marijuana use, with the law set to take effect on January 1, 2025. This move follows a growing trend, as 21 other states have implemented similar measures over the past decade.
As cannabis use continues to increase—61 million Americans consumed marijuana in 2023—state governments are stepping in to protect the rights of cannabis users, particularly in accessing medical treatments like organ transplants, which they have historically been denied.
Despite these state-level laws, the medical community remains divided. Organ transplant societies, which set guidelines for transplant care, have not developed standardized rules on cannabis use, leaving individual programs to determine their own policies. These range from strict zero-tolerance approaches to more lenient “don’t ask, don’t tell” policies. Some programs also permit cannabis users to be listed for transplant after six months of abstinence, even in states where such restrictions have been outlawed.
This lack of uniformity has led to disparities, particularly among wealthier patients who can afford to "shop" for transplant programs with more lenient policies. This practice further exacerbates inequities, giving affluent patients greater access to life-saving transplants.
A standardized national approach is essential to address the growing cannabis-using population fairly. Donor organs are a national resource, and a consistent, evidence-based policy would help ensure equitable organ allocation.
Historically, transplant centers prohibited cannabis use due to concerns about its effects on transplant outcomes. While the supply of donor organs remains limited, with about 100,000 people on waitlists and 6,000 dying annually without receiving a transplant, marijuana’s classification as a Schedule I drug has hindered large-scale research into its effects on transplant patients.
Current data suggests that smoking or vaping cannabis can lead to fungal infections in transplant patients and complicate the immune suppression required to prevent organ rejection. There is also anecdotal evidence that cannabis users may be less compliant with their post-transplant medication regimens. However, these studies are small and often biased, making it difficult to draw firm conclusions.
The best available data points to a key distinction between occasional cannabis use and cannabis use disorder (CUD), which affects about 30% of users and is marked by psychological and physical addiction. Patients with CUD have worse post-transplant outcomes, including higher rates of organ failure and death, particularly after kidney transplants. In contrast, studies have found no significant difference in outcomes between occasional cannabis users and non-users for both kidney and liver transplants.
This suggests that national transplant guidelines should distinguish between occasional users and those with cannabis use disorder. Occasional users, who make up the majority of cannabis consumers, should remain eligible for transplants. Meanwhile, patients with CUD should be required to undergo addiction treatment before being considered for transplant eligibility. Currently, only one-third of U.S. transplant centers offer addiction services, so expanding these resources is crucial.
At the same time, further research into the health impacts of cannabis is necessary, particularly in transplant patients. The Biden administration’s consideration of removing marijuana’s Schedule I status could facilitate more comprehensive studies, ultimately helping to create evidence-based, transparent standards for organ allocation and improving outcomes for all transplant recipients.
Dr. Sandeep Jauhar, a cardiologist at Northwell Health, and Dr. Maria Avila, medical director of cardiac transplantation at North Shore University Hospital, advocate for a balanced and evidence-driven approach to this issue, stressing the importance of distinguishing between recreational users and those with addiction in shaping future transplant policies.programs at North Shore University Hospital at Northwell Health
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