BILL ANALYSIS                                                                                                                                                                                                    Ó

                                                                       AB 258

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          258 (Levine)

          As Amended  March 25, 2015

          Majority vote

          |Committee       |Votes |Ayes                  |Noes                  |
          |Health          |13-3  |Bonta, Bonilla,       |Maienschein,          |
          |                |      |Burke, Chávez, Chiu,  |Patterson, Steinorth  |
          |                |      |Gomez, Lackey,        |                      |
          |                |      |Nazarian, Rodriguez,  |                      |
          |                |      |Santiago, Thurmond,   |                      |
          |                |      |Waldron, Wood         |                      |
          |                |      |                      |                      |
          |                |      |                      |                      |

          SUMMARY:  Prohibits a potential recipient of an organ transplant  
          from being denied based solely on their use of medical marijuana  
          (MM).  Allows for an exception to this if the patient's use of MM,  
          based on a case-by-case evaluation by a physician or surgeon, is  
          found to be medically significant to the provision of the  
          anatomical gift.
          EXISTING LAW:  

          1)The Compassionate Use Act, enacted by the approval of  
            Proposition 215 at the November 6, 1996, statewide general  
            election established the right of patients and their primary  


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            caregivers to obtain and use MM, as recommended by a physician,  
            in the treatment of cancer, anorexia, AIDS, chronic pain,  
            spasticity, glaucoma, arthritis, migraine, or any other illness  
            for which MM provides relief. 
          2)The Uniform Anatomical Gift Act regulates the making and  
            distribution of organ donations.

          FISCAL EFFECT:  None

          COMMENTS:  The Organ Procurement and Transplantation Network  
          (OPTN) is a public-private partnership that links all  
          professionals involved in the United States (U.S.) donation and  
          transplantation system.  The United Network for Organ Sharing  
          (UNOS) serves as the OPTN under contract with the Health Resources  
          and Services Administration of the U.S. Department of Health and  
          Human Services.  UNOS is a private, non-profit organization.   
          Currently, every transplant hospital program and organ procurement  
          organization in the U.S. is an OPTN member.  Membership means that  
          their transplant programs are certified by UNOS, and that they  
          play an active role in forming the policies that govern the  
          transplant community.  In California, there are 21 transplant  
          centers (hospitals) and four Organ Procurement Organizations  
          (OPOs), organizations authorized by the Centers for Medicare and  
          Medicaid Services to procure organs for transplantation.

          Each individual hospital comes up with their own policies  
          regarding how they evaluate a patient to determine whether or not  
          they are eligible to receive an organ transplant.  UNOS develops  
          the policies to determine how available organs are distributed  
          among eligible patients waiting for a transplant.

          Substance use vs. abuse.  A 2011 study published in the University  
          of Michigan Journal of Law Reform, "Transplant Candidates and  
          Substance Use: Adopting Rational Health Policy for Resource  


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          Allocation," notes that the autonomy OPOs and hospitals have in  
          determining selection criteria for transplant recipients has led  
          to striking differences in selection tactics with regard to  
          individuals who present issues of substance use and abuse, and one  
          of the greatest areas of regulation that lacks medical and policy  
          foundation is medicinal marijuana use and cigarette smoking.  The  
          evidence of cigarette smoking harm is clear.  According to the  
          World Health Organization tobacco use causes 8.8% of deaths  
          worldwide and kills more than 430,000 U.S. citizens each year -  
          more than alcohol, cocaine, heroin, homicide, suicide, car  
          accidents, fire, and acquired immune deficiency syndrome (AIDS)  
          combined.  According to a 2008 study of substance abuse policies  
          for liver transplant candidates, those who smoke cigarettes are  
          much more readily accepted by liver transplant centers than those  
          who use marijuana, even though marijuana has been found to have  
          beneficial health care uses, including relieving pain and curbing  

          The effect of MM on organ transplant recipients.  A 2009 study  
          published in the American Journal of Transplantation, "Marijuana  
          Use in Potential Liver Transplant Candidates", notes that  
          tetrahydrocannabinol, commonly known as THC, the active component  
          in marijuana, may contribute to the development of various liver  
          diseases and could exacerbate liver disease, however the study  
          also notes that cannabinoids have been shown to help regulate  
          immune system functions, and anti-inflammatory properties,  
          potentially reducing the risk of rejection.  The study finds that  
          overall, the survival of marijuana users with chronic liver  
          disease who present for transplant evaluation is not significantly  
          different from marijuana non-users, and from those findings, the  
          study concludes that marijuana users are not systematically  
          exposed to excess risk of mortality.

          A 2011 article in the American Journal of Hospice & Palliative  
          Medicine, "Medical Marijuana and Organ Transplantation: Drug of  
          Abuse, or Medical Necessity?" examined the case of a patient at a  
          state-funded hospital, in a state where medicinal marijuana (MM)  


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          is legal, who was disqualified as a transplant recipient for his  
          use of MM, even though it was recommended by his primary care  
          physician.  The patient subsequently died.  The authors of the  
          article concluded that this case shows the need for more research  
          on the medical use of marijuana and for states that have made  
          marijuana legal to examine how the laws affect the policies for  
          state-funded hospitals. 

          According to the California Hospital Association, policies  
          regarding the criteria for MM use and organ transplants vary at  
          each institution.  Eligibility to receive an organ depends upon  
          the type of transplant in question and often includes active  
          alcohol and drug abuse as a disqualifier for candidacy.  Some  
          institutions allow patients with a history of alcohol or substance  
          abuse dependency to be given the opportunity to re-apply for  
          transplantation after documented compliance with conditions such  
          as abstinence, attending substance abuse treatment, and  
          demonstrating negative drug tests.  Many institutions make  
          exceptions to their illicit substance use policies for MM when  
          lawfully recommended by a physician for medical purposes prior to  
          evaluation.  However, some institutions make the distinction  
          between smoking medicinal marijuana and ingesting medicinal  

          The California Medical Association passed a resolution in December  
          2014 urging transplant programs to clearly indicate their policies  
          on the use of cannabis to waiting list candidates prior to  
          evaluation of candidacy and opposing blanket restrictions of  
          potential organ transplant donors and recipients based solely on  
          reported or detected marijuana use.  

          Currently six other states provide legal medical cannabis patients  
          the protections proposed in this bill:  Arizona, Delaware,  
          Illinois, Minnesota, New Hampshire, and Washington.


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          Analysis Prepared by:                                               
          Lara Flynn / HEALTH / (916) 319-2097  FN: 0000114