Heart transplant programs disagree on how to handle cannabis use, with state legality shaping policies | Research

The takeaway

A survey of 140 transplant clinicians found significant disagreement on cannabis policies for heart transplant candidates, with programs in legal states more accepting of cannabis use and more likely to have formal policies.

Transplant cardiologists, heart failure specialists, medical ethics researchers, and transplant policy makers

140 transplant clinicians surveyed across legal/illegal states

What the researchers found

Whether cannabis was legal in the respondent's state significantly shaped clinical practices. Programs where cannabis was legal were more tolerant of higher use frequencies before listing exclusion (p = 0.033), more supportive of validated screening questionnaires (p = 0.011), and more likely to have formal policies addressing medical cannabis (p = 0.0001). Most clinicians agreed six months of abstinence was sufficient before listing.

Why it matters

The lack of consensus on cannabis policies for heart transplant candidates means patients may be denied or accepted for transplant based largely on geography rather than evidence.

The numbers in context

140 clinicians; 41.4% cardiologists; significant differences by state legality for: acceptable use frequency (p = 0.033), screening questionnaire utility (p = 0.011), program allows prescribed cannabis (p < 0.0001), formal policy exists (p = 0.0001); most agreed on 6 months abstinence

How the study worked

Web-based survey of 140 clinicians involved in heart transplant care (cardiologists 41.4%, surgeons 7.1%, pharmacists 9.3%, plus advanced practice providers and coordinators). Responses compared between those in states where cannabis was legal versus illegal.

What this study cannot tell us

Survey response rate not reported; self-selected respondents may not represent all programs; responses reflect stated practices which may differ from actual behavior; cannot assess patient outcomes associated with different policies

How to read the evidence

Clinician survey providing practice pattern data, but without response rates or patient outcome data to guide evidence-based policy.

When this study was published

2024 study

The bigger picture

As cannabis legalization expands, the transplant community needs evidence-based consensus guidelines to prevent geographic lottery in transplant access for cannabis-using patients.

Questions still open

Does cannabis use actually affect heart transplant outcomes? Would standardized national guidelines reduce transplant access inequity for cannabis users?

Common questions

How do transplant programs handle cannabis use differently?

Programs in states where cannabis is legal tolerate higher frequencies of use, are more likely to have formal policies addressing medical cannabis, and are more open to using validated screening tools. Programs where cannabis is illegal are more likely to prohibit pre- and post-transplant cannabis use entirely.

Is there any agreement among transplant programs?

Most clinicians agreed that six months of abstinence from cannabis should be sufficient before being listed for heart transplant. There was also general agreement that a validated cannabis use disorder screening questionnaire would be useful for evaluating transplant eligibility.

Read the original research

Cannabis use and heart transplant listing: A survey of clinician practices.

PloS one, 19(12), e0310778

View on PubMed ↗Publisher’s paper ↗

Citation

Ilonze, Onyedika J; Knapp, Shannon M; Chernyak, Yelena; Page, Robert L; Boyd, LaKeisha J; Mazimba, Sula; Raman, Subha V; Enyi, Chioma O; Allen, Larry A; Breathett, Khadijah. (2024). Cannabis use and heart transplant listing: A survey of clinician practices.. PloS one, 19(12), e0310778. https://doi.org/10.1371/journal.pone.0310778