Work

Associations of Marijuana Use History with Progression from Living Donor Candidate Evaluation to Approval: Analysis of the US SRTR Living Donor Collective

Year: 2025

Type: article

Abstract: Purpose: The legalization of cannabis for recreational and medical use in many US states has prompted relaxation of living donor (LD) candidate acceptance criteria in relation to marijuana use (MU).However, the impact of MU on progression from LD evaluation to donation remains unclear.We examined data from the Scientific Registry of Transplant Recipients (SRTR) LD Collective, a novel US LD candidate registry, to assess patterns and reasons for LD candidate non-approval according to MU history.Methods: LD candidates underwent evaluation at 10 US kidney and 6 US liver centers (06/01/18-11/30/24).MU history was defined as past or current use.The outcome of candidate evaluation was categorized as "approved" or "not approved/ withdrawal," with non-approval reasons including chronic kidney disease, medical risk, anatomical, psychosocial, economic, LD candidate withdrawal, recipient reason, or other (multiple reasons permitted).Results: Among 4,554 evaluated LD candidates (3,471 kidney, 1,083 liver) with a finalized donation decision, MU history was reported in 23.6% of kidney and 29.1% of liver LD candidates.In multivariate regression adjusted for age, sex, race, marital status, education, health insurance, and employment, MU history was associated with 25% lower odds of kidney donor approval (adjusted OR, 0.75; P<.0001) and a trend towards 20% lower odds of liver donor approval (aOR, 0.80; P=.11).Among kidney LD candidates, reasons for non-donation varied by MU history (P<.001): medical risk was cited in 18.6% vs 14.7%, psychosocial concerns in 8.6% vs 3.6%, while LD candidate withdrawal occurred in 9.9% vs 6.8% of those with vs without MU history.Among liver LD candidates, the largest differences were in LD candidate withdrawal (7.6% vs 4.9%) and recipient reasons (14.0%vs 11.6%; P>0.05).Conclusions: LD candidates with MU history have reduced rates of approval/ retention, associated with higher medical risk, psychosocial concerns, and LD candidate withdrawal among kidney candidates and increased donor withdrawal in liver candidates.Further research should explore medical and psychosocial profiles associated with MU to better tailor supports to address modifiable barriers to donation.

Source: American Journal of Transplantation

DOI: 10.1016/j.ajt.2025.07.156