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By Gillian Mohney Vice News
Nearly 19 years after her liver transplant, Yamileth Bolanos is no longer afraid of taking the medical marijuana that helps her get through the day.
Bolanos said her transplant doctors originally told her that if she used marijuana, she would be ineligible for an organ transplant if her liver failed again.
"I could be at the end of my warranty and what if they reject [me?]" she told VICE News.
This week, after California Governor Jerry Brown signed the Medical Cannabis Organ Transplant Act into state law, Bolanos was able to breathe a little easier.
The law bars medical officials from denying a patient a spot on a transplant list "solely upon a positive test for the use of medical marijuana," unless the drug use is clinically significant.
Bolanos' use of marijuana to cope with a major illness is becoming more common as 23 states have now legalized some form of medicinal marijuana. However, the drug can create problems at transplant centers since it is still illegal on the federal level, forcing medical staff and surgeons to consider if it should be considered an "illicit drug" that would make a patient ineligible for a transplant.
California is just the seventh state to pass a law protecting marijuana users from being removed from organ transplant lists, according to Americans for Safe Access, a pro-medical marijuana group.
As more states legalize medical marijuana, there are no guidelines or resolutions from the American Medical Association or the American Society of Transplant Surgeons regarding the issue as it relates to organ donation.
The United Network for Organ Sharing (UNOS), which administers the Organ Procurement and Transplantation Network, declined to speak directly on the issue but pointed out that transplant centers consider "all medical and social factors taken as a whole for any given patient."
While national medical associations have yet to comment, the California Medical Association passed a resolution in 2014 opposing "blanket restrictions of potential organ transplant donors and recipients based solely on reported or detected marijuana uses."
'Patients are often denied a life-saving organ transplant solely because they are prescribed medical cannabis.'
Bolanos started using medical marijuana four years after undergoing a liver transplant. The operation saved her life at age 41, but subsequent complications and medications left her with gastrointestinal problems that made her afraid to leave the house.
"There were days where I felt like it wasn't worth it," she said. Bolanos said it was life changing when she first tried taking a few puffs from a friend's joint.
"It was the first time I felt any relief after my transplant," the now outgoing 59-year-old medical marijuana advocate said. "Marijuana was what had given back to me my life and the quality of life."
Related: Medical Marijuana Laws Don't Cause Teens to Start Smoking Pot, Study Finds
While Bolanos said her doctors at UCLA initially said her marijuana use would disqualify her from getting a second organ, she felt she couldn't give up the drug. Years later, Bolanos said her physicians changed their minds, but she still feared that she could be barred from the transplant list due to her marijuana use.
California State Representative Marc Levine introduced the Medical Cannabis Organ Transplant Bill after hearing about patients similar to Bolanos being taken off transplant lists in the state.
"Arcane public health policies treat medical cannabis patients as drug abusers," Levine said in a statement. "As a result patients are often denied a life-saving organ transplant solely because they are prescribed medical cannabis. Many of these patients have died after being denied an organ transplant."
Bolanos herself was frightened into helping lobby for the bill after hearing about the death of Norman Smith, a 63-year-old cancer patient.
In a video made by Americans for Safe Access, Smith said he was taken off the organ transplant list at Cedars-Sinai Hospital after using medical marijuana that was prescribed to him by an oncologist at the same center.
Bolanos said after hearing Smith's story, she didn't really believe that he would remain off the organ transplant list as he got sicker.
"My thing has always been, 'What are they going to do, let him die?'" Bolanos recalled thinking at the time.
Smith did die in 2012 from complications of liver cancer, according to Americans for Safe Access.
A Cedars-Sinai spokeswoman declined to comment on Smith's case, citing federal patient privacy laws, but said at their "transplant program physicians take many complex factors into account in assessing every patient's viability for transplantation, ensuring the best chance for each patient's post-transplant health."
Dr. Christopher Wigfield, surgical director of the lung transplant program at the University of Chicago, said that transplant centers already consider multiple factors to determine a patient's transplant viability, including overall health, alcohol use, weight, and other chronic conditions.
"That's why transplant [surgery] is so complicated, we don't impose an abstinence policy just because," Wigfield said. "We need to be sure that we give the recipient [the] best chance of an outcome that matches their expectations."
Transplant patients who smoke marijuana have been found to have a higher risk of developing aspergillosis, a potentially fatal infection caused by a fungus that can grow on cannabis.
Wigfield said doctors also have to factor in how medical marijuana could interact with the delicately balanced regimen of drugs given post-surgery to keep patients alive.
Currently, 122,860 people are in need of an organ transplant in the US, according to UNOS.
Bolanos said she is now reveling in being able to use medical marijuana without the fear that she may be disqualified from getting a second transplant in the future. She uses the drug around three times a day just so she can bring herself to eat, but she isn't complaining about her daily regimen.
"I'm alive, honey, that's nothing — compared to being dead," she said.