Can anyone tell me if medical marijuana is permitted pre-transplant?

I also agree that your transplant dept will have the best answer but Ill share what I know as a former cigarette smoker and occasional alcoholic beverage in a prior life. I had given both up prior to needing a transplant, smoking was 7 years and drinking was 3 years. In the initial phase of testing to get on the list I was honest that I was a prior smoker and when I quit and it was not questioned. But it was 7 years. Now I do believe the main issue is that smoking anything carries the burning damage of possible emphysema from the heat of the smoke so I believe that was the issue mostly. I have heard of others who had to give up cigarettes prior to transplant and I don't know how long they had to be clean. Just sharing what I know and as @colleenyoung said the people from the Transplant social worker dept were very helpful in many ways and will have the exact answers you're looking for.
The one thing I can add is the fact that I was a Prior smoker, was not a hindrance to getting accepted.

From our experience (our family is in the kidney transplant approval process) there is definitely a no substance use policy at Mayo and that includes pot - recipients need to agree to permanently quit using marijuana, medical grade, recreational or otherwise, before or after transplant. The reasons from what I understand are both medical risk (no clarity on what it does/doesn't do re. long term graft health or rejection; how it interacts with anti-rejection med protocols) as well as compliance risk (anything that would impair or impact a recipient's ability to take a rigorous course of anti-rejection meds as prescribed, for life).

I would definitely be honest with your team and your social worker, and they will advise on what they'd require from you because every case is different. In our case, the recipient had to agree to permanent cessation, show 2-3 clean tests before they would present to committee, and agree to follow up screens post transplant. It delayed our process considerably but I respect Mayo's protocol and they were extremely forthcoming and clear about it with us about it so there was no grey area.

I don't know anything about Marinol but I would definitely bring it up. They can only tell you their guidelines and it's up to you to decide what works best for you. In our case, marijuana helped with pain and appetite for one medical issue, but is contraindicated in the kidney transplant protocol so we had to make a choice. It extended our evaluation process by several months but I think in the long run, it is done to improve the overall outcome in the end.

@waningphilosophic Welcome to Mayo Clinic Connect. I see you have had some great responses to your question!

While I am not a transplant patient, my husband is a kidney recipient [Oct 2016]. We have been involved with renal support programs for many years, and I myself am a ESRD patient not eligible for transplant [on dialysis, though].

Transplant centers, no matter where you go, want to insure the best possible outcomes for their patients, and to offer the available kidneys to those who will comply with the standards that center has set out. The success rate for a recipient depends on so many factors, including co-morbidities, lifestyle, and compliance with protocol. While they can sympathize [most of the time!] with a patient using medical marijuana for pain control/appetite encouragement, they may want you to reduce or stop its use. I know of a person who had to be "de-listed" because he would not cease use of a substance his team banned. Eventually he did comply, and received a kidney.

I will be very interested to hear what your transplant team explains to you, and your decision.
Ginger

Thanks, I appreciate your insight and will try to update when I get an answer.

@feruj - definitely check with your transplant team. In some states and hospitals it could kick you off the transplant list if you use marijuana. I never risked it. Post LT I did use CBD/THC gummies. I was nauseous, so thin, and couldn’t eat. My transplant surgeon okayed me using the gummies to try to gain weight. I only used them for a month and it helped me get back on track. Just be honest about it with your team because they will test for substances at least monthly pre-transplant. I had mine done at UC Health in Denver.

What test is used for thc detection (hair. Urine or blood?

This is a bit off topic but related. I have chronic kidney disease (CKD) stage 4. I’ve been looking for a living kidney donor for 7 years. I’ve met a handful of people that were willing to donate but couldn’t pass the health history screening because they use marijuana. It is heartbreaking.

My husband is 5 months post kidney transplant. The understanding we have after much discussion with transplant team and reading a ton of medical journals is that THC and CBD are taken up in the same pathways as the antirejection drug tacrolimus. If you have THC or CBD in your system it will mess with the Tac levels causing it to rise. Tac levels are kept at very specific levels to ensure keeping rejection at bay while also being at the lowest level possible to avoid negative side affects. My husband was honest about use and was given time to "get clean" before being put on the list but was tested regularly after to ensure adherence. While it is an unwanted lifestyle change, the risk to the transplanted organ was not worth it in our opinion and it was just something we had to give up. There are a lot of medical journals out there discussing the Tac THC relationship and while it does seem that moderate use would not really be a problem, we decided to err on the side of caution. I hope this helps!

What I know you can’t test positive for any type of drugs or you will not be put on transplant list

My transplant team oks use of THC post transplant (only in edible forms) but not CBD as it elevates Tacrolimus levels. I use it at night for back pain.