SEATTLE – Timothy Garon's face and arms are hauntingly skeletal, but the fluid building up in his abdomen makes the 56-year-old musician look pregnant.

ELAINE THOMPSON/The Associated Press

Timothy Garon has been refused a liver transplant in Seattle because of his medical marijuana use.

His liver, ravaged by hepatitis C, is failing. Without a new one, his doctors tell him, he will be dead in days.

But Mr. Garon has been refused a spot on the transplant list, largely because he has used marijuana, even though it was legally approved for medical reasons.

"I'm not angry, I'm not mad, I'm just confused," said Mr. Garon, lying in his hospital bed. He had just heard of the transplant committee's decision Thursday.

With the scarcity of donated organs, transplant committees like the one at the University of Washington Medical Center use tough standards, including whether the candidate has other serious health problems or is likely to drink or do drugs.

They also have to consider whether using dope with a doctor's blessing should be held against a dying patient in need of a transplant. A dozen states now have laws allowing medical marijuana use.

The Virginia-based United Network for Organ Sharing, which oversees the nation's transplant system, leaves it to individual hospitals to develop criteria for transplants.

At some hospitals, people who use "illicit substances" – including medical marijuana, even in states that allow it – are automatically rejected. At others, such as the UCLA Medical Center, patients are given a chance to reapply if they stay clean for six months. Marijuana is illegal under federal law.

Mr. Garon believes he got hepatitis by sharing needles with "speed freaks" as a teenager. In recent years, he said, pot has been the only drug he's used. In December, he was arrested for growing marijuana.

Mr. Garon, who has been hospitalized or in hospice care for two months, said he turned to the university hospital after Seattle's Harborview Medical Center told him he needed six months of abstinence.

The university also denied him but said it would reconsider if he enrolled in a 60-day drug-treatment program. This week, at the urging of Mr. Garon's lawyer, the university's transplant team reconsidered but it stuck to its decision.

Dr. Brad Roter, the Seattle physician who authorized Mr. Garon's pot use, said he did not know it would be such a hurdle if Mr. Garon were to need a transplant.

That's typically the case, said Peggy Stewart, a clinical social worker on the liver transplant team at UCLA. The patients "are trusting their physician to do the right thing. The physician prescribes marijuana, they take the marijuana, and they are shocked that this is now the end result," she said.

No one tracks how many patients are denied transplants over medical marijuana use.

Many doctors agree that using marijuana is out of the question after a transplant. The drugs patients take to help their bodies accept a new organ increase the risk of aspergillosis, a frequently fatal infection caused by a common mold found in marijuana and tobacco.

But there's little information on whether using marijuana before the transplant presents the same risk, said Dr. Emily Blumberg, an infectious disease specialist who works with transplant patients at the University of Pennsylvania Hospital.

Further complicating matters, Dr. Blumberg said, is that some insurers require proof of abstinence.

Dr. Jorge Reyes, a liver transplant surgeon at the UW Medical Center, said that while medical marijuana use isn't in itself a sign of substance abuse, it must be evaluated for each patient.

Dale Gieringer, state coordinator for the California chapter of NORML, the National Organization for the Reform of Marijuana Laws, scoffed at that notion.

"Everyone agrees that marijuana is the least habit-forming of all the recreational drugs, including alcohol," Mr. Gieringer said.

Gene Johnson,

The Associated Press