Determining who should get organ transplants
By Eric Wilkins, Assistant Editor
Torontonian, Mark Selkirk was diagnosed with acute alcoholic hepatitis in 2010. Told by doctors that his life was going to come to a premature end without a liver transplant, he was in dire straits. To make matters worse, Selkirk was an alcoholic, and all Canadian liver transplant centres require candidates to be alcohol-free for six months. Selkirk died two weeks later. His wife, Debra, is now trying to take down the policy on the basis that, “With universal health care, which as Canadians we pride ourselves on, every person who goes to a doctor or a hospital in Ontario has the exact same right to have their disease cured or treated, their condition improved, or their life saved, regardless of who they are, how they got there, or what their lifestyle is. We have the same right, under the law, to treatment.”
And she’s correct. To a certain point.
You walk into a hospital needing treatment, you get it. That’s your right. Organ transplants are another beast entirely though. Organs aren’t an infinite resource. There’s no facility churning out kidneys, hearts, and lungs as required. They’re not synthetically produced medicines; they’re unique organic machines. In BC last year, according to Transplant.bc.ca, there were 326 transplants. However, that left 465 people still on a wait list. Many will never see the organ they so desperately need (30 per cent rate of death according to bcmj.org).
With the need always well-beyond the supply, should it come as any surprise that there are restrictions and qualifiers in place? While Selkirk’s case is a little different—he couldn’t wait the necessary period (though he did die eight weeks sober)—the policy about being alcohol-free for six months for a liver transplant makes sense. Alcohol is damaging to the liver, and alcoholics aren’t classified as such just because they like the sound of the word.
Not being able to save everyone also means that doctors have to ensure those who can be saved won’t waste the gift of life being given to them. Someone who has shown a propensity to drink, and an inability to stay sober for even half a year may not be the ideal candidate. A study from the University of Pittsburgh in 2008 revealed that six per cent of liver transplant patients with prior alcohol issues faced setbacks, while 2.5 per cent fell off the wagon again outright. To further emphasize those numbers, these are people who are on their cat’s ninth life. Their last chance. It’s difficult enough getting a liver once; it’s virtually impossible to get another, especially if the need for a second transplant exists solely due to abuse again. That there are any people who relapse should be a testament to the need for the policy. If people can’t keep themselves away from booze when there’s a ticking clock, what chance do they have once that immediate threat is gone?
The six-month system isn’t perfect; medical professionals acknowledge that. But is any system, particularly in the quasi-ethics, quasi-science, area of organ transplants perfect? The intention is neither to discriminate nor pronounce a death sentence upon anyone—it’s there to try and make sure such a precious resource is given to a deserving individual who won’t squander it.