Change liver health rules
By any measure Delilah Saunders is a fighter. Indeed, the 26-yearold’s energetic activism for Indigenous women and human rights earned her Amnesty International’s Ambassador of Conscience Award this year.
Now the Inuk woman from Happy Valley-Goose Bay in Labrador is fighting for her life, and in doing so she is drawing attention to another wrong that needs righting. That is the refusal of Ontario’s health system to put people on the wait-list for a liver transplant if they haven’t abstained from alcohol for the previous six months.
Saunders, who is struggling in Toronto’s University Health Network with acute liver failure, has been denied access to the waiting list because she doesn’t meet that criterion.
It’s a rule that was originally established because doctors believed long-term sobriety was a key indicator of whether a transplant would be successful in the long run. They preferred to give scarce livers to patients with what they thought was the best chance of success.
However, the evidence is mounting that this is a policy based as much on moral judgment as on scientific evidence. And if that’s the case, it amounts to discrimination.
In Ontario, it starts with the Trillium Gift of Life Network, which co-ordinates organ donations in the province and implements those sobriety rules.
It does so even though other health institutions in North America and Europe have deemed the requirement unnecessary for positive health outcomes.
Indeed, three studies between 2008 and 2016 that reviewed liver transplant patients with alcohol disorders in the United States and Europe concluded that patients being sober for more than six months and staying sober afterward had only a minor effect on transplant success.
At the same time, health and ethics experts say the criterion discriminates against disadvantaged people who you might expect to experience higher-than-average rates of alcohol abuse. That would apply to Indigenous people, who often suffer from addiction issues due to intergenerational traumas such as residential schools.
As Arthur Schafer, the founding director of the centre for Professional and Applied Ethics at the University of Manitoba, told CBC Radio’s The Current: “The most disadvantaged people get doubly disadvantaged because we deny them life-saving transplants.” He compared the rule to denying someone life-saving treatment because they were hit by a car while jaywalking.
Disturbingly, Trillium is denying Saunders access to the wait-list even though it is also now questioning its own six-month rule. By August, it plans to launch a three-year pilot program that will make almost 100 patients with alcohol disorders eligible for liver transplants without having to be sober for a full six months.
One wonders why the test run is even necessary. In a document discussing the pilot program, Trillium itself says there is insufficient evidence for the six-month sobriety policy as it stands.
“There were no survival differences between problem drinking and non-drinkers,” said the document, referring to a Canadian study from 2009. “There is also no clear evidence that mandating a brief, arbitrary specific duration of sobriety is effective.”
Saunders is not alone in her battle to get on the wait-list for a liver transplant. Others have filed constitutional challenges against the policy.
As victims of the rule and their families point out, many people don’t even have six months to live without a liver transplant to prove they can go without alcohol.
On a brighter note, Saunders’ family reported on Monday that her health is improving and she may not need a transplant after all.
But in the meantime she has shone a spotlight on a policy that needs changing. Trillium should ensure its transplant policy is based solely on scientific evidence and not discriminatory, moralistic attitudes. At the moment, there is ample reason to question whether that is the case.