Widow’s fight has ‘moved the needle’
ONTARIO TO TRY RELAXING LIVER TRANSPLANT RULES
Debra Selkirk’s chances did not look good. Without a lawyer, without any legal training, she decided to take on the Ontario government in a constitutional fight over a difficult cause — whether patients should be denied desperately needed liver transplants because of their drinking.
But two years later, fuelled by love for her late husband and “blind determination,” Selkirk has achieved a surprising victory.
The agency that oversees Ontario’s transplant system has agreed to run a pilot project that will make patients with alcoholic liver disease eligible for a transplant — without first having to be sober for six months.
Individual hospitals in the U.S. and Europe have tried similar experiments. But the Trillium Gift of Life Network’s project may be the first effort by any large jurisdiction in the world to overturn the long-standing six-month abstinence rule, touted as a way to make best use of a scarce resource.
In a detailed plan, the provincial agency says over the study’s three years it expects to provide transplants to almost 100 patients with alcohol-related liver disease, starting next August.
Trillium has not committed to permanently trashing the six-month rule, but concedes that recent evidence suggests alcoholic liver-disease patients fare as well as others — even without the “arbitrary” half-year of sobriety.
At the same time, the document warns, the change could increase waits for liver transplants and might undermine public support for the program.
Selkirk sees shortcomings in the $3-million plan, but after months of frustrating legal tussling, she said she is happy to have at least temporarily changed what had seemed an immutable policy — one that proved fatal for her own husband.
“I’m very proud that up to 97 or 98 people will get the opportunity to have a new life,” she said.
Jennifer Long, a Trillium spokeswoman, confirmed the agency is finalizing the program and acquiring the needed funding. But she stressed the goal is just to “determine if there is an evidence-based basis to change the criteria,” and nothing is yet written in stone.
“In the interim, it is important for all Ontarians to know that the listing criteria for liver transplants remain unchanged,” Long said.
As a health issue, it’s hardly insignificant, with Statistics Canada estimating that more than 1,600 patients die yearly from alcoholic liver disease.
Among their number was Selkirk’s husband, Mark.
The Toronto businessman had battled a drinking problem for most of his adult life and in 2010 was diagnosed with advanced alcoholic hepatitis.
Doctors said a transplant could potentially save Selkirk, while his wife — who appeared to be a match as a donor — and other family members were willing to give up part of their livers for him.
But Toronto’s University Heath Network (UHN) refused to do the operation until he had been dry for six months. Two weeks after his diagnosis, Selkirk was dead.
As the Trillium document notes, the rule has been in place worldwide for a variety of reasons: the belief that a period of abstinence could in some instances remove the need for a transplant; the fear that transplant recipients will start drinking again and waste one of the donated organs; and worries that giving alcoholics transplants could undermine public support for organ donation.
Selkirk launched the constitutional challenge in 2015, arguing the policy violated constitutional rights to equal treatment, and to life, liberty and security of the person.
In an affidavit, Dr. John Fung, chief of transplant surgery at the University of Chicago and a member of the U.S. government’s advisory panel on transplantation, cited a series of studies indicating that alcoholic-liver disease patients do well with transplanted organs and rarely revert to heavy drinking.
That research includes a study of Fung’s that looked at 4,000 liver transplants, concluding that as many or more alcoholic-liver patients were alive five years after receiving a new organ as others.
Michael Fenrick, the lawyer who now represents Selkirk, says he’s worried the project has too many loopholes, including simply the “great reluctance on the part of Trillium to do the right thing.”
But he is still stunned by what his client has accomplished, largely without professional help.
“Debra is one of the most amazing and dogged people I have ever encountered,” said Fenrick. “She has managed to move the needle on this issue. It just needs to be moved further.”
I’M VERY PROUD THAT UP TO 97 OR 98 PEOPLE WILL GET THE OPPORTUNITY TO HAVE A NEW LIFE. — DEBRA SELKIRK, WHO LOST HER HUSBAND MARK TO ALCOHOLIC LIVER DISEASE