Short supply

Cape Breton case raises organ donation issues anew

The story of a 70-yearold Cape Breton man suffering from cirrhosis who claims a doctor told him he’s too old for a liver transplant may be lacking in credibility, since his physician’s side of it hasn’t been heard, but it still raises some valid issues about the shortage of organs for transplantation.

Lauchie Walker says a Halifax surgeon told him in a brief consultation last month that his age precludes him from receiving a new liver. However, Walker, an alcoholic who describes his drinking habits as “I won’t drink for eight months, then I will drink a quart of vodka a day for three weeks before stopping,” may not qualify for a transplant for a number of reasons.

According to the Canadian Liver Foundation, “abstinence from alcohol and medication will usually treat cirrhosis by giving the liver time to regenerate ... patients who continue to drink alcohol despite medical advice are not considered for transplantation in Canada.” Walker would appear to fall into the latter category.

Age is not a factor in deciding who gets a liver, but plenty of other criteria must be met, according to the foundation. These include the risks associated with such major surgery in a patient who is already debilitated: “Patients who are over the age of 65 and those who have other serious illnesses will find the transplant a greater challenge.” Assessments are based on extensive discussions with patients and their families, as well as on the results of a slew of tests, and the foundation says “prioritizing is based on severity of liver disease,” which is measured by a process called Model for End-stage Liver Disease.

There may be several mitigating factors in Walker’s case; the facts simply aren’t available.

More than 400 liver transplants take place in Canada every year. In Alberta, at the end of 2010, 118 people were waiting for new livers, while that same year, 72 Albertans received their transplants, according to the foundation. The average time spent on the waiting list was 260 days.

Presumed consent — a system in which everyone is assumed to be organ donors unless they fill out cards to opt out — might seem the way to go, as 24 countries have done. However, researchers at Johns Hopkins University found that donation rates were no higher in many of those countries, due in part to the fact that the families of the deceased, who have the final say in any case, objected to their loved ones’ organs being donated. Many of the countries the researchers looked at had much lower donation rates, even with presumed consent, than did the U.S.

There are no easy answers, for in discussing organ shortages, there is always the awareness that in most instances, someone has to die in order for someone else to get off the transplant wait list. The Johns Hopkins study found that Spain, one of the few countries with high rates of donation in a presumed consent system, has doctors at all hospitals conversant with transplant issues, who approach families and screen for donors. Clearly, education, advocacy and awareness are key to keeping the issue in Canadians’ public consciousness and increasing the donor list in this country, too.