Policy bars patient from liver transplant
Alberta has an extra rehab requirement
As soon as Eric Whitbread found out last August he was suffering from potentially deadly cirrhosis of the liver, he took drastic action.
The North Battleford, Sask., man poured every ounce of liquor he owned down the drain, and hasn’t had a drink since.
Whitbread is days from meeting the controversial requirement that alcoholic liver disease patients be sober six months before they can even be eligible for a liver transplant, his one chance for survival.
But the Alberta transplant agency that also serves Saskatchewan says that’s not enough, insisting that such patients also complete three weeks of residential rehab to make it onto the list. That is a problem, as the 40-year-old father of two is fighting for his life in the intensive- care unit of Saskatoon’s Royal University Hospital, hooked up to dialysis because of collateral damage to his kidneys.
His wife, Aimee, says the policies are moralistic, unjustified by science and unfair to people with addiction and mental- health issues. Eric also has bipolar disorder.
“It makes me angry and it makes me frustrated and it makes me sad for our kids,” she said. “I have a little boy who is dying to throw the football with his dad again. I have a little girl who is dying to sit around the campfire and play the guitar and sing with her dad again … This has completely upended our life.”
She said she and other family members and friends have indicated they are willing to be living liver donors, if found to be a match.
The case is the latest to challenge the six- month rule employed throughout the world, with the added wrinkle of Alberta’s rehab requirement.
While transplant agencies say the rule is necessary to make best use of a scarce, precious resource and encourage people to donate organs, some experts argue the policy is not supported by the evidence.
One province, Ontario, is launching a pilot project this summer that will see the rule shelved for two years, following the lead of a smattering of hospitals in the U. S. and Europe.
Kerr y Will i a mson, a s pokesman f or Alberta Health Services, said “our hearts go out” to Whitbread and his family. But he said some patients are simply too sick to undergo the complex surgery. And those whose illness is related to alcohol must either be abstinent for two years, or for six months and undergo rehab before being eligible for transplant. Such rules ensure they better follow drug and other treatment regimens after getting a new organ, he said.
“It is important to remember that there are a limited number of organs available across Canada for transplantation,” said Williamson. “We must ensure we follow guidelines that allow us to achieve the best outcomes for all of our patients.”
But Debra Selkirk, who has been a dogged advocate for alcoholic liver- disease patients since her own husband died after being denied a transplant, says the rehab requirement is just another needless obstacle for Whitbread.
“It’s a Catch-22,” she said Tuesday. “He can’t get out of ICU without a transplant, and if he doesn’t do the rehab, he can’t get a transplant.”
There is no reason Whitbread couldn’ t undergo rehab after he gets a new liver, as happened with a patient in the U. S. she helped recently.
A 2013 journal paper by six Canadian experts also questioned the six- month policy, noting that even the relatively small percentage of transplant recipients who start drinking again consume limited amounts that are unlikely to harm their new liver.
Aimee Whitbread says her husband was far from a lifelong alcoholic, drinking heavily for three years after the business he co- owned collapsed. She admits it was an inappropriate response, though complicated by his mental-health issues.
And she suspects there are other factors contributing to the liver failure. To treat a spinal problem, he had earlier taken copious amounts of acetaminophen, a drug linked to liver damage. His bipolar disorder was until recently treated with Seroquel, a medication that also lists liver problems as possible side effects. And a specialist initially blamed fatty-liver disease, not booze.
Meanwhile, Selkirk says the family is now hoping to have Whitbread admitted to an Ontario liver- transplant program where, as of Feb. 7, he would meet the sixmonth- sober rule, but not have to enter rehab.