Friday, December 15, 2017

Getting a Liver Transplant - is it a Right?

In Canada, before someone can be put on the list for a liver transplant, they must demonstrate that they have not used alcohol or illegal drugs for at least six months. The logic behind this policy is obvious. People who have destroyed their livers due to the over consumption of alcohol need to prove that they will not do the same thing again with their new liver. This rule is in part based on the reality that in 2016 while there were  420 (Canadian Institute for Health Information) individuals on the transplant list - there were only 381(ibid) transplants performed. In a 2015 broadcast on CBC, Dr Gary Levy who manages the liver transplant program at University Health Network in Toronto, reported that 100 people had died the previous year because there were not enough livers available.

Livers are clearly in short supply. They need to go to those whose needs are the highest and to those who will benefit the most. It is not that those who have abuse alcohol are less human or less deserving of medical intervention but rather as there is a limited supply - the system needs to manage it in a way that ensures the highest rates of long term success. It may not be fair - in a perfect world everyone would get the transplant when they needed it regardless of their previous experiences. But this is not a perfect world.

In the last few days there has been some media attention placed upon the case of Delilah Sanders who is in a hospital as a result of liver failure. Ms Saunders is the sister of Loretta Saunders, an Inuk woman going to university in Nova Scotia and who was gathering information on the number of murdered and missing indigenous women for her thesis before she was murdered in 2014. The argument being made on behalf of Ms. Delilah Saunders is that it is her right to have a transplant. I understand the frustration and the anxiety of those who are avocating on her behalf. It must feel so terribly wrong to know that there is little that can be done to save her life.

There is also however, a subtext that is of some concern. Throughout the CBC story, Ms. Saunders' Indigenous status and her active engagement in her community is mentioned a number of times or ways. While it is never directly stated, there is the implication that Ms. Saunders is either being treated differently because of her Indigenous status or she should be treated differently because of it. If the former is true (although there is no indication that that is the case) then it would be a clear violation of human rights. If the latter occurred then it would be a clear violation of rights for whom ever was taken off the list to make room for Ms. Saunders.

The fact that Amnesty International has joined the debate, stating that “"We are deeply concerned that the decision to deny Delilah access to a liver transplant is on the basis of a policy which is discriminatory and inconsistent with Canada's international human rights obligations,"(CBC)  will only add fuel to the debate but do nothing to correct the problem - there are not enough people donating their organs when they die. By engaging in such rhetoric, it potentially reinforces the concept that the discrimination is based on her Indigenous status. Canada has a long history of making bad decisions that were based on race and were discriminatory. This is not one of them.

If in fact, the argument is based on the fact that someone is being discriminated against because they are an alcoholic or have abused alcohol in the past - that in all likelihood is true. The system of allocating liver transplants is inherently unfair. It does not treat all people as equal. In recognition of this, next year (too late for Ms. Saunders) the agency that oversees Ontario transplant system “ will make patients with alcoholic liver disease eligible for a transplant — without first having to be sober for six months.”(National Post). While this is great news for some - it will just make the waiting list for a liver transplant longer and other people will die.

It is right and proper that friends and family raise issues in the media so that we can be made aware. But those who do so need to be careful that the language that they use and the issues that they raise are relevant to the issue.

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