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.

I Told You So

I am sure I am not the only person who, at least secretly, likes being able to say "I told you so". It may not be particularly to tell someone how wrong they were and how right you were (or at least to brag about it), but it does, on occasion feel good. Today I can say to all of those folks on Vancouver Island who so naively believed that the political world had changed when earlier this year the NDP, with the support of the three Green Party members elected from the island became the provincial government - nothing has changed and I told you so! I wish it wasn’t so but it is.

Part of the Green Party’s campaign platform was the absolute cancellation of the Site C dam. While the NDP’s platform on the same issue was less clear, certainly on Vancouver Island (so far removed from the proposed dam site that Islanders’ opinion should have been almost irrelevant) it was understood that Site C was nothing but a Liberal boondoggled to be done away with a soon as possible. Yesterday, John Horgan as the Premier of the province, with the support of the Green Party leader Andrew Weaver announced that the Site C dam would go ahead as planned. In a world where politicians could be counted on to do what they said- the Green Party would have withdrawn their support for the government. In a world where politicians were held to their promises, this decision would be grounds for an immediate election.

While both leaders expressed their discomfort over their decision, they neither apologized to those who had elected them nor explained how they could go back on their words. John Horgan’s words which he perhaps meant as an apology to the First Nations ( “I am not the first person to stand before you and disappoint Indigenous People” (CBC)), strike me as blatant political self-justification and do nothing to encourage any sort of dialogue. If nothing else, both party leaders should apologize to the Liberals for suggesting that they (the Liberals) were rapists of the land who did not care about the future.

I do not know if the Site C dam is needed or if so, if it is in the right location. I cannot imagine the complexity of trying to determine the electrical needs of a growing province ten years from now. I suspect that that type of decision is well beyond the capacity of most British Columbians. It needed to be made without emotion - based purely on economic needs of all British Columbians. However, I think it is fair to assume that in the past six months, there has not been any significant new data added to equation. Therefore, both the NDP and the Green Party could have said what they said yesterday, six months ago. They perhaps would not have got elected, but at least they would have been honest. Right now it appear as if they said some things just to elected - just like all other political parties.

I take no pleasure in being marginally less politically naive than some of my peers. There is no joy in watching people becoming disengaged from politics because it feels as if everyone always lies. It is profoundly discouraging to watch one’s last hope of an environmentally aware political party become as self serving as all of the rest. It will be tempting for those who feel betrayed by the Green Party’s decision to support the building of the Site C dam to vote some other way the next election, or even worse to ignore their failure to keep their promises. The public need to develop comprehensive critical thinking skills so that during the lead-up to the next election we ask questions and demand answers that are not based on emotion but based on facts. Answers based what is good for the province as opposed to what fits a particular personal or political ideology.

Parties that attempt to give me the answer they think I want - will always betray me if for no other reason than they have no real opinions of their own.