Making A Life-Altering Decision

"It is quite amazing the stories I am hearing. I am totally blown away by it, and I am not going to claim I totally understand it. It is a remarkable thing these people are doing [offering part of their liver as a donor for life-saving transplant]."
"[The transplant] ... could happen as early as tomorrow if the conditions were met, or it could be next week. We don't have weeks to conclude this We are looking at days, maybe a week at most. We know we have to move at a rapid pace."
Dr. Gary Levy, medical director, live donor liver transplant program, Toronto General Hospital

Peter J. Thompson/National Post/Files   A kidney transplant. “We can’t have public policy subverted by those who have the capacity to shout the loudest,” one expert in bioethics says.

Yesterday, a public notice was published in an Ottawa newspaper by the city's NHL hockey team, asking for people willing to donate part of their liver to save the life of the owner of the Ottawa Senators hockey team in a live liver operation, to step forward. Usually such donations come from the deceased who have indicated their wish that their organs be used to benefit other people in desperate need of organ replacement donations.

It is a lot to ask of anyone, close family members included, to risk potential death, injury or a long, complicated recovery as a result of offering part of their liver. To broadcast an appeal to the public at large to make such a sacrifice, anonymously, to benefit a stranger, is highly unusual and is a reflection of the shortage of donor organs from cadavers. Evidently the man in question is facing imminent death with the total collapse of his liver function.

That man is Eugene Melnyk, the founder of a generic Canadian pharmaceutical company, an immensely wealthy man who is also the owner of the city of Ottawa's hockey team. It appears that Mr. Melnyk is well known in the Ukrainian community for his philanthropy within that community. There was an instant response to the plea for people to step forward to aid this man; some two thousand people did just that.

Mr. Melnyk has a rare blood type which would have to be matched under usual circumstances, but which could be waived or manoeuvred around with a live donor where success is more prevalent than with cadaver organs. Those who volunteer for such a surgery transferring a large part of their liver to another person, without which that person would die, must undergo stringent examinations and interviews to ensure they are healthy and of sound mind.

That there are so many potential volunteers from such a large pool representing people moved by the plight of this man augurs well for a successful transplant and the longevity of Eugene Melnyk. There are issues involved in this situation; not the least of which is placing prospective donors into a situation which could prove dangerous to their own heath and longevity. The other involves the fact that as a man with immense wealth Mr. Melnyk could very well 'buy' a liver from a donor in India or China.

He and his family have chosen the ethical route; to pay someone to sacrifice an organ or part of an organ for transplant is illegal in Canada, and for obvious reasons. Desperately poor people in deprived conditions living in emerging economies where poverty is endemic see selling their organs as a way to sustain their own lives in another way; paying for the necessities of life for themselves through such a sacrifice.

Dr. Levy had vetted the public announcement of Mr. Melnyk's dire medical condition before its release by the NHL team's leadership: "I thought it was very professionally crafted and compassionate" he said, in view of strict rules on the solicitation of live organ donations. "But reaching out and telling people that you are sick and you need help, we would welcome this", he explained.

Not everyone agrees: "This is wading into a ethically very complex situation" pointed out Dr. Steve Paraskevas a transplant surgeon working out of McGill, president of the Canadian Society of Transplantation. Mr. Melnyk's case could have the effect of arousing public debate on the requirement for increased organ donors, but it might just as well, "create a negative impression about organ donation and the ability of certain people to harness resources that are not available to every individual".

His point is well taken, in that Mr. Melnyk is a public figure of some note and influence. His profile among sport fans is high, and he is no doubt admired by many of them who might wish to respond positively, in an effort to aid him, simply because of who he is. This is a course of action which, pursued by any other ordinary person in such a plight, might not elicit the same kind of public reaction.

Dr. Levy himself explains that many transplant centres feel uncomfortable with live liver donations: "We are talking about a life-threatening operation, albeit a life-saving one. Many people don't feel comfortable with that." On the other hand, he said, he and the hospital initiated live donations in view of a shortfall of organs from deceased donors: "We were losing 40 to 50 percent of recipients. We had to make a decision."