Life, Liberty and Security of the Person

"[The goal is to] determine if there is an evidence-based basis to change the criteria."
"In the interim, it is important for all Ontarians to know that the listing criteria for liver transplants remain unchanged."
Jennifer Long, Trillium Gift of Life Network

"It was devastating for me to lose my husband. Once I realized what happened to him, I felt it was time to create some change in the system."
“They are heartbreaking [emails she has received from families awaiting organ transplants]. There was a mom who made it to five months and three weeks in April, and because of that last week that she had to wait, she died."
"I'm very proud that up to 97 or 98 people will get the opportunity to have a new life. And I'm very hopeful the practice will continue."
Debra Selkirk, whose husband Mark died in 2010 after being refused a liver transplant

Debra Selkirk believes that her husband Mark could be alive today, if he’d had a liver transplant in 2010  CTV News

Debra Selkirk was devastated, but also determined after the death of her husband who was denied a liver transplant as an alcoholic under the rules demanding that to qualify for a transplant a patient had to be verifiably free of alcohol consumption for six months prior to surgery. Ms. Selkirk's husband Mark, who struggled with alcoholism didn't have six months to spare before emergency surgery, and so he died two weeks after he was diagnosed with advanced alcoholic hepatitis.

Mark's wife Debra was identified as a match as a potential liver donor - for part of her liver to be given to her husband to save his life. Other members of their family were also prepared to surrender part of their livers so that Mark could be saved. They were assured by doctors that a transplant could restore his lifeline. Toronto's University Health Network declined to operate on Mark nonetheless; he was still required to be dry for a six-month period before they would agree to surgery.

Statistics Canada estimates that over 1,500 people die on an annual basis as a result of alcoholic liver disease. Canada is certainly not alone in requiring that people whose liver disease developed as a consequence of alcohol intake be required to prove sobriety resulting from spurning alcohol for a six-month period on the obvious premise that their addiction was the cause of their disease. Society in general in most countries accept that people are themselves responsible for the choices they make in life and any consequences that arise from free choice.

The agency that is responsible for the Province of Ontario's transplant system, the Trillium Foundation, uses the six-month abstinence rule as a worldwide requirement settled upon for a number of reasons, one of which is that a period of abstinence might for some people, obviate the need for a transplant, and of course the scarcity of organs for transplantation might be seen as a reason to deny an alcoholic an organ when there are such long wait lists for people desperate to receive one. As a matter of popular judgement, people might be less inclined to underwrite organ donation, in addition.

Some hospitals in the United States and Europe have operated projects to alter eligibility on a trial basis for people diagnosed with alcoholic liver disease, minus the provision for sobriety for a previous six-month period. Now, resulting from Debra Selkirk's unswerving determination to alter the situation to give alcoholics suffering from liver failure the same transplant opportunities as others, the Trillium Gift of Life has agreed to a pilot project to make such patients eligible for transplant.

Over a three year period, the provincial agency anticipates that close to one hundred patients with alcohol-related liver disease will be provided with organ transplants. Recent evidence has helped to persuade the authorities that patients with alcoholic liver-disease even without the half-year of sobriety rule, tend to share a positive outcome after surgery, just as others do. At the same time the pressure of organ scarcity for transplants will suffer increased wait times with the inclusion of these patients is recognized.

In a persuasive affidavit, a series of studies concluding that alcoholic-liver disease patients recover well with their transplant organs, rarely turning back to heavy drinking, Dr. John Fung, chief of transplant surgery at the University of Chicago, also as a member of the U.S. government's advisory panel on transplantation, succeeded in encouraging second thoughts on the standard six-month wait for alcoholics suffering alcohol-related liver damage.

Four thousand liver transplants were studied and the resulting conclusion was that as many or more alcoholic-liver patients survived five years post-surgery with an organ transplant, as others who weren't tainted by alcoholism prior to surgery. So while Trillium is not prepared to abolish the six-month rule entirely yet, it does agree that recent evidence is suggestive of alcohol liver-disease patients faring well, half-year sobriety aside.

"Debra is one of the most amazing and dogged people I have ever encountered. She has managed to move the needle on this issue. It just needs to be moved further", stated the lawyer who represented Ms. Selkirk's 2015 constitutional challenge that argued the six-month sobriety policy stood in violation of Canada's constitutional rights to equal treatment, to life, liberty and security of the person.