Home News Articles Requiring alcoholics to be dry months before a liver transplant is a serious bureaucratic overreach

Requiring alcoholics to be dry months before a liver transplant is a serious bureaucratic overreach

By | National Post on Nov 02 2015

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We are told that the organ transplant rules in Ontario, which require six months of sobriety before a patient can be considered as a recipient for a liver transplant, are necessary to protect a scarce resource — and the organ donors who provide it. Yet if one believes an alcoholic who brought on his own terminal health crisis should not receive an organ that could otherwise have gone to a dying patient with no “culpability” in his illness, it’s not clear that the six-month rule is especially helpful.

Since known living donors — family and friends — may be willing to donate directly to an alcoholic loved one, but would not simply give up part of their livers to an unknown individual, these donors are not so much allowing their loved ones to jump the queue as they are removing the loved ones from the queue altogether.

This was apparently the case with Debra Selkirk, whose dying husband Mark Selkirk was ineligible to receive a transplant of liver tissue from his willing wife because he’d only been “dry” for six weeks. Mark died due to his acute alcoholic hepatitis months before doctors would have been prepared to even consider him as a transplant recipient; now Debra has launched a constitutional challenge to the six-month rule.

The Post’s Robyn Urback has argued previously that although Mark Selkirk’s story is tragic, the six-month rule is necessary. She pointed out that the organ transplant system might benefit from different rules for living and cadaver donors. But she concluded that even in a known living donor situation, which would not take an organ away from another waiting recipient — a situation such as Debra Selkirk donating liver tissue to her husband Mark — precious hospital and physician resources would be expended on the alcoholic patient rather than on someone else.

For all the good sense this argument makes, I shudder at the potential logical outcomes of rationing health care based on how much some politician or bureaucrat feels a patient deserves to live.

Since hard drug users contribute to their own physical demise, should they too be denied medical resources that could be devoted to more “blameless” patients? Do car accident victims who were wearing seat belts get triaged in the emergency room before car accidents victims who flouted the law? What if their injuries are equally serious? What if the seatbelt wearers weren’t as badly hurt? Does this not quickly become an exercise in passing moral judgment, rather than making medical decisions about saving lives?

And what of the significant role genetic predisposition is said to play in alcoholic liver disease? Have we decided it’s necessary to punish individuals who have inherited this particular physical weakness, but not, say, those with a family history of diabetes, whose condition similarly depends on “lifestyle” choices?

Perhaps this six-month rule could be justified on the basis that it limits organ transplants to the operations most likely to be successful — sending the liver tissue to the patient most likely to survive and thrive with it. Except that, as Post reporter Tom Blackwell pointed out in an article about the Selkirk case this past weekend, American Association for the Study of Liver Disease guidelines note that “survival and transplant rejection rates are similar between alcohol-related and other recipients.”

“Not judging” is a well-intentioned concept that can be taken too far. Parents know that teaching a child that he is loved unconditionally is no more or less important than teaching him that his behaviours can be right or wrong, good or bad, acceptable or unacceptable, condoned or condemned. That is also true for society as a whole, which must be permitted to pass judgment on its members in order to hold them responsible for their own actions, yet also must find a certain baseline of unconditional respect for them as human beings, no matter their choices, if it is to remain a humane civilization.

It is one thing to say that a person must live with the health consequences of his own choices, but is it not another to say that we will purposely hold back available life-saving health treatments based on those choices? Isn’t the surgeon supposed to work just as hard to save the life of the prisoner as the parson? Should Debra Selkirk really have been barred from trying to save her husband’s life simply because her husband had a drinking problem?

When medicine becomes a government or quasi-government “system,” it’s ultimately the “system” that chooses who will live and who will die. Some decisions are just too important and individual for a system make. I’d argue that this is one of them.

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