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Organ recipients need to meet strict guidelines, even if family wants to help them

Birmingham, England hospital conducts kidney Transplant on June 9, 2006. (Getty)
Birmingham, England hospital conducts kidney Transplant on June 9, 2006. (Getty)

Ontario businessman Mark Selkirk was diagnosed with acute alcoholic hepatitis in late 2010. To be eligible for a liver transplant he had to stay sober for six months. At the time of his diagnosis, he’d abstained for six weeks. He died two weeks later.

Earlier this fall, Selkirk’s widow, Debra, filed a constitutional challenge in court against the provincial waiting policy. Her argument is that the six-month abstinence period discriminates against alcohol addicts and violates Canada’s Charter of Rights and Freedoms.

In early November, during an interview on CTV’s Canada AM she discussed her husband’s death: “You leave the hospital thinking he’s at peace and there was no future for him. The most difficult part is finding out some two or three years later that the most likely thing is, he wouldn’t have drank again and that his prognosis would have been really good.” She added, “As Canadians we have the right to healthcare regardless of the providence of our disease.” She said she’d offered to donate part of her liver but was turned down by his healthcare providers.

In Selkirk’s case, the six-month guideline of sobriety was overseen by the Trillium Gift of Life Network, Ontario’s organ and tissue donation agency. In Ontario today there are more than 1,600 on the wait list for an organ transplant. A similar six-month-window of abstinence (for alcohol, cigarettes, and illicit drug use) is applied at transplant centres across Canada.

Ivana Irwin, recipient transplant program manager at Alberta Health Services (AHS), declined to comment about Selkirk’s situation, but told Yahoo Canada “healthcare isn’t punitive and that abstinence isn’t to punish. It’s to give individuals time to put in coping strategies and so we can work with them so they are successful long-term.” The time allows the liver to recover. And the yearly demand for livers exceeds the supply.

“We have that obligation not just to the person receiving the transplant but to the donor family as well. They lost a loved one,” she said. “They would like to make this ultimate gift to someone so we have an obligation to make sure that organ is well taken care of.”

The AHS assesses approximately 500 patients and completes 200-300 organ transplants annually. Thirty per cent of the patients on the list die waiting for an organ, Irwin said.

Nationally, the picture is just as bleak. At the end of 2013, according to the latest data available from the Canadian Institute for Health Information, more than 4,400 Canadians were waitlisted to receive kidney, heart, liver, lung, pancreas, or bowel transplants. 

Very specific set of requirements for receiving an organ

The process for Canadians to qualify and be waitlisted for an organ is complex and comprehensive.

A transplant team – doctors, nurses, psychologists, social workers, and other transplantation specialists – meets to discuss the patient’s medical results and health markers. They examine the medical necessity and urgency of the transplant; health and function of the other organs; blood type; patient’s lifestyle; they make a psychological assessment; and do much more.

To get on the wait list, end-stage organ failure must be imminent or have already occurred, said Maureen Mooney, of B.C. Transplant, the agency that manages organ donation, retrieval and delivery in British Columbia. Doctors use a scoring system – and the results of medical tests – to assess the severity of chronic end-stage liver disease and predict mortality within three months of surgery. Known as MELD, it’s used to prioritize liver transplant patients. With kidney patients, the patient may already be on dialysis. Sicker patients are placed higher on the list.

Critically ill patients in hospital are assessed daily or even several times a day. A patient’s position on the wait list is dynamic and can change frequently, Irwin said. Patients who are at home are assessed monthly.

There’s a very fine line between a patient being too sick to undergo surgery and being too sick to survive without it, Irwin explained. “You are required to have a little bit of medial reserves so you can actually do well in what we call the post-operative ICU medical storm.”

A patient’s blood type can be a disadvantage, Mooney said. For example, the largest group of kidney recipients is blood group O and they can wait years on the deceased donor wait list.

Patients become ineligible for organ transplant and are temporarily removed from the list if they have any kind of infection. They must contact the social worker assigned to their case and inform them that they are sick. 

“You can’t take a patient with an active infection and ‘blind’ their immune system and put in an organ. When the immune system can’t see the infection it just goes in and has a party for lack of a better word,” Irwin said. “And it can be extremely problematic in that initial ICU phase” Once a patient recovers, they are reassessed and placed back on the wait list.


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The requirements for eligibility are the same whether a recipient is receiving an organ from a live donor (a family member like a spouse, brother or sister) or a deceased donor (natural cause of death with no brain activity). And the assessment of a potential living donor (organ compatibility; their physical and mental health etc.), can’t occur until the recipient meets the requirements for deceased donation, according to the Trillium Gift of Life. In other words, the recipient remains on the waitlist during the evaluation and has the same priority status. Why?

Because even if pre-testing determines that the live organ is compatible, there’s always the possibility the recipient’s body will reject the transplant.

“If the live donor transplant fails because the immune system attacks the organ, or you have complications in surgery, you have to immediately put the patient on the list for urgent transplant from a cadaver donor,” said Irwin. The patient should already have met the requirements of the cadaver recipient program. Time is crucial.

In a deceased donor case, from the time a family gives consent to the time of time of transplant, there are more than 150 people involved, said Peggy John, manager of communications and community relations at B.C. Transplant. “There are hundreds of phone calls that take place. They have to do all the testing. They have to make sure it’s safe, that it matches [and the organs are compatible]. It’s a complex program and time frame. All of that activity takes place between 24 and 36 and sometimes 48 hours.”

Money almost as big a factor as time

When a potential recipient lives far from a transplant centre, there are out-of-pocket travel expenses. For three months after surgery, patients must stay near the transplant centre, Mooney said. In British Columbia, for instance, where the transplant centres are at Vancouver General Hospital, St. Paul’s Hospital, and B.C. Children’s Hospital, costs can ratchet up quickly if they live far from the lower mainland.

And AHS’s Irwin pointed out that most people with end-stage failure are too sick to work and someone must accompany them for appointments before and after transplant. Which means lost income. After surgery, patients have to pay for various medications if they lack private insurance. In most cases, immunosuppressive medications are covered by provincial health plans. 

The system only works when there are enough deceased donors.

They key to improving donation levels is public awareness and supporting donation at the hospital level, said B.C. Transplant’s Peggy John.

Every year as Christmas approaches, B.C. Transplant arranges for a group of transplant recipients to visit donor hospitals with festive tins of popcorn. They pop into emergency rooms, intensive care units, and operating rooms.

“And they go say Thank You to the staff, because the doctors and nurses are seeing the other side of the patients. They [see the] ones who die. They don’t often get to see the people whose lives were saved because of the work they did as a donor hospital,” said John. “It’s pretty powerful.”