Pilot project to halt six-months sober requirement for liver transplants

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The agency that runs Ontario’s organ transplant system will launch a three-year pilot program that could eventually overturn its policy requiring alcoholics to be sober for six months before they can be eligible for a new liver.

The move comes after a more than two-year fight by Debra Selkirk, whose husband died of liver failure in 2010. Just two weeks before his death, Mark Selkirk was diagnosed with acute alcoholic hepatitis and told he needed a transplant.

In Ontario, patients must refrain from drinking for six months in order to get on the liver transplant list. Selkirk, a long-time alcoholic, didn’t have that kind of time.

Debra Selkirk said Wednesday she cried when she got the news of the pilot project, which is set to get underway in August of 2018.

“It’s bittersweet for me because I’m very pleased with the program that they’re introducing, but I’m not happy with the timeframe that they set around it,” Selkirk told CBC Toronto. “I believe that starting next summer is an extremely late start because between now and then patients will be dying that had the right to access¬†treatment.”

Debra and Mark Selkirk

Debra Selkirk and her husband, Mark, who died of liver failure in 2010. (Debra Selkirk )

According to Selkirk, 640 patients die every year in Ontario alone due to alcoholic liver disease.

In 2012, Selkirk filed an application with the province’s Human Rights Tribunal to try to overturn the policy. In 2015, she launched a constitutional challenge. This spring, she got the news that Trillium Gift of Life Network, which manages the province’s transplant program, will launch the pilot to determine whether it should change the liver transplant guidelines.

“People need to understand that every patient deserves universal health care,” Selkirk said. “No matter what their disease is caused by, they have the same right to treatment.”

For now, criteria ‘remain unchanged’

In a statement, Trillium Gift of Life said the current guidelines are based on “jurisdictional reviews and advice from expert working groups.

“Our research on liver listing criteria points to a six month abstinence from alcohol for alcoholic liver disease patients as the most commonly used protocol across Canada, the U.S. and other international jurisdictions.”

The statement goes on to note that the three-year pilot will determine whether there is an “evidence-based basis to change the criteria.”

The statement went on: “In the interim, it is important for all Ontarians to know that the listing criteria for liver transplants remain unchanged.”

‘Very few waste the organ’

Selkirk says when her husband, a businessman whose firm was responsible for the moose sculptures that were placed around the city as part of a public art project many years ago, was diagnosed, she was told by medical staff that alcoholics tend to start drinking again and end up wasting the new organ.

“So I assumed that the research showed that 90 or 95 per cent of them were not successful. And I believed that. So when I originally started this challenge I thought that I would be fighting human rights versus medical research and that Mark deserved a chance even regardless of what the numbers were,” Selkirk said.

“But the more I got into it and the longer I studied, I realized that the medical research does not support the six-month rule, and Trillium actually acknowledged that in meetings with me.”

Research shows that alcoholics who are granted liver transplants don’t typically drink again and “very, very few waste the organ,” Selkirk said.

Their prognosis is often equal to or better than other recipients, she added.

Last year, Selkirk met with representatives from Trillium and the agency’s lawyers and agreed not to take her constitutional challenge to court. The agency asked if instead, it could work on developing the pilot project. She agreed.

So far, some individual hospitals around the world are running their transplant programs without a wait time for alcoholics. But Selkirk believes Ontario is the first jurisdiction to implement such a change, if even in a pilot project.

“I’m sure Mark would be very proud.”

http://www.cbc.ca/news/canada/toronto/liver-transplants-pilot-project-1.4299787?cmp=rss