Quivering livers

Photo of Delilah Saunders Delilah Saunders is a 26-year old woman who remains hospitalized for acute liver failure. Saunders has been told that she does not meet the eligibility requirements to be an organ transplant recipient. The agency responsible for establishing the transplant guidelines, the Trillium Gift of Life Network, require a six month period of sobriety in order for candidates to be considered as recipients. According to a recent CBC report, family and friends of Saunders claim that she has been sober for about three months; about half the time required by the agency to be considered for organ transplant. The Current, a daily CBC newscast, recently covered the Delilah Saunders story in a somewhat critical broadcast, characterizing the sobriety requirements surrounding organ transplant in the Province of Ontario as without foundation.

Dr. Rolf Barth, Associate Professor and the Director of Liver Transplantation at the University of Maryland School of Medicine, asserted that when they examined the rule surrounding a sobriety requirement, they determined that it "has origins that were relatively arbitrary". According to Barth, a rigid criteria does not consider the "complex social histories" of patients and that a "six month absolute rule may not be appropriate".

Jed Gross, a bio-ethicist at the University Health Network in Toronto, asserts that with respect to 6 months sobriety being a reliable predictor of relapse, there simply is "not a lot of evidence to support that" argument and the data suggests "it's time to revisit" this rule. Arthur Schaefer, founding Director of the Center for Professional and Applied Ethics at the University of Manitoba asserts that the primary starting point from which to consider patients as transplant recipient should be by asking the simple question "Will the patient benefit from this treatment?". Schaefer adds that doctors, health care systems and organ transplant agencies should not make moral judgements on individuals with at-risk life-styles and to do so is an "ethically indefensible approach".

It's unfortunate that the program focused almost entirely on the shortcomings of the existing system; a focus which characterizes it as unethical or, in the extreme, discriminatory. Ironically, there was no discussion on how the adoption of a system which uses case-by-case eligibility criteria would be, in any way, an improvement from the current system or how it could be free from moral judgements and prejudice. What's even more troubling, however, is that at no point during the discussion did the wishes of the organ donor even enter into the equation.

We do not apply the same logic to estate law that Schaeffer espouses should be applied to organ transplant criteria. Should an individual wish to leave their property to a person, group or organization, the law provides mechanisms through which successors and heirs may acquire such transfers. Yet, when it pertains to a person's organs, no mechanism seems to exist. It's my liver for crissakes... what makes the Trillium Gift of Life Network or, under a different scheme, doctors or a selection committee any more or less capable of determining who should receive it once I shuffle off the mortal coil?

Would I, as an organ donor, want Delilah Saunders to receive my liver? Absolutely not. I would not want my liver being transplanted into anyone who has not been sober for six months. In fact, I would not want my liver being transplanted into anyone who has not been sober for at least a decade! Nor would I want my liver being transplanted into anyone with a history of substance abuse. Moreover, I'd want my liver going to someone under the age of 50. I would not care if the recipient were white, black, yellow or red. Their gender, religion or orientation would be irrelevant as would their socio-economic status. Does that make me guilty of moral judgements? Absolutely... MY liver... MY moral judgement call.

Submitted by Bob Shurunkel, 14 January 2018