Debra Selkirk.  Photo: LinkedIn


Debra Selkirk. Photo: LinkedIn

Debra selkirk is appealing an Ontario court ruling that ruled in March that the organ transplant regulations of the Trillium Gift of Life Network and the University Health Network are neither unconstitutional nor discriminatory against people with alcohol addiction.

At the time of his death, Mark Selkirk could not be put on the waiting list for a liver transplant because he had not been sober for six months.

He entered the hospital in the fall of 2010, where he was diagnosed with acute liver failure. “He was told he needed an urgent liver transplant, because blood tests showed he had a 10-20% life expectancy without a transplant,” recalls his wife Debra Selkirk.

Mr. Selkirk explains to his hematologist that he has not had a drink for three weeks. “She told him that we would not take her case into account, since you have to be sober for six months before your name is placed on the list of patients awaiting a transplant,” continues Ms. Selkirk.

Mark Selkirk died a dozen days later of liver failure on November 24, 2010 at the age of 52.

“People with alcohol dependence are stigmatized in the medical community, which is reluctant to treat them, or offer them a transplant, and this admonition is universal,” says complainant Debra Selkirk.

Faced with the doctors’ refusal, Mrs. Selkirk offered to donate part of her liver to her husband, but to no avail. “The liver is an organ that regenerates itself in three months, but a portion of it must be removed from 60 to 70% in order to be able to transplant the healthy organ to a patient,” she explains.

Ms Selkirk says she was not worried about her health and was prepared to make the sacrifice, because the University Health Network (UHN) has performed 800 operations in 20 years, according to her research, using organs. from a living donor.
“There is nothing more traumatic than seeing doctors who refuse to do everything in their power to save a loved one,” she says.

Rules and obligations

In Ontario, the Trillium Gift of Life Network (TGLN) administers organ donation programs in the province. It establishes the eligibility criteria for patients. The UHN (University Health Network) manages the organ donation program for living donors.

As of 2015, Ms. Selkirk is challenging the six-month sobriety deadline TGLN set in 2010 for people with alcohol dependence. A delay that she considers unconstitutional and discriminatory, since patients who suffer from a liver problem unrelated to alcohol do not have to wait.

At her hearing in February 2021, Ms Selkirk argued that the hospital’s refusal to help her husband violated his charter rights and that this violation resulted in his death.

“There is a fear in the public that donors will not agree to donate their livers to a recipient who has an alcohol use disorder because they feel their organ will be wasted and it ‘that’s exactly what the doctors told me, ”Debra Selkirk said.

The Hamilton resident adds that this is in fact just a myth, since UHN’s rules are based on anonymity, meaning that the donor, or his family, ignores everything about the identity and medical condition of the recipient.
Ms Selkirk says drug addicts should have the same access to a liver transplant as those living with hepatitis C or who are overweight.

For example, she explains that people who have bad eating habits do not have to prove that they are able to stop consuming junk food. “Those who consume too much alcohol are therefore punished compared to those who eat badly,” she said.

According to her, the criteria of the Trillium Network are arbitrary and they endanger the lives of patients, although they have no scientific proof. “On the other hand, it is medically proven that patients like my husband die before six months if they do not receive a transplant on time,” she says.

Judge’s decision

In her verdict, the judge Jasmine Akbarali notes that organ donation is rare in Ontario and that this shortage is forcing physicians to make difficult decisions. “The waiting list was established to judiciously allocate the available organs,” she writes.

She cites statistics indicating that 202 livers were transplanted in Ontario from April 2018 to March 2019, while 700 to 750 patients were waiting for a new liver in the province during the same year.

“Transplanting the liver from a donor to an unsatisfactory patient will probably not save the life of the recipient, but will certainly sacrifice the life of a promising patient who could have survived if he had received the same liver. The stakes could not be higher, ”says magistrate Jasmine Akbarali.

The magistrate further reminds Ms. Selkirk that the morbidity rate in a living donor is 30% following the removal of part of a liver, although the mortality rate is only 0.2%. “Too high a risk for the health of the donor,” she emphasizes.

The judge ruled in favor of the Trillium Network, stating that there is no exact science. “The medical world has failed to develop a better method of ensuring that organs that are scarce are donated in a reasonable way to those who will probably benefit the most for their health,” she continues.

She finally praised Ms. Selkirk’s efforts for her determination to advocate for patients who are in the same situation as her husband’s. “You have given him back his dignity,” she concludes.

An already obsolete cause

The magistrate recognizes, however, that half of Ms. Selkirk’s arguments lapsed during the hearings, because the obligation of six months of sobriety was abandoned with the adoption of a pilot project, which became the norm in November 2020. .

The Trillium Network has indeed changed this controversial criterion, launching a pilot project in 2016 after discussions with UHN. “I was very happy to hear that, because other addicts would finally have better luck than Mark,” recalls Selkirk.

The complainant admits that it is now easy to get on the waiting list, but the new selection criteria are so strict, according to her, that only 10% of patients with alcohol dependence manage to obtain a transplant. .

“They see if you are able to stay sober for six months, they test your alcohol dependence, they look at your consumption history … nothing has changed, you are de facto disqualified,” he explains. she giving the reasons for her appeal.

“It is unacceptable to maintain the status quo if you know that you are going to refuse a patient; it’s up to you to continue the research and relax your selection criteria, because it’s about an individual’s life, ”said Debra Selkirk.

The Trillium Network never responded to our interview requests for the purposes of this article. The UHN for its part writes in an email that it would be inappropriate to comment, since the dispute has entered its appeal phase.