'August is a long time away': Dying man will fight liver transplant rules in court
Cary Gallant argues that his rights are being violated by the Trillium Gift of Life Network, which bars alcoholics from the list until they have been sober for six months.
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The case of an Ontario man dying of liver disease will go to court Friday to challenge a rule that has kept him off the province’s list of potential transplant recipients.
Cary Gallant argues that his constitutional rights are being violated by the Trillium Gift of Life Network, which bars alcoholics from the liver transplant list until they have been sober for six months.
Gallant, 45, said he hasn’t had a drink since the beginning of July. Documents filed with the court say he has a 75 per cent chance of dying from liver failure before he reaches the half-year of sobriety demanded by the organ and tissue donation agency.
“We are asking to have him assessed for transplant and, if he is otherwise a suitable candidate, that the six-month sobriety rule be suspended and he'll be listed like other people on the list,” said his lawyer, Michael Fenrick.
Trillium has said it will launch a $3-million, three-year pilot program next August that will make almost 100 patients with alcohol disorders eligible for liver transplants without having to be sober for six months.
But that could be too late for Gallant.
“August is a long time away,” Gallant said from his home in Sault Ste. Marie. He’s exhausted and weak, and speaking takes effort.
Gallant said after years of drinking regularly, he had “no idea” what alcohol was doing to his liver until he suddenly got sick.
“As soon as I found out what my scenario was, I was done with drinking,” he said.
“I just don’t know why it takes so long (to get on the transplant list). I’ve heard stories. A lot of people don’t even make it to get on the wait-list.”
In the pilot program document, Trillium itself states there is insufficient evidence for the six-month sobriety policy as it stands.
“There were no survival differences between problem drinking and non-drinkers,” said the document, referring to a Canadian study from 2009. “There is also no clear evidence that mandating a brief, arbitrary specific duration of sobriety is effective.”
About 80 per cent of Canadian patients were still alive five years after a liver transplant, reported the Canadian Institute for Health Information, which analyzed data from 2004 to 2013. In 2014, more than 500 Canadians received livers, making it the most common organ transplant after kidneys.
Debra Selkirk has been a vocal advocate for changing the six-month rule. In 2010 her husband, Mark, was told he’d die if he didn’t have a liver transplant — but was not eligible because he’d been sober for only a few weeks. He died three weeks later.
In 2015, Selkirk filed a constitutional challenge against Trillium’s policy. This past summer, she reached a settlement that led to Trillium launching the pilot program.
“The loss of Mark was devastating,” Selkirk said. “But I spent five years studying the law, researching and finding out that his death was unjust . . . needless and unfair. It’s brutal.”
Gallant is bedridden and too weak to attend Friday’s hearing in Toronto.
“I’m worried right now — his appetite isn’t great,” said his mother, Joanne. “I worry this problem with the liver is going to affect his other organs.
“People should be on a list according to their needs.”
Almost 1,500 Canadians — two-thirds of them men — die of alcoholism-related liver disease each year, according to Statistics Canada.
In an email, spokesperson Jennifer Long said Trillium’s “research on liver listing criteria points to a six-month abstinence from alcohol . . . as the most commonly used protocol across Canada, the U.S. and other international jurisdictions.”
A similar rule applies in Ontario to lung and heart transplants, for which patients must not smoke tobacco or other substances for six months before being listed.
However, the six-month rule for liver transplants has come under scrutiny in recent years, with critics calling it discriminatory and arbitrary.
Three studies between 2008 and 2016 that reviewed liver transplant patients with alcohol disorders in the U.S. and Europe concluded that patients being sober for more than six months and staying sober afterward had only a minor effect on transplant success.
A European study found that patients with alcohol-related liver disease had a “significantly higher” success rate than those with other causes of liver failure. Of the one-third of patients who relapsed, 64 per cent consumed alcohol on occasion, the rest consumed alcohol heavily.
A University of Pittsburgh study recommended three months of sobriety “may be more ideal than six months.”
“The real issue has never been allowing alcoholics to jump to the top of the wait-list, but to have a level playing field not based on discriminatory attitudes,” Fenrick said.
Meanwhile, the wait until the Ontario wait-list changes is frustrating to Selkirk.
“There’s already success in liver transplant patients (with alcohol disorders) and others shouldn’t have to wait,” she said. “Why are people left dying between now and next summer?”
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