Off the Wagon, Off the Transplant List - OZY | A Modern Media Company

Off the Wagon, Off the Transplant List

Off the Wagon, Off the Transplant List

By Melissa Pandika

SourceTim McConville/Corbis


Because alcoholics need compassion and medicine, not judgment. 

By Melissa Pandika

Mark Selkirk wasn’t an an angel, but in some ways he came pretty close. He volunteered at a women’s shelter, doted on his grandchildren and was loved by his family. But he also drank. And in late 2010, his habit cost him his life when a doctor in his Ontario hometown diagnosed him with acute alcoholic hepatitis.

End of story. Although it didn’t have to be. Selkirk’s family learned that he might have survived with a liver transplant, but would need to stay sober for six months before the transplant program would consider him. He was gone within two weeks. 

So what’s unfair about this? Transplant programs across Europe and North America are open to the vast majority of candidates who are sick. But for alcoholics, it’s a different story. Liver transplant programs, like the one in Canada, typically require candidates to prove they’ve been sober for up to six months before they’ll consider them. Sympathizers argue that discriminates against those suffering from alcoholism, a disease with a high risk of relapse. Why require addicts to prove they can control their disease when we don’t ask the same of those who suffer from other conditions with strong behavioral components — like obesity — to be considered for life-saving treatments?

Sobriety requirements reveal just how much the world stigmatizes addiction.

The argument for sobriety requirements isn’t hard to make, both on pragmatic and moral grounds. We face a huge organ shortage, with more than 1,500 Americans dying each year awaiting a liver transplant, and prospective donors might worry that their livers will “go to waste” on addicts who will only squander a precious gift. Indeed, some 90 percent of alcoholics end up falling off the wagon at least once within four years of getting on it. “If we can’t guarantee some minimal survival, we’re not using the gift well,” said Gary Levy, director of the living donor program at University Health Network in Toronto.

A sobriety period might also allow addicts’ livers to recover on their own. All well and good, except “by the time you make it on the list these days, you’ve got to be pretty sick” — so sick that even an abstinence period probably won’t help recovery, said Arthur Caplan, director of the division of medical ethics at NYU Langone Medical Center. He deems the six-month time frame “arbitrary,” especially since there’s not much data showing transplant candidates do better with it. In fact, evidence supporting the benefits of an abstinence requirement, period, still isn’t conclusive

The bigger issue, of course, is that sobriety requirements reveal just how much the world stigmatizes addiction. We pretend we’re open minded, but it turns out that smokers face a similar quandary: being forced to stop smoking before getting a shot at a life-saving lung transplant. As for Mark Selkirk, his widow, Debra, is seeking a constitutional challenge of Ontario’s policy. As she put it, alcoholism is “an ugly disease” whose sufferers deserve compassion. “It’s a horrible thing to lie in a hospital bed thinking you’re a failure.”

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