Organ donation ethics: How doctors decide who gets a transplant – Health – CBC News

By Aleksandra Sagan, CBC News Posted: Jan 29, 2015 10:24 PM ET Last Updated: Jan 30, 2015 1:03 PM ET


Twins Binh, left, and Phuoc Wagner have Alagille syndrome, which affects the function of their livers. Michael Wagner, their adoptive father, is set to donate part of his liver to save one girl, but he cannot donate to both. (Wagner family/Canadian Press)

With organs a scarce commodity for the many patients needing transplants, doctors are forced into making tough decisions that sometimes determine who gets to live.

“Telling someone that they’re not a candidate for a transplant is, in some cases, is denying them a life-saving therapy,” says Steven Paraskevas, president  of the Canadian Society of Transplantation and a transplant surgeon at McGill University Health Centre. “And that is one of the most difficult issues, I think, that physicians have to wrestle with in our field.”

Each year, more than 1,600 Canadians’ names are added to transplant wait lists, according to the Canadian Transplant Society. One-third of those who need a new organ never receive one, according to Canadian Blood Services.

Wait-list obstacles

With not enough organs for patients, doctors must make tough decisions about who even makes it onto a waiting list.

Mark Selkirk, a long-term alcoholic, died in 2010, two weeks after being diagnosed with acute alcoholic hepatitis. Doctors told him he would die without a transplant, but Ontarians in need of a new liver must abstain from alcohol for six months before being eligible for surgery.

‘Telling someone that they’re not a candidate for a transplant is, in some cases, is denying them a life-saving therapy.’

– Dr. Steven Paraskevas

Debra Selkirk, his widow, is preparing a constitutional challenge of that policy, arguing it violates Canadians’ right to universal health care.

Paraskevas says doctors invoke the six-month principle frequently across most North American transplant centres.

Part of the reason, he explains, is that patients need to follow strict guidelines for medication and taking care of themselves after surgery. If they don’t adhere to these rules, their body could reject the liver and they could die.

Alcoholism can make someone less likely to follow through with doctor’s orders, he says — and alcohol can damage the new liver.

There are other conditions where doctors may suggest similar tactics for potential transplant candidates, he said, including asking morbidly obese people to lose weight or smokers to quit.

‘Doctors aren’t priests’

But, doctors shouldn’t dole out medical services based on a value judgment of a patient’s virtues and vices, says Arthur Schafer, a philosophy professor and director of the University of Manitoba’s centre for professional and applied ethics.

“Doctors aren’t priests, ministers, rabbis and they’re not moral judges,” he says.

Organ donation after cardiac death

Watch the fifth estate’s Dead Enough

A patient’s age, gender, religion, beauty, income, contribution to society or any other extraneous factor should not be tied to whether they receive an organ, he says. Someone who injured an organ while robbing a bank should receive the same consideration as a young teenager with cancer, on one condition: that they will benefit from the surgery.

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