Friday December 15, 2017

Delilah Saunders needs a life-saving liver transplant. Ontario rules say she's ineligible

Delilah Saunders was diagnosed with acute liver failure Friday. The 26-year-old has been denied a liver transplant due to a history with alcohol use disorder.

Delilah Saunders was diagnosed with acute liver failure Friday. The 26-year-old has been denied a liver transplant due to a history with alcohol use disorder. (Submitted by Rebecca Moore)

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Delilah Saunders, an Indigenous rights advocate, is in an Ottawa hospital with acute liver failure — but she's been denied access to a waiting list for a liver transplant based on her history of alcohol use disorder, according to her friends and family.

The Inuk activist from Happy Valley Goose Bay, N.L., is barred from a transplant due to a six-month sobriety requirement.

'The government is murdering my baby because they are capable of saving her life.' - Miriam Saunders, mother of Delilah

Her mother, Miriam Saunders, now faces the prospect of losing two daughters in the space of a few years. She spoke to As It Happens Thursday about her daughter, Loretta, who was murdered in 2014.

"I didn't think I could hurt any harder than when I lost my baby. I told people I can't hurt no more than when I lost my baby because those murderers killed her."

"But now to sit down and watch people, who's supposed to be saving lives, watch my baby [Delilah] die. It's the same thing, the government is murdering my baby because they are capable of saving her life," said Miriam Saunders.

Delilah Saunders

Delilah Saunders, seen here speaking at an inquiry into murdered and missing women, is suffering from acute liver failure, and her friends says she could die without a transplant. (CBC)

Delilah Saunders's work was recently recognized by Amnesty International after she spoke at the federal inquiry into murdered and missing women about her murdered sister.

The Trillium Gift of Life Network co-ordinates organ donations in Ontario and implements those strict sobriety rules. Those rules have been challenged in the past, and similar rules have already been dropped from some hospitals in the U.S.

There are two reasons behind the sobriety requirement according to Jed Gross, a bioethicist with the University Health Network in Toronto: it gives patients with less-acute conditions the time to recover through medical management, and that a relapse might lead to the transplanted organ becoming damaged.

'If the patient can't benefit, you shouldn't do it. It's just futile; it's a waste of resources.' - Arthur Schafer

The requirement, he tells The Current's guest host Piya Chattopadhyay, was made in good faith, but should be reviewed to maximize both access and outcomes.

He says that there is not a lot of evidence of organs going to waste through relapses, and the process should instead "look at factors that are linked to good long-term transplant outcomes."

Arthur Schafer, founding director of the Centre for Professional and Applied Ethics at the University of Manitoba, argues that when you're allocating scarce medical resources, it is ethically defensible to ask whether the patient is equipped to benefit from that resource.

"If as a result of alcoholism or some other condition perhaps a patient is psychiatrically unstable," he says. "If those people don't have support systems and aren't really committed to following the protocol, then they aren't going to benefit."

"If the patient can't benefit, you shouldn't do it. It's just futile; it's a waste of resources."

Transplants and sobriety2:08

Some advocates suggest that transplants in Canada should be granted on a case-by-case approach, but Gross warns the process must be transparent "whenever you introduce discretion, there's the possibility of prejudices creeping in or arbitrariness."

'The most disadvantaged people get doubly disadvantaged because we deny them life-saving transplants.' - Arthur Schafer

Schafer is concerned that the rational question of whether the patient will benefit is often clouded by moral preconceptions: that an alcoholic's liver damage is self-inflicted and "blameworthy."

"What if you're jaywalking and you're hit by a car. Well it's your fault. Should you be denied life-saving care?"

He also argues that when patients lack the support to make a success of transplantation, "part of the health-care system's obligation is to provide that."

Delilah Saunders vigil

Some people gathered in Halifax to hold a vigil for Delilah Saunders. (CBC)

In Saunders's case, he notes that her Indigenous background is an important factor.

"The most disadvantaged people get doubly disadvantaged because we deny them life-saving transplants because we judge them to be not likely to succeed."

He believes the six-month rule "should be scrapped and the one question we should ask is can this patient benefit or can this patient benefit if we provide adequate supports for them. If the answer is yes, they should not be excluded."


This segment was produced by The Current's John Chipman and Susana Ferreira.