Health Committee on May 7th, 2018

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Okay, thank you. That's very useful.

I'll start with you, Ms. Gavsie. I might only have time to start with you—I have less than a minute left. I was privileged because I worked in a large teaching centre. We had all this infrastructure. We always had our radar up about organ donors. You'd get primary care practitioners in more isolated centres, low-volume centres, who might not realize that certain kinds of patients could be organ donors. They're more than just car accidents and bullet wounds. There are a number of conditions in which patients can be suitable as donors.

Have you been reaching out to the medical profession and medical education so that medical professionals know all of the indications or suitable types of patients for organ donations?

[Ronnie Gavsie]

We have worked with the Royal College to develop e-books for physicians coming into critical care, for residents in the critical care unit. In addition, in Ontario we have 58 donation physicians who are accountable to us, including in all of the smaller hospitals, not just the large trauma centres, such that we get referrals of an amazing number of potential donors from these smaller hospitals.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

[The Chair, Liberal, Bill Casey]

Now we have three minutes with Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

In three minutes, I have two short snappers and a tough one.

Does anybody know and can anybody tell me whether the buying and selling of organs for transplantation—we know it's prohibited—is a Criminal Code matter or is found in provincial statutes? Does anybody know? No?

Okay. Here's number two.

Mr. Levy, you gave I think a very articulate expression of the strong ethical opposition to the selling and purchasing of organs and tissues. Does the same rationale apply to the purchasing and selling of blood and blood products?

[Dr. Isra Levy]

I think I would say that the issue is situation-specific, product-specific, and context-specific. Purchasing in the context of transplantation tourism is what I was responding to, but in the broader context, I think the ethical underpinnings of different scenarios would need to be thought about in their own domains.

[Don Davies, NDP, Vancouver Kingsway, BC]

There's border tourism, but surely you wouldn't be in favour of Canadians being able to purchase and sell organs to each other on the commercial private market, would you?

[Dr. Isra Levy]

I don't know. I haven't conceptualized it, but the context in which the question was asked, or at least that I was responding to, was tourism.

[Don Davies, NDP, Vancouver Kingsway, BC]

Okay. Thank you.

The tough one is for you, Ms. Gavsie. There was a pretty prominent case of a Trillium Gift of Life decision to deny Delilah Saunders, who had acute liver failure and was in a Toronto hospital in December, access to a life-saving liver transplant. As we understood it, I think Trillium requires patients with alcohol-associated liver diseases to be alcohol-free for six months before being accepted as potential patients.

Amnesty International wrote the following in an open letter to you:

...states have an obligation to guarantee the right to the highest attainable standard of health of all individuals, free from discrimination. To deny individuals access to necessary and lifesaving medical treatment purely on the grounds of their prior or current health status—including conditions resulting from the use of alcohol—is discriminatory.

It goes on to talk about requesting a change to that policy.

I know it's a very difficult ethical issue, but has there been thought about or any change to Trillium's policy in regard to people who may be suffering from substance abuse disorders and needing transplants?

[Ronnie Gavsie]

I'm pleased to respond to that difficult issue. There is an alcohol-related liver disease pilot program that is about to be launched, a three-year pilot, which will tell us whether or not there's evidence for a better policy than the six-month rule, the six-month rule being the one that is used internationally. It is the most common rule.

We're all happy that Ms. Saunders was assessed. In other words, the six-month rule does not stop someone from being assessed. They are not just automatically not put on the waiting list. She was hospitalized. She was assessed. She received medical treatment and went home. She didn't need a liver transplant. The outcome of that situation was a happier one.

On the six-month rule, there is no scientific evidence that six months is the right number. In some cases, it might be two months. In the case of other people, it might be two years. This pilot program, which is being supported by the province, will give us evidence as to whether, when the individuals receive the right therapies and support from social workers and addiction specialists, the six-month rule may no longer be applicable. We'll have evidence as to whether there's a different, logical rule.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

[The Chair, Liberal, Bill Casey]

That completes our testimony for today.

I have two thoughts. First of all, on behalf of the committee, I want to thank you for what you do. I think you're amazing in what you do, and I hope our committee can give you a little bit of help to do it.

My second thought is that we deal with the most fascinating things here, but they hardly ever have a predictable outcome, and this could have a predictable outcome. If we could help you raise public awareness and professional awareness, it would have a predictable outcome. For so many things we deal with, we don't really know how they're going to turn out.

This might help or it might not. There are differences of opinion. I'm sure the committee members will put our heads together and see if we can't come up with some ways to help, but I want to thank you for your testimony, and again, I want to thank you on behalf of the committee for what you do.

[Ronnie Gavsie]

Thank you.

[The Chair, Liberal, Bill Casey]

We're going to adjourn for a few minutes. Then we're going to go to committee business in camera. Thanks again.

[Proceedings continue in camera]