Liver transplant alcohol abstinence policy discriminatory: Union of British Columbia Indian Chiefs

Now-deceased transplant seeker called policy a “lethal form of racism”

surgery istock

B.C.’s policy requiring six months’ abstinence from alcohol prior to a liver transplant discriminates against aboriginal people, alleges a complaint accepted for a hearing by the province’s human rights tribunal.

The Union of British Columbia Indian Chiefs brought the case as a class action on behalf of B.C. Indigenous people denied a liver transplant.

The complaint is against the Ministry of Health, the Provincial Health Services Authority, the British Columbia Transplant Society and the Vancouver Coastal Health Authority.

It said an applicant with a history of alcohol use disorder must adhere to a mandatory six‐month abstinence policy before being considered for placement on the liver transplant waitlist.

The complaint said while transplants are a service customarily available to the public, the policy has a discriminatory impact on Indigenous people with alcohol use disorder disabled by that disease.

“Indigenous persons suffer disproportionately high rates of alcohol use disorder due to historic and ongoing oppressive and colonialist policies,” the decision to hear the case said of the allegations. Contributing factors to the higher rates of alcohol use disorder, the complaint said, include a lack of genetic protective factors combined with genetically mediated factors that combine with key environmental factors such as trauma exposure, early age onset use and environmental hardships.

The complaint said the abstinence policy lacks a reasonable or scientific justification for its continued use as exclusion criteria for a liver transplant.

“This policy delays or prevents Indigenous persons from receiving necessary and life saving medical treatment. It places their health at risk and is an affront to their dignity, respect, and self‐worth.”

Tribunal chair Diana Juricevic said in her July 14 decision to accept the case that she was satisfied the allegations, if proven in a hearing, would constitute discrimination on the grounds of Indigenous identity and physical disability.

David Dennis, who died May 29, made similar allegations in 2019.

“I’m not just at the bottom of the waiting list for a liver transplant; I’ve been kicked off the list entirely,” Dennis said when the complaint was filed.

“I want to continue to live and be here for my children and family.”

Dennis called the policy a “lethal form of racism.”

Lawyer Jason Gratl is handling the case. He said Dennis was denied a transplant in June 2019 because of the policy.

Gratl said when Dennis told him of the situation, he wrote to the ministry and the transplant society.

“No response was forthcoming in a timely fashion,” he said.

Gratl said the goal of the complaint is to ensure the policy, which he said the respondents say no longer exists, is applied in a non-discriminatory fashion.

The alleged discrimination also extends to others with substance abuse disorders, he said.

“It’s difficult to bring (the complaint) as those affected by the policy die,” Gratl said. “It’s a type of policy that’s resistant to review.”

“The old justification is that you shouldn’t give an alcoholic a new liver because they’ll just drink it away and destroy a new liver,” Gratl said.

In a statement to Glacier Media, the Provincial Health Services Authority (of which BC Transplant is a program) said it is “deeply committed to equity in healthcare and working with our Indigenous colleagues to understand, define and eradicate anti-Indigenous racism at interpersonal, organizational and systemic levels.”

The statement stressed the decision is a screening one, meaning it's a decision by the tribunal that the complaint may be filed. 

“As the case is ongoing and out of respect for due process, we are not providing comment at this time,” the statement said.

“With respect to BC Transplant requirements, in 2019 the Liver Transplant Program removed the absolute requirement for a six month period (minimum) of alcohol abstinence and no patients have been refused or removed from the transplant list for this reason alone,” the statement said.