Is there a human right to organ transplants?
On December 15, Amnesty International sent an open letter to the Ontario provincial government and Ontario’s donor transplant agency calling for the province to ensure non-discriminatory access to healthcare, including organ transplants, for all Ontario residents. This is the first time that Amnesty International has commented on access to organ transplant services in Canada, and we wanted to publicly respond to some of the questions we have received to help advance discussion on this issue.
Why did Amnesty comment on the case of Delilah Saunders?
Delilah Saunders is a global Amnesty International Ambassador of Conscience award recipient and Indigenous rights activist in Canada. She was diagnosed with acute liver failure and was deemed ineligible for a liver transplant because of prior alcohol use within the immediate preceding six months. Delilah has said that her liver was damaged because of acetaminophen used to control wisdom teeth pain, not because of alcohol. Delilah has not been able to afford wisdom tooth extraction. Though she is now recovering and is unlikely to need a liver transplant, Delilah has indicated that she plans to continue advocating for equal access to health services for all people in Canada.
Delilah’s case drew our attention to discriminatory health policies in Ontario surrounding organ donation. As is always the case in our human rights work, we looked at those policies to determine whether they were consistent with Canada and Ontario’s international human rights obligations. Our intervention on behalf of Delilah, and other people in similar circumstances and with respect to the organ transplant policies in general, reflects concerns about violations of international rights regarding health and non-discrimination.
No one in Ontario can receive a liver transplant if they haven’t met the "six months sober"* requirement. But this policy isn’t new, and other people have died while waiting to reach the six month mark.
In January 2017 in Thunder Bay, Ontario, Barbara Kentner was struck by a trailer hitch that was allegedly thrown from a passing vehicle. She sustained severe liver damage and died in July because she had not abstained absolutely from alcohol for six months and therefore was ineligible for a liver transplant. Many other people—including Indigenous women like Barbara and Delilah—have been denied access to life-saving care because they have not been sober for six months.
In recent years, Amnesty International has deepened its research into the right to health, human rights and drug policy, the criminalization of drug users, and the right to substantive equality in services for Indigenous and non-Indigenous peoples, in Canada and globally. This new research is directly applicable to the denial of healthcare because of addiction issues. As a result of this research, Amnesty International now has a strong basis of research and policy analysis from which to comment on the "six month sober" requirement that is in place in many jurisdictions across Canada, including Ontario, and in other countries.
Amnesty International is a human rights organization, not a medical organization, so what legitimacy do you have to talk about a medical issue?
As a human rights organization, Amnesty International seeks to ensure that health policies and practices are consistent with international human rights standards. International human rights law provides a framework for governments and health professionals to operate within and Amnesty International calls on governments to ensure they adopt laws, set polices, make decisions, and allocate resources within this framework. Amnesty International recognizes that governments and health professionals are then best placed to reach medical decisions, within this framework, that will best meet the needs of patients.
Is there a human right to receive an organ transplant?
We all have a right to the highest possible standard of health. We all have a right to live free from discrimination. And we all have a right to have these rights respected and protected regardless of whether or how we use alcohol or drugs.
Denying someone access to medical treatment because of their health status violates the right to live free from discrimination and the right to the highest possible standard of health.
Denying access to health-related information, prevention, harm-reduction, or treatment also violates the right to health. A lack of addictions treatment programs in Canada, including a lack of culturally-relevant programming for Indigenous peoples, violates the right to health. This is compounded when people with a history of alcohol use are then denied access to organ transplants because of the “six months sober” rule, a further denial of the right to health.
There is not a specific human right to receive an organ transplant. But there is a right to ensure that all people, regardless of their health status (including substance use-related conditions), have equal access to medical care including non-discriminatory assessment to see if they are eligible for a transplant.
Donor organs are in short supply. How can Amnesty advocate for some people to be prioritized for a transplant over others?
Amnesty International is not advocating for anyone to be bumped to the front of the line. When it appeared likely that Delilah needed a transplant, Amnesty simply advocated that Delilah—and all others who face discrimination under the same policy—not be barred because of the discriminatory "six months sober" rule, thereby allowing her to be tested in order to see if she would be eligible for a transplant.
It is worth noting that the contrary is actually the case. The "six months sober" policy de facto bumps people with addiction issues to the back of the line, denying people with a history of alcohol use—including people living in poverty or who are otherwise marginalized—from accessing life-saving medical care on an equal and non-discriminatory basis.
Amnesty International also notes that in Delilah’s case there were reportedly a significant number of individuals willing to be assessed as possible live organ donors for her specifically and uniquely. These are not individuals whose livers might have gone to other individuals, so this did not involve Delilah being prioritized over anyone else. The "six months sober" policy, however, meant that this was not even a possibility.
Amnesty International calls for equal access for all people in Canada to all health-related information and services including transplants, to ensure that all people in Canada have access to the highest possible standard of medical care.
* According to Ontario policy, "six month sober" means “Any alcohol and/or illicit drug misuse within six months; i. For patients with alcohol associated liver disease: inability to absolutely abstain from alcohol and/or illicit drug use for six months."
Donor organs are in short supply in Canada. For more information on becoming an organ donor in Canada visit www.beadonor.ca.