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My husband was admitted to the hospital in November 2010 with acute liver failure caused by alcohol use disorder. Mark’s doctor said he needed a liver transplant, but that they “wouldn’t even look at him” until he was alcohol-free for six months. His doctors also refused to assess me as a living donor. “Alcoholics just drink again and waste the organ,” I was told. At the time, I believed it.

Mark lived for just 16 days more.

Two years after his death, I stumbled across legislation that brought me to a shocking realization — Mark had the same right as any other person with liver failure to be put on the transplant waitlist without a six-month delay.


I was devastated. In that moment, I decided to fight so other families would not face the same pain our family was going through. I started a legal challenge to this policy, believing that I ultimately would have to prove in court that even if most alcoholics drank again after getting a liver transplant, they still have the right to be put on the list for one without a six-month “test.”

My first goal was to find out how many people returned to drinking after a liver transplant. I was shocked to discover that most of them do not drink post-transplant. I was also shocked to learn that the liver transplant community has been aware of this fact from the very beginning.


A consensus conference organized by the U.S surgeon general in 1983 concluded that liver transplantation should transition from an experimental procedure to mainstream therapy for end-stage liver disease. The debate over whether or not to include patients with alcoholic liver disease began shortly thereafter. Dr. Thomas Starzl, the pioneering liver transplant surgeon, believed in equal access for these individuals, concluding in 1988 that “the imposition of an arbitrary period of abstinence before going forward with transplantation would seem medically unsound or even inhumane.”

Mainstream research continuously concurred with Starzl’s position. I reviewed dozens of research papers that explored outcomes after liver transplant among patients with alcohol use disorder. They do as well as, or better than, those with other types of liver disease. Depending on the study, their survival rate at five years is between 78 percent and 89 percent, well above the 50 percent likelihood of survival required by liver transplant centers. The majority of patients who return to drinking consume small amounts now and then with no effect on the transplanted liver. And the six-month wait does not improve survival or predict return to drinking. These results were confirmed by a 2008 University of Pittsburgh meta-analysis of 22 years of research in more than 3,600 patients.

A 2011 French study published in the New England Journal of Medicine reported positive transplant results among patients with alcoholic hepatitis, triggering several international centers to review the six-month wait and begin trials of their own. Dr. Robert Brown at Columbia University is among those doctors now speaking out against the six-month wait.

How could a policy with such deadly consequences, especially one not backed by medical research, be put in place at transplant centers around the world? The six-month wait is a standard policy in all Canadian transplant centers. The United Network for Organ Sharing, America’s organ transplant network, leaves waitlist criteria to individual hospitals, though most employ a six-month sobriety test for people with alcohol use disorder. Some states, such as Ohio, dictate their own waitlist criteria, which includes three to six months of being alcohol-free and participation in a recovery program. While the state policy has some provision for patients who cannot survive the wait, they are still subjected to a complex matrix of assessing their risk of return to drinking, recording times they have not remained alcohol free, and the quality of their social support system. Insurance companies often dictate a pretransplant alcohol-free wait as long as one or two years as a condition for payment.

In too many cases, a delay of any length results in unnecessary and preventable death.

This discriminatory policy is based primarily on a moral judgment of patients with alcohol use disorder, supported by an acute fear that public perception of the disorder will harm donation rates. This fear has been buoyed by occasional public outcries over celebrities such as Larry Hagman or Mickey Mantle receiving liver transplants in spite of their “self-inflicted disease” before patients who had been waiting longer for them. However, even public reticence to donate livers has never been objectively analyzed.

For four years, I was driven by blind determination, realizing that the imposition of a six-month delay for a liver transplant had ended my husband’s life despite a high likelihood that he would have survived for years with a new liver and little chance that he would return to drinking.

On Oct. 27, 2015, without the assistance of a lawyer, I filed a constitutional challenge against the six-month wait in the Ontario Superior Court of Justice. Seven months later, the respondents — the hospital that denied my husband a liver transplant, the provincial government, and Ontario’s organ network — asked me to stay my challenge and let them embark on a six-month review, which they felt they would have to do if I were successful in court. I agreed to let them proceed.

After months of negotiations and delays, we agreed to an out-of-court solution, which I recently announced: a three-year pilot program to launch in 2018 that would assess patients with alcohol-associated liver disease for liver transplants without the six-month wait. Patients accepted onto the recipient list will enter a program of care that includes a transplant surgeon, a liver specialist, an addiction psychiatrist, a nurse practitioner, and a social worker.

A three-year trial is not the perfect solution to my original quest to end the six-month wait. I am confident, however, that the results from the Ontario pilot program will mirror historical transplant success rates among individuals with alcohol use disorder, ensuring that the policy change becomes permanent.

I believe I was successful for many reasons. First, although I did this myself without representation by a lawyer, the law was on my side. The six-month wait is unconstitutional under the Canadian Charter of Rights and Freedoms. Second, I did my homework, revealing that the policy is not supported by medical research or science. Third, and most important to me, was having the right person in my court. My dream expert witness was Dr. John Fung, a world-renowned transplant surgeon from the University of Chicago. I cried when he offered to help. I strongly believe that his affidavit played a major role in getting the respondents to the negotiating table.

I am incredibly proud that Ontario will be the first jurisdiction in North America to introduce such a dramatic policy change. The six-month wait is still imposed on patients with alcohol use disorder at most U.S. liver transplant centers, though since my quest began in 2012, several centers in the U.S. and Europe have implemented a more modern approach that accepts all liver transplant candidates on equal terms.

I can only hope that someday every transplant center in Canada and the rest of the world will follow Ontario’s lead. But it will always be heartbreaking to me that with all the evidence against the six-month wait, it still took a court battle over my husband’s death to end it in Ontario.

Debra Selkirk, a former communications professional, is now working to start the nonprofit, Selkirk Liver Society, dedicated to advocacy and support for individuals with alcohol-associated liver disease.

  • The 6 month sobriety period is not a “test.” Its to allow for time to attend AA and addiction counseling in order to learn better coping skills than turning to alcohol. Also, ask your casual individual on the street their views on this. Most people are horrified to think of their organs going to an alcoholic who has had no treatment, no sobriety period. I think The donor pool will shrink substantially if they do away the 6 month rule.

  • Debra, I live in boston massachusetts and my boyfriend of many years is in the hospital where he has been denied a liver transplant. He is being transferred to a hospice today. He is an alcoholic and has struggled with drinking for years. I feel like the doctors have just given up on him. He has a disease, alcoholism, and still deserves a second chance at life. I am beyond devastated for him. I am at a loss as to what to do. I know that his situation is dire but he is a human being not a “drunk” as i feel the hospital staff are viewing him. Any advice from you would be so helpful. I may need to just accept this but if i can get him a second opinion and make sure all options have truly been exhausted, this would be helpful. Thank you for your time if you see this message. Sincerely, martha

    • Hi Melissa, I am so sorry to hear that your ex husband is in the ICU. On December 13th I road in the ambulance with Daniel to the hospice. He passed away two days later on December 15th at the hospice. His family was there but had gone out to get food and he passed away in my arms. He was 49 years old. Daniel was ill for about three years and it became really bad in early 2018 where he was going to doctors constantly and trying to get better. I am still at a loss as to why he did not improve as he was taking better care of himself then. I feel like the doctors/hospitals really missed something and that Daniel would still be here if his condition had been taken more seriously. I am so sorry you are going through this. I still struggle everyday to keep my head up and miss Daniel tremendously. Sorry, if my response is not helpful. I wish you and your ex husband the best. Please keep in touch if you need to talk. – Martha

  • We all have a story. Alcoholism is a disease. If a person has less than 6 mos to live because of the disease, doctors oath for some reason is not required to do what they can to save that life? They decide who lives and dies based on moral judgement. I get that we need to match the best candidate but survival and mortality rates of ALD patients are amongst the highest. I am sitting in hospice right now with my best friend and his wonderful supporting family that offered up part of their liver but doctors will not perform the surgery. What a travesty!!

    • @Mike, ok I’ll list a few liver diseases that are not the patients fault: PSC, PBC, Autoimmune hepatitis, Hemochromatosis
      Hyperoxaluria and oxalosis, Wilson’s disease, Alpha-1 antitrypsin deficiency, Liver cancer, Bile duct cancer, liver trauma from physical accident, etc etc etc.

      I could keep going for a while. Almost everything in that list has no direct underlying cause like Alcoholism or obesity (fatty liver disease).

      I’m ok with them going on the waiting lists. But they should always be lower priority then other matching patients who’s conditions are *not* self inflicted, even if that patient has a lower MELD score then the alcoholic patient.

      The alcoholic’s chances of relapse is immaterial in the decision in my opinion. If someone robs a store should we lower their sentence because they have a low chance at “relapse” and robbing another one? Because that’s exactly what they have done, robbed an organ since they had, completely within their own power, the ability to *not* need that transplant at all. They made a choice and now that the penalty has arrived they want a “take back” , a “do over”. And they shouldn’t ever get one at the cost of someone else who didn’t destroy themselves out of their own choice.

      Now, if they can get a liver donor from a family member or friend than absolutely, go for it. And once we have the ability to grow replacement livers using the patient’s own cells, again, go for it. But right now where we have a list system they should be at the very very bottom.

  • Wow! So glad u fought for this! Would explain why my sons father (after relapsing heavily) prior to the 6 month waiting period and endangering the life of my child was able to get a new liver.

    I am sorry for the lose of your husband. However, the reason they implicate the 6 month rule is to show the seriousness of the person receiving this chance at life. Due to poor evaluation and testing on someone who was not sober for that 6 month period… they were entitled to a new liver and a new mean of life! Makes me sick cause a week after leaving the hospital he began drinking again and smoking!

    The donor family should be able to have their loved ones liver returned to them! Someone else, who was deserving probably died so he could ruin yet another liver and create more problems.
    If your husband did that to his liver, chances are high he would have again! And living in denial and wishful thinking based on an ideal is sad! I’m sure he created many tragic and sad situations from his alcohol abuse! U should spend ur energy on educating the children of these liver thieves versus trying to paint a picture of ur husband that isn’t realistic! I apologize for coming off so harsh, but clearly u are still enabling his behavior even after he passed away! The lack of screening these liver transplant e’s go through sicken s me! My son is devastated because he yet again is disappointed by his father. He should never have been allowed that liver! And u Shouldn’t waste ur time fighting for people who don’t deserve a millionth chance!!!

  • Mike–. There are diseases which are hereditary, genetic,caused by toxins others than alcohol who should rise to the top of the list. My sister in law had liver failure due to years of alcohol and drug use. The goofy doctor said Well there are transplant centers in Philly that do liver and kidney transplant. Outrageous. We told her she was going to die and said let me go to hospice and coast out of this world high on morphine. She would have wasted two organs. So I have no desire to waste my liver on some looser boozer.

  • 1. Livers in the US are in short supply due to opt in organ donation registry.
    2. There are other countries that perform transplants and have organs, consider that option.
    3. I would love to drink every night but I do not because I do not want to be on a liver transplant list, period.
    4. In the US, which dying person gets a liver transplant before the other due to the limited supply is best up to the doctors, and the number risk / success factors that they take into consideration. Remember critical care medicine is dictated by triage practices.
    5. If you love drinking, put money into your health tourism account, because the US is freaking expensive for liver transplants.

  • I am so sorry for your loss. I had a successful liver transplant on 9-10-11,I believe every one including alcoholics, I waited for 9 months, my score was very high, and I did not know if I would make it.

  • Removing waitlist restrictions will not necessarily reduce available livers for transplantation. A relative of mine has a matching, and willing living donor adult child, but because of the six month restriction, he cannot receive said liver for six months because insurance will not pay until the six month period is up. Even if his child was not a match for his dad, the child could and would participate in a chain match donation to someone else who was in need and still find a match for the father. So removal of the six month wait could actually INCREASE transplants and saved lives.

  • Unfortunately, the alchoholics are ruining the prospects of getting a liver for the truly medically handicapped who have genetic or disease through not fault of their own. Alcoholics had a choice to keep their healthy liver rather than destroy it by excessive alcoholic consumption. I have to agree with Benji. All the no wait policy will do is reduce the number of donors.

  • It doesn’t seem reasonable to send a good liver to a person who destroyed their liver by choice. There are rehabs and 13 Step programs. So this is a classic example why I withdrew my name from donor registry. I’m donating my eyes and ears and bone tissues.

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