Dying man's family pushing for liver transplant says Quebec's rules are unfair

Daljinder Nahar is turning 44 this month, and he may not live much beyond that.

The patient at Lakeshore General Hospital in Montreal's West Island is running out of time as his family desperately scrambles to get him a liver transplant after several requests have already been denied. The refusals are in large part due to his years-long struggle with alcohol addiction.

The damage to his liver has reached cirrhosis, which means it is irreversible. There's about a 70 per cent chance that Nahar will die by mid-October, according to medical documents obtained by Radio-Canada.

His loved ones are not only dealing with the prospect of losing him, they're also frustrated by the criteria for a potentially lifesaving transplant, which they say give Nahar the slimmest of chances of survival.

A July medical document, drafted by the McGill University Health Centre (MUHC), says the 43-year-old can be referred for an orthotopic transplant — the most common type of liver transplant which involves a deceased donor — if he can be sober out of hospital for more than six months and go through a detox program.

The MUHC and the Centre hospitalier de l'Université de Montréal (CHUM) are the only two hospital centres in the province that perform — if possible — liver transplants for adults. Both of them have refused to consider him for the procedure.

Nahar has been in hospital since May. That's when doctors informed him that his health had deteriorated to the point where only a transplant could cure him.

"For someone who is gravely ill and basically cannot survive outside of a hospital, for them to keep telling us that he has to go home and be sober at home for six months, it doesn't make a lot of sense to us," said Amid Tak, Nahar's brother-in-law.

Tak and other family members are willing to see if they are a match and donate part of their liver in hopes of saving Nahar's life, but even those requests have been denied, they say.

"We're conscious of the fact that it may not even work. Other problems may come up. We don't know. But the thing that is difficult is that no one is giving us the chance to be considered," Tak said.

Rules for transplant discriminatory, says lawyer

Since 2017, Nahar has suffered from an alcohol addiction and has had several stints in rehab. His condition, according to medical documents, was largely caused by his alcohol consumption.

His brother-in-law says a bout with depression is what led to Nahar's alcohol abuse.

"He would drink at night in order to fall asleep. That's the only time he drinks," said Tak, who also pointed out that his brother-in-law was a successful chef in Montreal's West Island.

"During the day, no one would be able to tell he's an alcoholic."

The eligibility criteria for liver transplants in Quebec and many other jurisdictions are in place mainly because of the scarcity of available organs.

According to a letter from the MUHC, exceptions to the six-month rule are possible, but the patient must meet other criteria. Nahar, it seems, does not.

The letter also states the MUHC reached out to several other hospital centres in Canada to see if Nahar would be considered for a transplant. All of them said no.

"Our policy at McGill is that untreated or uncontrolled medical illnesses are a contraindication to transplantation. In this case, his alcohol use disorder and depression are not successfully treated and are not controlled," that letter from July reads.

"If these can be treated and controlled, he can be reassessed for transplant candidacy in the future, if needed at that time."

Patrick Martin-Ménard, the lawyer for the Nahar family, said he believes the criteria are unfair.

"A person that has made poor nutrition choices that led to losing their liver will be eligible for a transplant, but a person that has an alcohol problem won't be," Martin-Ménard said.

"It also does not take into the account the underlying mental health causes of alcohol consumption issues and it ends up really creating a discriminatory situation."

Martin-Ménard also said the criteria should not apply to transplants with living donors.

The patient's brother, Kiranpal Nahar, said his inability to get tested to see if he's a match "feels like it goes against everything that should be going on in this country, that should be going on in this province."

"It's a violation of the Charter. It's the right to life, liberty and freedom," he said. "They're taking that away from us as a family and for my brother who is only 43 years old. He did this because he was in a state of mental depression and to write him off like this is unfair."

The MUHC declined an interview request, citing confidentiality reasons.

"Multiple factors are taken into consideration when decisions about a candidacy for transplantation are made," said spokesperson Gilda Salomone in a brief statement.

Guidelines tested in court

The notion that the guidelines are unfair, or unconstitutional, has already been tested in Canadian courts.

For years, Debra Selkirk, a Toronto woman whose husband died in 2010 died of liver failure caused by alcohol addiction, has tried a mount a legal challenge of those guidelines, including the fact that they also apply to living donor transplants.

In June, two of the three judges on the Ontario Court of Appeal declined to say if they agreed or disagreed with the Superior Court ruling that the living donor criteria is not subject to Charter scrutiny. As a result, Selkirk — who is representing herself and her husband's estate — will try to get her case to the Supreme Court.

"One of the points I'm making in court is if you have a living donor, you shouldn't be so heavily scrutinized ... To me it's outrageous," Selkirk told CBC News. "A living donor is not a scarce resource because it's your own personal donation and I feel that you should be able to use your family member as a donor. Period."

In 2018, Trillium Gift of Life, the agency that runs Ontario's organ transplant system, launched a three-year pilot program that temporarily suspended its policy requiring that alcoholics be sober for six months before being eligible for a new liver.

The way patients are assessed for possible transplants has changed over the years and people with severe alcohol-related can be eligible before the six-month wait, according to the Canadian Liver Foundation (CLF).

"Studies also suggest that carefully selected people with severe alcohol-related liver disease have similar survival rates following their transplant as those who received a liver transplant due to other types of liver disease," said Holly Nyenkamp, a spokesperson for the CLF.

In its case, the lawyer for Nahar said a court challenge to help secure a spot on the transplant waiting list is being considered.

"We keep fighting, we keep pushing," the patient's brother said. "Time is of the essence."