Treatment outside Ontario
In 2018, Ontario will be the only province that is not imposing the 6-month wait. All other Canadian liver transplant centres have chosen to leave the policy in place. We are hopeful that some other family will challenge the policy in court.
Below is a list of U.S. liver transplant centres with a link to their policy, where possible. The centres are listed by volume as of 2016. We will be adding hospital until centres are listed.
In 2018, we shared the news that Ontario's two liver transplant centres - UHN in Toronto, and LHSC in London - will assess all persons with alcohol use disorder for transplant like every other patient.
In all other Canadian provinces, the 6-month wait is still imposed on persons with alcohol use disorder.
The Selkirk Liver Society continues to advocate for all Canadian patients to be assessed under the same criteria as Ontario patients.
Treatment in Ontario
In August 2018, Ontario will become the first jurisdiction in North America to assess patients with alcohol-associated liver disease without any period of sobriety.
We are watching carefully for the list of medical and psychosocial requirements that will be part of the assessment process. Trillium Gift of Life Network expects between Ontario’s two liver transplant centres – Toronto General Hospital and London Health Sciences Centre – 26, 32 and 39 patients will be transplanted respectively over the three years.
The two centres will support these patients with a dedicated multidisciplinary team embedded in the liver transplant program. The team will include, but is not limited to, a hepatologist, psychiatrist, addictions specialist counsellor, nurse coordinator and social worker.
Treatment outside Ontario
Ontario is currently the only Canadian province that is not imposing the 6-month wait. All other Canadian liver transplant centres have chosen to leave the policy in place. We are hopeful that some other family will challenge the policy in court.
Transplant for Alcohol-associated Liver Disease
U.S. LIVER TRANSPLANT CENTRES
WALL OF SHAME
United Network for Organ Sharing (UNOS), America’s organ transplant network, leaves the decision about waitlist criteria to individual hospitals. In some cases, such as Ohio, state policy dictates transplantation criteria. In other cases, patients face the 6-month wait at the hospital, go to a new centre and face it a second time when their insurance company assigns a wait as long as two years. The wait often results in death.
We are working to compile a complete list of U.S. liver transplant centres with their waitlist criteria in the context of alcohol-associated liver disease. We search for their policy on the 6-month wait. The centres are listed from the largest by volume as reported to UNOS in 2016. We also add in centres, regardless of size, from emails we receive. We are doing our best to constantly check back for changes or updates.
In cases where the button does not link to the centre's alcohol policy, it is because we have confirmed policy through direct contact with the centre itself.
Note: The colour of the buttons that follow are based on published policy statements by, or direct email confirmation from, each transplant centre. We ask for copies of documents where possible. Patients still have to meet regular medical and psychosocial requirements, even when the centre no longer applies the 6-month wait.
If you contact a centre whose button is green, and you are turned away because of the 6-month wait, please contact us so we can re-assess the centre's statement to us and adjust their button to red.
Liver transplant waitlists track patients' MELD scores. The Mayo Clinic defines it as: "The Model for End-Stage Liver Disease (MELD) is a reliable measure of mortality risk in patients with end-stage liver disease. It is used as a disease severity index to help prioritize allocation of organs for transplant."
A patient's MELD score is calculated using an algorithm developed by the Mayo Clinic which looks at levels of INR, creatinine and bilirubin. The Clinic also provides a tool to calculate the 90-day mortality rate for patients with alcoholic hepatitis on this same page.