Gay activists, pundits and opposition pols took a swipe at Health Canada recently for its new policy deterring “high-risk” groups – i.e., gays – from organ donation.
But was the policy excluding organs from men who’ve had sex with men in the past five years really a Tory plot, as many have charged, or can it be explained as just an over-anxious case of legal ass-covering?
Certainly, many human rights advocates saw the policy change as a particularly nasty version of homophobia – all the more so when lab work checking for the presence of HIV in organs is extremely reliable.
The nucleic-acid test (NAT) can detect the virus as early as 11 days after infection. Still, while the risk of contaminated organs being transplanted is very, very low, it can’t be eliminated altogether.
This is where the scientific showdown over stats and risk assessment comes from.
Screening processes excluding gays are “odious but hard to argue against,” says Edward White, a gay man and epidemiologist with the Yale Center for Interdisciplinary Research on AIDS.
“Men who have sex with men form a dense, highly connected sexual network separate from other sexually active people,” he says, so a woman who has anal sex with multiple straight men generally has a much lower risk of getting HIV than a gay man who does so with other men.
The higher prevalence of HIV among gays, says White, warrants the government’s cautious approach.
According to a 2005 Health Canada report, gay men represent 45 per cent of new HIV infections. Because current screening is imperfect, White argues, disallowing sexually active gay men as a group could reduce the risk of HIV transmission via organ transplants by up to the same percentage.
No study has yet shown that the benefits of gay organ donation outweigh the risks, he says.
But Paul MacPherson, an infectious disease specialist at Ottawa Hospital, sees it differently. “Yes, HIV is more prevalent among gay men, but we are a small minority within the Canadian population,” he says.
Only a small number of gays in Ontario are HIV-positive – roughly 9 per cent, according to a 2004 study. As a consequence, the number of bad organs that could escape detection is minuscule, but vast numbers of good organs will be needlessly wasted, he says.
As for screening questionnaires, they’re flawed anyway, MacPherson says. “People are free to lie. Much organ donation happens when the donor is dead and the family agrees to it.
How many people are not out to their families?” If a donor is deemed high-risk through the questionnaire, the organs are excluded from the organ pool unless a recipient is told about the risk category and is willing to accept their use.
It’s possible that no one will ever know how many organs are lost to those who need them as a consequence of Health Canada’s move.
When Paul Leonard, who is gay, cleaned out his old wallet recently, he threw his organ donor card in the trash. “Every usable organ or tissue from my body should be harvested and given to someone else after I die,” says Leonard, who believes guidelines should consider behaviour alone.
“Why should I be barred even if I’ve only engaged in mutual masturbation with another man, but still be able to donate if I had unprotected anal intercourse with numerous promiscuous women?”
Queer activists were not the only ones who expressed their dismay at Health Canada’s policy shift; anti-Tory pols joined the fray as well. Federal Liberal health critic Robert Thibault accused the government of “ideological discrimination” – and Ontario’s openly gay health minister, George Smitherman, vowed that the province’s Trillium Gift of Life Network would ag-gressively recruit gay men as organ donors.
But would a change in government get this off the books? MacPherson doubts it. The most likely motivation for the policy, he argues, is fear of lawsuits.
“This has nothing to do with being Liberal or Conservative, and little to do with protecting the organ supply from genuine risk. It’s about covering your ass from a legal perspective,” he says. “I’d be surprised if this policy got reversed by anybody.”
No transplanted organs in Canada have led to HIV transmission, but in a high-profile case in Chicago last year, four people contracted HIV and hepatitis C from a gay male donor who acquired HIV just before death.
In that case, the NAT test was not used.
Jim Pickett, advocacy director for the AIDS Foundation of Chicago, says the case was highly unfortunate but didn’t lead to dramatic policy changes. “It was a one-in-a-million freak occurrence.”
Pickett says that in addition to consistent organ testing, the solution is a more rational approach to risk. “An organ transplant is invasive surgery,” he says, involving an inherent level of danger. “We can try to reduce risks, but it’s simply impossible to eliminate them.”
Number of people on Canadian waiting lists for organ donation in 2006 4,240
Number of people who died while waiting 243
Number of people who had to withdraw from the list while waiting, in some cases because they had become too ill 471
Organ Donation and Transplant Association of Canada