Comment: Canada’s ban on gay organ donation

Illustrated rainbow pride flag on a white background.

As Prime Minister Gordon Brown announces plans to rapidly expand the organ donation scheme in the UK by effectively making everyone a donor unless they choose to opt out, Canadian health authorities are under fire for appearing to exclude sexually active gay men.

Dr Gary A Levy, one of Canada’s leading transplant experts, speaks out against a new policy that seeks to exclude donors on the grounds of their sexual orientation.

As the Medical Director of Canada’s largest multi-organ transplant programme, I see people when they are at their most vulnerable.

I am told stories of tragedy and triumph by patients and their families.

I celebrate their successes and console them when things go wrong.

This past week I have heard more heartrending stories and seen men break down and cry but it isn’t because they need an organ transplant.

It is because they believe that society has judged them – again – and labelled them as ‘undesirable’.

I’m speaking about the recent controversy with regard to the ability of gay men to become organ donors.

I write, to set the record straight, as far as I am able and to tell everyone that health care professionals who work in the field of transplantation are deeply concerned about the pain that members of the gay community are experiencing and about the impact that this pain and the misconceptions of recent legislation may have on organ donation in Canada.

I want to clearly state that the programme I lead at University Health Network has never adopted a policy of banning the use of organs from homosexual men or women.

All donors, regardless of their sexual orientation, are screened by blood tests for any potential known infectious diseases and this information forms part of our decision-making process.

All donors, regardless of their sexual orientation, are asked questions about their sexual history, intravenous drug use, tattooing and piercing practices, and other behaviours which might contribute to the risk of acquiring a blood borne infection.

Any potential donor who has a number of sexual partners in the past five years, be those partners male or female, would be considered at higher risk for acquiring any number of infectious diseases.

We need this information because a donor organ from an individual with an infection could compromise the health of the recipient at a time when the recipient will be at their lowest ebb in terms of resistance to disease.

People’s sexual orientation or their sexual practices are only our business as they relate to the potential for the transmission of infectious diseases.

Transplantation of any organ carries significant risk from the process alone, without an added burden of disease from the transplanted organ.

The legislation currently in place allows for the use of organs from individuals who have engaged in ‘high risk’ behaviours provided the potential recipient is informed about those risks.

We talk to the potential recipient about the risks, as we know them, from the donated organs, and a decision is made based on as much information as we have and can give.

The legislation, as currently worded, does specifically identify the sexual practices of gay men and women.

It should be amended to refer to the relative risk of sexual practices and frequency of all men and women.

If you engage in unprotected sex with multiple partners, you are at higher risk for acquiring an infection. If you add anal sex to the mix, there is an increase in the risk.

We know that some men and women, no matter their sexual orientation, engage in anal sex. Depending on where you are in the world, the practice may be more common than it is here in Canada.

It is our programme’s responsibility to identify all risk factors and give potential recipients the choice about assuming those risks.

Organ donation represents the gift of hope and life. This controversy has the potential to hurt a significant part of our community and derail some organ donations.

We will continue to practice as before the introduction of the present legislation and I encourage you to register to donate organs and tissues to help individuals who would die without this gift of life.

I, and our programme, will work tirelessly to correct any misconceptions that this legislation implies and will work with all communities and interest groups to this end.

Gary A Levy MD FRCP (C)

Director Multi Organ Transplant programme

CIHR/Novartis Chair in Transplantation

Professor of Medicine, University of Toronto

Toronto General Hospital, University Health Network