B.C. has agreed to change its policies for how it prioritizes Indigenous people for liver transplants, and to end practices alleged to be discriminatory, the province confirmed on Thursday (Nov. 13).
The changes were agreed to in a settlement between the province and the Union of B.C. Indian Chiefs (UBCIC) to resolve a longstanding Human Rights Tribunal complaint ahead of a public hearing scheduled for Nov. 3.
The deal was reached between the UBCIC, Provincial Health Services Authority, BC Transplant and Vancouver Coastal Health.
“The settlement was a collaborative effort between all parties, and we offer our gratitude to Grand Chief Stewart Phillip and UBCIC for working with us to bring meaningful and positive change to our liver transplant program,” says a statement from the Provincial Health Service Authority to Black Press Media.
The complaint was brought on behalf of patients adversely impacted by the use of the Model for End-Stage Liver Disease (MELD) scoring system to determine eligibility, and those refused because of policies requiring six months of alcohol abstinence before transplant.
The province removed the alcohol abstinence requirement in 2022, but retained the MELD scoring.
The UBCIC argued in its tribunal filing that Indigenous people suffer more from alcohol-use disorder due to factors such as trauma exposure, aren’t able to process alcohol as well due to genetic traits, and are more likely to be diagnosed with Primary Biliary Cholangitis, a liver-destroying condition, which can result in lower MELD scores.
Primary Biliary Cholangitis can cause cirrhosis (it used to be called Primary Biliary Cirrhosis), but it is not caused by alcohol.
According to information from the University of Victoria, it is a genetic condition that predominantly affects women, and could be as much as eight times more common in First Nations people than in non-First Nations populations.
The UBCIC complaint argues that because of stereotypes, Indigenous people with Primary Biliary Cholangitis often have liver disease mistakenly attributed to alcohol use.
Attorneys for the UBCIC, Gratl & Company, describe the settlement on the firm’s website, explaining that the province has committed to changing policy to ensure health-care providers emphasize Indigenous patients’ overall condition, rather than just their MELD score.
And MELD scores for patients with Primary Biliary Cholangitis will not be used to impede transplant eligibility.
The settlement also includes a commitment from the province to direct health-care providers to “mitigate, eliminate or accommodate” issues stemming from a patient’s lack of social supports, financial resources or housing.
These are barriers that would previously have resulted in a patient being deprioritized for a transplant.
UBCIC argued that this took the place of the six-month alcohol abstinence requirement and created a “functionally equivalent restriction” on Indigenous access to liver transplants.
High-profile case leads to calls for change
This Human Rights Tribunal complaint was brought in 2020 after the death of 45-year-old David Dennis, an Indigenous-rights activist and former head of the B.C.-based United Native Nations group.
After Dennis’s death, the UBCIC released a report called ‘In Plain Sight,’ which explores various ways B.C.’s health-care system discriminates against Indigenous people.
It describes Dennis’ case, explaining how the trauma and lack of care he received from his parents — both residential school survivors — led to post-traumatic stress and depression. After some early bouts of alcoholism, a head injury then led to heavier drinking.
In 2019, he was hospitalized with liver cirrhosis due to alcohol use.
Dennis stopped drinking when he found out he was sick, but after meeting with doctors four months later, he found out he was still just below the threshold for a transplant. He died about eight months after that.
UBCIC filed the human rights complaint about two months later.
This settlement was only reached after the Human Rights Tribunal ordered the province to turn over data related to race and liver transplant rates.
That Aug. 22 order compelled the Provincial Health Services Authority to hand over information from a database called PROMIS, which includes the dates and decisions made about transplant eligibility and MELD scores.
On Nov. 3, just before the main tribunal hearing for the case was set to begin, a settlement was reached.
This settlement does not affect the rights of individual Indigenous people to sue or file a human rights complaint.
The transplant guidelines will be updated online in the coming days, according to the Provincial Health Service Authority.
The UBCIC did not respond to a request for comment about the settlement.