Amanda Fuska has been in an Ontario hospital for nearly three months with severe liver failure, spending the majority of her time in the intensive care unit on life support, and her drinking history is preventing her from receiving the only treatment available: a liver transplant.
“We were told last week she had a few weeks left to live, maybe a month if we were lucky,” her partner Nathan Allen said.
Fuska, 36, was offered a liver transplant at University Health Network (UHN), the nation's largest liver transplant center, but was turned down.
Documents shared with CTV News state that after UHN's alcoholic liver disease team reviewed Haska's medical information and conducted a psychological evaluation, Haska was denied admission, noting that the decision was based on “minimal abstinence outside of the hospital.”
According to medical records, she began drinking alcohol in her late teens, tried unsuccessfully to quit drinking, and then relapsed after periods of abstinence, which may put her at higher risk for continuing to drink after transplant.
Allen said Haska enrolled in an addiction program early in her stay in the hospital in hopes of quitting drinking after she was released. Hospital records also noted she suffered from anxiety.
“She told me this was a wake-up call for her and that she wanted to turn her life around,” Allen said.
Amanda Fuska, 36, is in desperate need of a liver transplant. (Image by Nathan Allen)
UHN's refusal also meant she could not receive a liver from a living donor, who must have a matching blood type and meet other medical criteria.
Nathan said his blood type matches hers and he would like to be her donor if possible.
'Turned Away'
“Access to life-saving treatment is based on what is perceived as bad behaviour,” said Debra Selkirk, who campaigns for more compassion for people with liver failure due to alcohol abuse.
Selkirk's husband, Mark, was denied a transplant because of his drinking and died of liver failure in 2010.
Selkirk points out that many other chronic diseases can also lead to organ failure.
“People aren't being turned away because they didn't exercise, or they worked too much, or they didn't sleep enough, or they didn't follow their doctor's orders. So in the case of Nathan and Amanda, we're seeing them being told, 'You didn't follow your doctor's orders, so we can't help you. We're going to have to let you die,'” she said.
Debra Selkirk is pictured with her husband, Mark, who died of liver failure in 2010. (Image courtesy of Debra Selkirk)
Hepatologists say Amanda's story is part of a growing and worrying trend: Historically, cirrhosis and liver failure were a disease of older men who had been drinking alcohol for decades, but it's now increasingly affecting younger adults and women.
“We're seeing a lot more patients under 40 coming into hospital with severe alcohol-related liver damage, which is a change from when I was training more than 10 years ago,” said Dr Jennifer Fleming, associate professor of medicine and public health sciences at Queen's University.
Data collected by Fleming based on emergency department visits in Ontario showed that 36% of young adults who went to the emergency department with liver disease were women, and further analysis showed that these women were 50% more likely to progress to liver failure than men.
Patients diagnosed with liver failure often require a liver transplant to survive, “and there are only a very limited number of organs available for transplant,” Fleming added.
However, the chances of obtaining a liver, either from a deceased or living donor, are slim.
A University Health Network study found that 86% of people with alcohol-related liver damage who were offered transplants were rejected, while only 14% of those who applied were accepted and only 6% actually received a transplant. Liver transplantation.
Nathan Allen says he would be a donor to Fuska if allowed. (Avis Favaro/CTV News)
The criteria are strict and involve physical, medical and psychological evaluations to determine who will benefit the most in the long term.
“Unfortunately, as we try to resolve this, more and more young people are suffering because they don't have access to transplants,” Fleming said.
Studies have shown that transplants for alcohol-related liver failure are generally successful — more than 94 percent survive after one year — but about one in 10 people resume drinking.
There are about 600 Canadians waiting for liver transplants for a variety of illnesses, including hepatitis and cancer, and deciding who will receive a liver is not an easy task.
“It's a precious gift. It's a limited resource,” said Dr. Saumya Jayakumar, a liver transplant surgeon in Edmonton.
She wasn't involved in Amanda's case, but points out that the seven transplant centers across Canada use roughly the same criteria for selecting recipients. These typically include the patient's awareness of their addiction, their willingness to quit drinking, their mental health, and family support after the transplant.
“As you can imagine, making these decisions can cause a significant amount of emotional distress for team members, so this is a decision that is made by the whole team and there are a number of different people involved – hepatologists, transplant surgeons, social workers,” she told CTV News.
According to her research, Abstinence from alcohol before transplant It didn't affect the results. In other words, patients who abstained from alcohol for the six-month baseline period did just as well as those who had “urgent” transplants with no waiting period.
Jayakumar said he believes mental health issues are paramount in determining suitability.
“We can give you a new liver, but unless we can change all the circumstances that led to the liver failing, have we really helped you?” she said.
“I would say every transplant centre in Canada has challenges both in accessing mental health funding for patients and accessing mental health professionals for their transplant programs,” she said.
Approximately 86 percent of patients who need a transplant for alcoholic liver failure are denied a transplant. (Source: University Health Network)
Meanwhile, when asked for comment about Amanda Fuksa's case, UHN officials provided a statement to CTV News.
“While we cannot comment on specific cases due to patient privacy, we can say that there are multiple criteria for living donor eligibility, two of which are blood type and willingness. Recipient criteria are managed jointly by the Transplant Center and the Trillium Gift of Life Network,” they wrote.
Nathan says he has found a hospital in Europe that will do a living donor liver transplant if Amanda survives long enough to survive the ordeal, but he is hoping to raise the money through crowdfunding, as the cost could exceed $300,000.
“I'm going to do everything I can to save her life, just as the medical professionals should do here,” he said.
Why are women at higher risk for alcohol-related liver disease?
Doctors say there are several reasons why women appear to be at higher risk of alcohol-related liver disease than men.
Women produce 30 percent less of the enzyme that breaks down alcohol in the stomach than men, which means the effects of alcohol can be more noticeable.
Women also have less lean body mass and less water in their bodies, so their alcohol levels are higher.
Research has shown that alcohol consumption among women is on the rise, with products like fruity coolers targeted at young women.
When you consume too much alcohol over a long period of time, your liver stops processing it and produces highly toxic chemicals that cause inflammation. This can kill healthy liver cells and permanently damage your liver. The International Agency for Research on Cancer classifies alcohol as a toxic, addictive carcinogen that is linked to cancer and liver disease.
Canada Issue New Alcohol Guidelines It suggests that by 2023, people will drink no more than one drink per week.
If detected early, the condition is treatable: behavioral and lifestyle changes, such as reducing alcohol consumption, can help regenerate the liver and other vital organs, eliminating the need for hospitalization and transplants later in life.
Some health groups are calling for stricter alcohol controls, fearing that Ontario's planned expansion of alcohol sales this fall will lead to increased alcohol consumption and a higher risk of liver disease and cancer.
