TheStar.com | News | Most gays ruled out as organ donors

TheStar.com | News | Most gays ruled out as organ donors

Jan 09, 2008 04:30 AM
Joseph Hall
Health Reporter

A Health Canada regulation that bans most gay men from donating organs is scientifically unjustified, virtually unenforceable and could worsen critical transplant shortages, a prominent Toronto AIDS doctor says.

The regulation, which took effect in December and closely resembles blood-donor guidelines, prohibits organ donations from sexually active gay men, intravenous drug users and hepatitis victims.

Both strictures are unfair to thousands of conscientious gays, says Dr. Philip Berger, head of family and community medicine at St. Michael's Hospital.

"What about a gay monogamous couple, (Health Canada) is not going to let them donate? It's ridiculous," says Berger. "It's been known for 20 years that the risk factor is not in being gay (but) in risky sexual behaviour."

Heath Canada officials did not respond to numerous requests for interviews yesterday.

Berger says "it's what the individual does in their sexual lives, whether gay or straight, (that) puts them at risk."

"To exclude bona fide donors because they've had sex with another man ... would exclude a lot of people who are no risk at all. Zero risk."

Berger says the "unreasonable" restriction is bound to reduce the supply of transplant organs at a time when the need is growing more urgent.

But Dr. Gary Levy, head of Canada's largest organ transplant program, says the new regulation simply formalizes precautions in use across Canada for at least 10 years.

The precautions were based largely on blood donor criteria that exclude sexually active gays, says Levy, head of the transplant program at the University Health Network.

Still, Levy says, Health Canada's formalizing of the criteria was bound to cause "some anger and hostility" among many homosexuals.

And he agrees with Berger that the restrictions likely go too far in excluding all sexually active gay men.

"I personally believe someone who has been in a monogamous relationship for 30 years, regardless of the gender of their partner, is a safe situation," Levy says.

Levy says transplant physicians will likely urge Health Canada to reconsider the ban to put the emphasis on high-risk behaviour, whether promiscuous sex or illicit needle use.

In the end, however, Levy says transplant surgeons will continue to make the final decision on which organs are suitable for use.

He says many organs from known gay men have been used in his program after physicians determined from retrieval agencies that the donor's sexual behaviour did not carry a significant HIV risk.

Under the new regulation, however, surgeons will have to sign a form stating they authorized the use of an organ that would normally be excluded.

In the vast majority of organ donation cases, sexual history is assessed through interviews with relatives of the deceased. Even if a donor card has been signed, the family or the courts must give permission for harvesting in Ontario, Levy says.

But Berger says the Health Canada regulation is fundamentally flawed because the organ harvesting system depends entirely on the goodwill and honesty of donors or their families.

He adds that current HIV screening tests can confirm the infection-free status of donated organs rapidly and with virtual certainty.

The only risk would come from donors in the "so-called window period when they've been recently infected," Berger says, calling that an "infinitesimal" worry.

However, Levy says HIV can incubate for 20 days or more before becoming detectable.