Putting Gay Rights Before Health

George Smitherman's attempt to stir controversy by criticizing the federal government's guidelines for organ donation leaves us wondering who he really represents as Health Minister of Ontario.

A directive issued last summer by Health Canada, but only noticed now by Mr. Smitherman, formalized the long-standing and clinically accepted practice of labelling organs from the donor pool if they have come from a member of a group that is at high risk for serious blood-borne diseases. The risk groups identified in the document include prison inmates, recent recipients of tattoos or piercings, non-medical intravenous drug users, prostitutes and men who have had sex with another man within the past five years.

Organs thus labelled as risky can still be used for transplantation if the recipient and his physician agree that there is no superior alternative to going ahead in the face of the added risk. So there is no chance that the supply of the most urgently needed organs will be restricted by having such a guideline in writing, unless the risk groups decide to punish the sick by boycotting organ donations.

Nonetheless, Mr. Smitherman thinks that the identification of known risk groups for infectious disease is a matter of "wonky bureaucrats" "ghettoizing communities" by means of "nonsense." His passion for the social inclusion of skid row smack addicts and 15-year-old girls who have just had their ears pierced is truly moving, but letting identity politics imperil the health of the public is really not what one expects from a health minister. The victims of Canada's tainted-blood scandal, which resulted partly from the purchase of blood from risk groups (notably American prisons) and partly from a politically motivated failure to introduce behavioural screening, are still dying around us thanks to the Smithermanlike attitudes of the 1980s.

And it so happens that Health Canada's guideline is, if anything, looser than some would suggest it ought to be. A 2005 American study using data from the Retrovirus Epidemiology Donor Study (REDS) found that MSMs whose last male-male sexual activity took place less than five years ago were, unsurprisingly, at significantly greater risk of carrying HIV or hepatitis.

Those with more than five years elapsed were not statistically different in screening tests, but were for some reason markedly more likely to have other behavioural risk factors — such as engaging in prostitution — that might lead to a "window donation" (that is to say, an organ donated between the time of the initial infection and the point at which it becomes identifiable to rapid disease screening). The threat of such donations is the reason the system does not, and cannot, rely solely on the tests done on the transplanted organ it-self; if a donor got his ear pierced yesterday, he might be infected with hepatitis at an undetectable but still contagious level.

Under the circumstances, the five-year cutoff appears to be the one with the strongest existing evidentiary support. Patients who need organs, and who are committed to the Smitherman view that behavioural screening is nonsensical and odious, should celebrate the Health Canada guidelines' reliance on informed consent. In a crisis, they will have the freedom to choose a risk-labelled organ, and to feel good about having it installed. Perhaps when the Minister realizes this, he can move on to less important responsibilities like reducing clinical waiting times or planning for the next SARS.