White Coat Black Art26:30The Gift of Life
When Tara De Pratto saw a Facebook post about a woman who desperately needed a donor to give her part of their liver, she immediately knew she was going to be the one to make the life-saving donation.
“I’d actually had a conversation with my partner about how, in theory, I would donate an organ,” De Pratto told White Coat, Black Art host Dr. Brian Goldman. “And then two days later pops up this opportunity that I knew in my body and soul that I needed to do.”
The person in need was Farah Ali, a wife, mother and grandmother from the Ottawa suburb of Nepean, whose liver was failing as a result of complications from Hepatitis C. In addition to cirrhosis, Ali, 60 at the time, also had liver cancer too advanced to be removed surgically.
Two years ago this month, De Pratto gave part of her liver to Ali. She’s one of a small group of living donors who have stepped up to help address Canada’s shortage of donations from deceased people, which lags far behind nations like Spain, Portugal, France, the United States and the United Kingdom.
Donors such as De Pratto cite both the need for organs and a sense of meaning from helping to save a life as reasons for making a donation that requires major surgery and recovery time. Living donors can share a kidney, a lobe or full lung, or a part of their liver.
Of 2,936 organ transplants performed in Canada in 2022, 20 per cent were from living donors, according to data from the Canadian Institute for Health Information (CIHI). That same year around 273 people died while waiting for an organ donation.
Among transplants from living donors in 2022, just under half were unrelated to the recipient.
And that’s an important development, says Dr. Nazia Selzner, a transplant hepatologist and medical director of live donor liver transplantation at University Health Network in Toronto, which she helped to establish in 2000.
“In 2005, a gentleman came forward and actually challenged our program at that time, asking us why he cannot donate to someone to whom he is not biologically or emotionally related.”
The resulting policy change paid off. In 2023, the program conducted around 130 anonymous, non-directed, living donor liver transplants, said Selzner.
The process
For Tara De Pratto, the process of donating a piece of her liver involved two trips to Toronto for comprehensive screening tests at the University Health Network (UHN).
“Then they called me and said that I was a match and that we could go ahead with it and pick a date,” said De Pratto.
That was a big day in the Ali household, said Sidra Ali-Khan, the youngest of Farah’s two daughters.
“Dad picked up the phone, and then he was like, ‘Oh, it’s the transplant team calling.’ So then Mom picked up the phone, too. And they gave us the news and we’re like, ‘Oh my God.’ There were a lot of happy tears that day.”
The surgeries took place a week later in Toronto, on Jan. 24, 2021.
De Pratto said she was nervous — not about the surgery itself — but because she’d never before had anesthesia.
“But the anesthesiologists were amazing at the hospital and they just put me right out.”
The risks
The worst-case scenario would be for something to go catastrophically wrong, resulting in the death of the donor, said Dr. Selzner. But in the UHN program’s 23 years, that’s never happened. She says the risk of donor death is “probably around one per cent.”
Although only healthy donors get the green light, there are risks associated with surgery. These include things such as possible reactions to the anesthesia, wound infections and blood clots.
Some pain and discomfort is expected, and recovery time is around six weeks.
“I just remember waking up being like, ‘Oh my goodness, what did I do?’ because it was so painful,” said De Pratto. But around five or 10 minutes later, the pain medications were already helping, she said.
“It was very weird to have this giant incision in your body. But, you know, your body’s an amazing thing and it can heal quickly.”
The anonymous donors
In cases like Farah’s, the donor steps up because they connected with one recipient’s story. But unrelated donations are anonymous, with neither the donor nor the recipient knowing the other’s names or details, said Selzner.
In 2018, Heather Badenoch, also from Ottawa, gave part of her liver to a child she’s never met.
Badenoch said she’s received updates about her recipient on two occasions, first the evening after the transplant when the recipient’s surgeon visited her bedside to say the child was doing well.
On the fourth anniversary, she sent an email to her own surgeon, Dr. Mark Cattral, to wish him “a happy liver-versary,” said Badenoch.
“And he wrote back and quite unexpectedly told me that my recipient is doing really well. I printed that email off. It sits beside my desk. I can look at that every day.”
After becoming part of the transplant community, Badenoch, who runs a communications business, realized she could help would-be organ recipients connect with potential donors.
She crafts their stories and gets them onto relevant platforms, such as the Facebook group Being Neighbourly Nepean, where Badenoch helped Farah Ali connect with De Pratto.
So far she’s helped with more than 30 successful campaigns to find a donor.
The reasons
Because organ donation is the responsibility of the provinces and territories, Canada has a fragmented system that in most cases requires people to opt-in to be organ donors.
The federal government says less than 25 per cent of people living in Canada are registered.
Some of the countries with the highest deceased donor rates have “presumed consent” or “opt-out” systems — where willingness to donate one’s organs is assumed unless people say otherwise.
New Brunswick and Nova Scotia have recently adopted opt-out systems, and Quebec is in the process of doing the same.
Living organ donors are often called heroes, but what drives them to go through surgery to save someone else’s life? CBC’s Ioanna Roumeliotis explores what science has learned about these extreme acts of kindness and why some people are compelled to help.
In an email to CBC, Health Canada said that while organ donations are increasing — 23 per cent between 2013 and 2022 — there’s still “a gap between the need for organs and the number of donors and of transplants performed.”
In 2018, Health Canada established the Organ Donation and Transplantation Collaborative to help co-ordinate organ donation nationally.
The email also said that the federal government allocated $36.5 million in 2019 to develop a pan-Canadian data and performance system to “avoid missed opportunities and improve patient care.”
The 2022 tax year was also the first time people in Ontario and Nunavut could tick a box on their tax forms to indicate interest in becoming organ donors. Nearly 2.5 million people opted to do so.
The outcome
About six months after the transplant, De Pratto met her recipient, Farah, and her family, in person for the first time over lunch.
“As usual, we cried,” said De Pratto. “But it was just nice to see her looking so healthy and looking so different from the photos. Her cheeks were pink.”
“I recovered amazingly well. It helped me learn a lot about myself and my body. I would consider potentially donating an organ again in the future. I have to think a little more about it, but it’s not off the table.”