Living Donor Program at UHN

​Frequently Asked Questions

Q. What organs can be donated through this program?

A. The Multi-Organ Transplant Program (MOT) at University Health Network (UHN) also provides living liver transplants where a donor gives a portion of their liver to a recipient. MOT is internationally known for living liver donation and has the most experience of any program in North America. The donor’s liver will grow back to its normal size within two months and the liver in the recipient will also grow to normal size.
The program also transplants a kidney from a donor to someone who needs a kidney. People with one kidney have no residual effects of the donation and the recipient returns to a normal life and is off dialysis – a significant improvement in the quality of that individual’s life.

Q. Are there risks involved in donating a kidney or a piece of liver?

A. Yes. Any surgical procedure has associated risks. Incision pain and the loss of work time because of the need to rest are the most common risks for the donor and the donor work up takes as long as necessary to ensure their safety. UHN’s MOT has never had a donor die as a result of the surgery but this risk is discussed with all donors because it is a risk associated with surgery. UHN’s experience with both of these donor procedures, the care that is taken in identifying potential donors and the after care provided are all elements of the program which allow us to go forward with living donation in a relatively safe way, with outstanding outcomes.
We have excellent surgical outcomes and long-term results that generally exceed international benchmarks at one, five and ten years post-transplant.

Q. It seems as if this is putting a healthy person at risk? Why would you do that?

A. Our preference would be to have an adequate supply of organs from people who have died and indicated that they want to be organ donors. However, this isn’t the case so people wait for organs and they die on the waiting list. Live donation is an option for all of these people if they need a kidney or a liver, and there are many ways of approaching this topic with family and friends.

Q. But in this case, the donation was from someone that the patient didn’t know. How unusual is that for transplant?

A. The first step in a live donation is to approach friends and family but you may not find a match within the group of people close to you. Or, you may not find someone who is willing to donate if they are a match. If that is the case, then some people broaden their search and, increasingly, we are seeing the use of social media to make that search as broad as possible. We have also seen celebrity endorsement of a search and community endorsement of a search. In the case of Mr. Melnyk, many of his family and friends stepped forward to be considered for donation but a match was not found, so the search was extended to his community. In this case there is clearly a very large community that supports the Ottawa Senators.

Q. What was the response from that community?

A. Our understanding is that the hockey team received over 2,000 phone calls from which we received – as of the weekend – over 500 health histories from people who indicated that they were willing to be considered as a living liver donor. From that group, we identified 12 potential candidates and we retain 26 files of individuals who have said that they would be happy to be considered in the future for another person who might need a liver transplant.

Q. Why would someone who doesn’t know the patient consider doing this?

A. We have had a number of appeals of this nature and the answer to that question is complex and related to the potential donor but we always see a generosity of spirit, the intention of doing good because they can, and sometimes the donation is related to a past experience. They know someone who has received an organ transplant – or they may know someone who has died because no organ became available. They are universally kind, thoughtful people who choose to do this for someone they’ve never met and probably never will meet.

Q. The cynic would say that they do this for a reward. What do you say to that?

A. If there is any indication in the evaluation process that a potential donor expects some kind of repayment – money or any other consideration – they are not considered for donation.

Q. What about the donor in this case? Who are they and will they meet Mr. Melnyk?

A. The donor has requested anonymity which we will respect. The donor has stated to the team that the reward is knowing that the recipient is doing well and can now enjoy further time with his family and friends.

Q. There’s been comment that Mr. Melnyk has “jumped the queue”. What do you say to that?

A. It shows a lack of understanding of the process of live donation. To be considered for live liver donation at the UHN and in Ontario, a potential recipient must first be eligible for a deceased donor. Thus they would meet all criteria for receiving a deceased organ and be listed on the Trillium Gift of Life Network site, a not-for-profit agency of Ontario which coordinates and supports organ and tissue donation and transplantation across Ontario. The rationale for initiating the live donor program in Toronto in 2000 was the fact that nearly 40 per cent of listed patients die before a deceased organ became available. There is no queue for live donation. Anyone who has a live liver donor and who qualifies for a transplant will be transplanted. The queue for needing transplantation is determined by the health status of the recipient – the sickest person is at the top of the list. This determination is made using objective and standardized parameters. In fact, by receiving a living donation, it allows another transplant to take place with the next deceased donor organ, thus freeing up organs and reducing the number of people needing a transplant.

Q. What do you think about the fact that Mr. Melnyk was able to use his network which is much larger than anybody else’s and therefore gives him a better chance to get a donor?

Anybody who needs a transplant uses whatever network or community they have to further their search. Social media has made this possible and there are many cases of people with very small networks being successful. Our only focus is on saving the lives of those who need a transplant and ensuring that living donors do well. Given that 26 people have indicated their interest in staying on the potential donor list the program is confident that this appeal has been very beneficial. It has also raised the idea that more people should go online at www.beadonor.ca and sign up to be a donor.

Q. Isn’t carrying a donor card good enough to be a donor?

A. Ontario now has online registration which is what is consulted by the teams in hospitals. You need to register there if you want to be a donor. You also need to talk to your family and friends about your wishes so that they can be honoured should you be in an accident which may make the conversation a necessity.

Q. Why would someone need a liver transplant?

A. There are a number of conditions which mean that the liver becomes diseased and transplant is necessary. They include viral hepatitis, autoimmune disease, metabolic condition, alcohol consumption, cancer and a large number of other medical conditions.

Q. Why did Mr. Melnyk need a liver transplant?

A. We are not going to discuss Mr. Melnyk’s medical history. We have permission from Mr. Melnyk and his family to talk about his transplant and his recovery and our responses will be limited to those topics.

Q. Was Mr. Melnyk given any special treatment given his public profile?

A. No. When anyone is very ill and a living donor comes forward, we can expedite the process for the donor and complete the evaluation in 24 hours. We have done this before and could well be doing this next weekend. The MOT team always works to save lives and it is the urgency of medical need which determines whether we use an expedited process. It is not unusual to have the MOT team respond quickly if there is a medical need and a living donor willing to participate.

Q. Mr. Melnyk was born in Canada and is a citizen but he lives in Barbados. Does he have OHIP coverage?

A. We are not going to discuss Mr. Melnyk’s personal health information beyond the transplant and his recovery from transplantation.

Q. When was Mr. Melnyk admitted to hospital?

A. Again, we are not going to discuss anything beyond what we have permission to discuss which is the transplant process and what happens after transplantation.