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If Delilah Saunders can benefit from a liver transplant, then she should get one. Whether or not she drinks alcohol is beside the point.

The 25-year-old Inuk woman has already survived a lot – three years ago, her sister Loretta was brutally murdered in Halifax. Since then, Delilah has become a dogged advocate for Indigenous rights: writing lyrics for a chamber opera about the over-incarceration of Indigenous people in prison; going on a hunger strike to defend Inuit land in Labrador, where she is from; and testifying at the Missing and Murdered Indigenous Women and Girls inquiry about her sister's death.

It was after that October testimony – about her older sister's pregnant body being dumped in a hockey bag at the side of a highway by a couple, Blake Leggette and Victoria Henneberry, who killed her rather than paying $430 in rent – that Ms. Saunders began drinking again.

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Her brother, Garrett, said Friday that she had been sober for months before she relapsed, and that she was on a waiting list for treatment.

Instead, she went into acute liver failure. Now, because she wasn't sober for six months before that happened, she says that Ontario's Trillium Gift of Life Network is refusing to put her on a waiting list for a liver transplant, even if it would save her life. The provincial health network is apparently also unwilling to test her loved ones for donor compatibility.

Spending some time alcohol-free is a common requirement for liver transplant patients around the world. The reason is a constant shortage of organs, and the need to figure out how to prioritize those in line for new ones. The liver is highly resilient, and one hope is that with time, it might repair itself enough that the patient doesn't need surgery at all.

That's usually wishful thinking: A 2011 study in the New England Journal of Medicine found that between 70 and 80 per cent of patients die before six months is up, instead. When it comes to the pre-surgery waiting period, a high chance of liver regeneration is not the only bit of unreliable science.

Researchers in publications such as the World Journal of Gastroenterology and the Journal of Hepatology have noted that abstinence before surgery doesn't necessarily lead to abstinence afterward. They've also pointed out that strong support networks, like the one Ms. Saunders seems to have, are an undervalued indicator of post-transplant success.

"The scientific evidence does not justify the waiting period. At some centres it's one year, some it's two years, in Ontario it's six months. It's arbitrary," says Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba. Doctors often muddy the line between assessing the usefulness of a treatment and the value of a patient's life, he says. "I think there's a widespread belief that people who engage in 'at-risk' lifestyles deserve their fate."

When faced with the unenviable job of prioritizing lives, it's probably tempting to make a quick moral judgment of those guilty of alcohol "abuse" (a tricky term, especially at this free-pouring time of year). Mr. Schafer wants every patient to be individually assessed for their chance of being helped by a transplant, which would require more resources than punishing those supposedly guilty of poor willpower by simply making them ineligible.

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Demonizing alcohol seems like an unstable stance for the Ontario government, which is denying Ms. Saunders while proudly touting $2-billion in LCBO profit in the 2015-2016 fiscal year. It's also counter to the opinion of addiction experts, most of whom see drug and alcohol abuse as a complicated health issue, one with a knotty mess of causes that rarely, if ever, boils down to personal weakness.

Ms. Saunders' trauma is both old and new: Her hunger strike was to draw attention to long-time mercury contamination in Lake Melville, where her people fish for food; her sister Loretta was studying murdered and missing Indigenous women before she became one.

Family say Ms. Saunders' liver issues were partly caused by taking acetaminophen for pain, but even if they weren't, she'd be far from the first person to use alcohol to cope when things get difficult, and denying her a transplant won't make her the last.

Perhaps the worst part of this story is that the Trillium network is planning to temporarily soften its six month sobriety requirement next August to study the long-term effects of transplants on those whose liver disease is related to alcohol.

To abandon Ms. Saunders today because she became sick nine months early would be callous, and another blow to a family painfully acquainted with suffering.

Editor’s note: An earlier version of this story incorrectly said Delilah Saunders is 26 years old. In fact, Saunders is 25.
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