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The Current Transcript for December 15, 2017

Host: Piya Chattopadhyay

STORIES FROM THIS EPISODE

Listen to the full episode

Prologue

[Music: Theme]

SOUNDCLIP

Right off the runway it started moving sideways. The plain open and people are starting start yelling at us. That is the last I remember

PIYA CHATTOPADHYAY: He's talking about the flight that crashed this week just outside of Fond Du Lac Saskatchewan. It was a near tragedy but luckily he and the rest of the people on board survived. Yesterday though in Eastern Ontario four people died after their helicopter crashed. Aviation disasters forever changed the lives of those involved. For those on board and those off as well including rescuers and their loved ones. In a moment we'll be hearing some of their stories. Then, she's a journalist and activist whose commitment to helping her fellow Eritreans who are routinely kidnapped and tortured as they flee their country is - well it's incredible. For example when she travels to the kidnapping hotbed of Sinai, she sometimes hopes this would happen.

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Maybe I will get kidnapped with them. Because I am a Swedish citizen and the camerawoman that was with me was French, the EU or somebody will try to rescue us and we would be able to rescue the others as well.

PC: A feature conversation with Meron Estephanos in about half an hour. Also today, Delilah Saunders needs a liver transplant to save her life. But the 26 year old indigenous activist is being denied it because she hasn't been completely sober for the past six months. Her family and friends say that is not fair.

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Anybody in this situation should be able to have access to a liver. This is a policy put in place to punish people for their addictions issues. Delilah deserves this because of all that she has given.

PC: Delilah's story and the ethics of strict transplant rules in an hour. Hi I'm Piya Chattopadhyay and this is the Friday edition of The Current.

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'I didn't want to die': Plane crash survivor and rescuer share their stories

Guests: Timothy Fern, Jeremy Kerr, Lindy Philip

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NEWSCASTER 1: Investigators in Saskatchewan are trying to figure out what caused a plane to crash. It happened last night less than a kilometre.

NEWSCASTER 2: Helicopter has crashed in eastern Ontario, north of Kingston. Four people are dead. The helicopter belonged to Hydro One, the province's largest power utility.

PC: Two days and two aviation crashes in Canada. First near Fond Du Lac Saskatchewan where thankfully all 25 people on the plane survived a crash on Wednesday. Then yesterday near Tweed Ontario where four Hydro One power utility employees were killed when their helicopter crashed. Statistically speaking these events are rare but when they happen they can have a profound effect, not only on the survivors but on their loved ones, their communities and on the people who show up to help. Timothy Fern is 16 years old and was on that plane that crashed in northwest Saskatchewan on Wednesday. I spoke with him yesterday when we reached him in Fond du Lac Saskatchewan.

PC: Timothy. Hi it is Piya. How are you?

TIMOTHY FERN: I am doing good. Pretty beat up, pretty sore but I'll be fine.

PC: What's going through your mind?

TIMOTHY FERN: It was terrifying. Something they never ever ever to experience.

PC: Tell me about being on that flight. When did you know that something wasn't quite right?

TIMOTHY FERN: We took off; it was okay, seemed okay. Nothing seemed wrong. I was sitting by the window. That's where I usually sit all the time. And I was looking down - as I was looking down when we were driving I could notice the trees were coming closer, closer and closer then my uncle Arson yelled out. And then the first engine, which was on the right wing I believe, cut off. The second wing cut off and then we hit the ground. And then I'd gotten knocked out. I woke up. I don't know how how long ago but I woke up then the person who was sitting beside me was gone. I unbuckled myself. I looked all around me. He wasn't there. I got out of the plane. Heard someone calling my name and it was him. He was standing there and just repeating himself over and over again the my name. He was pretty freaked out.

PC: What happened next?

PC: I asked him how did he remember what happened. He just told me that he woke up on the ground, and I told him that he flew out of the plane. After that I turned around and I noticed a lady just hanging there off the plane and she was covered in blood all over. I couldn't even see her face. Then she was asking for help. I had to help her so I helped her. After we got her down, she had her phone on her and then I asked her to call the cops but they didn't answer at all. Then I went back to the plane to check if everyone was okay. I was yelling there for about five minutes or so. No one was yelling back so I just decided it was best to go get help.

PC: And so you went. You walked and you left to go get help. Where did you walk?

TIMOTHY FERN: Just followed the moonlight. Followed the moonlight. Just keep walking. Kept walking with [unintelligible]. he stopped a lot of times. But I told them to keep following me. After a while we hit a trail when we had that trail. We've seen trucks and ski-doos and they were all driving by. So we just ran to the road and then Ranger Ivan Adam was on the ski-doo. It was the first one on the ski-doo stopped by me and asked where the plane was but I didn't know where it was. I just told him to follow my footprints in the snow. And then I left someone to the clinic as soon as we got to the clinic everyone was getting treated. And then my granny said that her and the lady named [unintelligible] heard the flight attendant talking to the pilot saying the plane is overweight. It is overweight and when the plane took off it didn't go straight. It was just the back part it was just leaning down and then after a while it just hit the ground.

PC: How would you describe how you're feeling and what you're thinking today?

TIMOTHY FERN: I feel okay. I do not know it is hard to say, but something I'll never forget but I feel okay.

PC: And when you were on that plane and you knew it was going down.

TIMOTHY FERN: I just thought I was going to die. I have seen the trees coming closer and closer and closer and we just hit it. The worst feeling ever. I didn't even... I don't want to die. I just didn't want to be there after the plane was going down but I was there.

PC: It's been less than 24 hours since you were involved in this plane crash. Have you talked to any doctors or seen any medical people yourself?

TIMOTHY FERN: Everyone got treated at the clinic. Everyone got checked out.

PC: You have physical injuries?

TIMOTHY FERN: Just bumps and bruises. That is about it. Scratches. That is it.

PC: What about your headspace?

TIMOTHY FERN: I didn't feel scared. I didn't panic. I just wanted to get out of there. I just wanted to go home. So I thought about just going home.

PC: What happened once you got home?

TIMOTHY FERN: I was so relieved.

PC: How's your family doing?

TIMOTHY FERN: We're all good. Yes pretty tough but we will be fine.[Unintelligible] I just feel gratefull.

PC: Yes.

TIMOTHY FERN: Very grateful. I do not feel like I am in shock or anything I am just grateful to be alive.

PC: Timothy thank you. Please do take care of yourself and check in with some people Okay.

TIMOTHY FERN: Thank you.

PC: was part of my conversation yesterday with Timothy Fern, a 16 year old survivor of Wednesday's plane crash in northern Saskatchewan. And we reached him in Fond du Lac, Saskatchewan. Well as word got out about that crash in Fond du Lac many community members rushed to the scene to help. Jeremy Kerr knows just what that feels like. In 2011 he was one of a handful of people who rescued six passengers from a burning plane that had crashed near Vancouver airport. Three years later he was awarded Canada's medal of bravery. Jeremy Kerr joins us from our Vancouver Studio. Jeremy Hello.

JEREMY KERR: Good morning.

PC: As you heard Timothy Fern just now speaking. What were you thinking?

JEREMY KERR: Ugh. It brought back everything that I went through with the plane crash here in Vancouver.

PC: So take me back to 2011. You were driving near the airport and then what.

JEREMY KERR: The flight path comes right over a six lane road and it was during rush hour. And I was making the turn to just head right underneath that flight path and I saw this plane coming down very awkwardly and something was very clearly wrong. And I just watched it drop right into the ditch beside the road it hopped up crossed six lanes of traffic and as it crossed over the median it shredded the bottom of the plane and it blew up. So the cockpit and the wings were on fire. And this was about 20 feet in front of my truck.

PC: And was there a moment where you thought what do I do? Or were you just like "rush and help"?

JEREMY KERR: I tried jumping out of the vehicle before unbuckling my seat belt. I remember that. I don't know exactly - I didn't really have much of a thought process at the time. I just had to act. I was the first person there. So as I was running towards the plane somebody else had pulled over and he and I were kind of running towards the back of the plane. There was a door at the back of the plane where there was no fire. And he and I were converging on this door looking at each other wondering what on earth we're doing?

PC: Because you've had no training with rescue prior to that day.

JEREMY KERR: None.

PC: And people died in that plane crash. There were fatalities. How many people did you - How many survivors did you help?

JEREMY KERR: Six survivors. We pulled six out. The pilots did not - well the pilot survived initially but unfortunately they passed away in hospital due to their injuries.

PC: And you know talking to Timothy yesterday for me what was so apparent was admitted or not, I mean that is a shocking traumatic experience and he's just at the beginning of that experience in a sense. So help me understand what the days after were like for you when you helped people in a plane crash and what the experience has been like since then. Has it changed your life?

JEREMY KERR: Yes it was a pretty remarkable very unusual experience. I felt a partial brush with death because we were going into the plane that was burning to pull passengers out. But in the days following the crash we went to a celebration of life for the pilot, the first pilot who ended up passing away. And that's where I met the families of the passengers that I pulled out. And the emotion I mean it was like nothing I've ever felt before. People hugging me and crying and thanking me - myself and the three other rescuers, just so appreciative for keeping their families together. It was just - it was something I had never experienced. And I instantly realized this is something I don't have in my life. You know I was happy being single for the rest of my life and it was very clear to me at that point that this is what life was about.

PC: So it changed you.

JEREMY KERR: Oh, drastically.

PC: And so what's changed practically.

PC: Well. I realize there were several - My life could use some improvement. I kind of did a full and a life analysis and I think the idea of your own mortality has an effect on you or certainly when you have a brush with death or when you're involved with the people who have had one. Well I wanted to check. I had all of a sudden this new checklist of the things I've been putting off like learning how to deejay, public speaking, develop a better relationship with my dad and the biggest one to allow love into my life. And following the crash I had a very open heart and through the help of friends sort of guiding me and I allowed love into my life and got married and we just we had a son eight months ago.

PC: Congrats.

JEREMY KERR: Thanks.

PC: This week we saw in Fond du Lac people from the community at small northern Saskatchewan community come out to help. And so you have helped strangers too. I imagine that community, a lot of the rescuers knew people. What do you want to say to them, to the people that helped as they sort of go through these days?

JEREMY KERR: Get help. I was very fortunate. I knew one of the firefighters at the crash site and so I was - and a lot of my friends from home a couple of my best friends are firefighters and they all urged me instantly right after the crash to come in to the fire hall. My friends from home encouraged me to go in and my friend here invited me in. And so I got to spend time with the firefighters who were part of the - we did most of the extraction. They came and put the fire out and pulled out the pilots. What they did is we stood around the back of the truck and had a kind of filled in the blanks for each other. I shared my story which was the part that they weren't there for. And then they shared their experience after because I was - I had to make the call to not go back in after the pilot. The flames were just too great at that point. And that really twisted me up and you feel like you could have done more. You really start questioning yourself and your decision making. And what the firefighters provided me was closure or at least they close the loop on it saying "no like we this is our experience. Here's what you don't know. We had to use jaws of life to get those people out". And you know so by having that, it kind of allowed myself to be easy on myself. After that I certainly went and got some help with a psychologist as well. It was a traumatic event. Whether people die or not I think you still question whether you could have done more. And this is one of the things the firefighter said to me is "we don't run into burning planes. And if we do go into a burning building we're wearing fire retardant gear. So you guys did far more than what we would have done". And that's a pretty remarkable thing to acknowledge when you're in a situation where you were recently in a situation like this.

PC: Jeremy Kerr that is part of the reason you got the care that Canada's Medal of Bravery for helping in the rescue of those six passengers from that crashed plane in 2011. Thank you very much.

JEREMY KERR: Thank you.

PC: Jeremy Kerr was in our Vancouver studio. I want to get one more person in on our conversation who isn't just a plane crash survivor herself but has gone on to reach out to other survivors and to collect their stories. Lindy Philip is co-author of a book called Bracing for Impact: True Tales of Air Disasters and the People who Survived Them. And Lindsay Phillip is in Sooke which is near Victoria British Columbia. Hi.

LINDY PHILIP: Hi there.

PC: You were in a plane crash back in 1995. Just tell me what happened.

LINDY PHILIP: Well first of all I just want to say a huge kudos to the first responders for sure. They're you know amazing. And secondly that recent plane crash they were all very very lucky. And as we were as well. It was a beautiful May long weekend back in 1995 and we were going, my friend and I, for a nice little vacay and I had a pilot friend. And we were just going over for the weekend. And ready to land on the airstrip. We are in a small Cessna 172 and he ran into some wind seer in a down draft. So he aborted the landing and tried to re re land and the plane didn't have enough juice. So all I heard was his beep beep beep beeping sound. I was in the back seat and a little confused about what was going on, and then all of a sudden the plane just started nose-diving towards a huge mountain and ravine. We clipped a whole bunch of trees, the top of the trees and crashed right into a huge ravine. And at that point I thought I was definitely losing my life. I grabbed my friend's hand and basically said this is it. And went down for cover and that's what happened. And we had 32 rescue workers coming to the scene to come and get us.

PC: You were rescued. I'm wondering it's been almost I guess 20 years almost. What's it like for you to get on a plane now? Do you get on planes?

LINDY PHILIP: I do. I certainly questioned it after the fact. I was scared to walk across the street with the trauma that happened but obviously life goes on and I did get the courage to go on a plane because I'm a traveller. And I thought there was no way this is going to you know ruin my life. I got to get you know back out there and so I did. But I prefer not to fly on small planes.

PC: And you were saying that you were on a plane with your friend, that was your boyfriend at the time who is now your husband. Right?

LINDY PHILIP: Correct.

PC: Tell me, you know with our last guest Jeremy Kerr how much what happened to you that day informed how you choose and chose to live the future so to speak.

LINDY PHILIP: Well now I totally choose to live more by the moment. I mean after that I mean I just you know I grasp like more fully I take the opportunities that I can. My emo is sort of like buy the shoes you know. Life is short.

[Laughter]

PC: And so you went on to co-write a book about the experience of other plane crash survivors. What is their relationship with like with one another? I imagine this is a very close bond that some of them form.

LINDY PHILIP: It is actually and how we came about all the stories in the book and the people, access to the people was I created a Facebook group page called Plane Crash Survivors and that's how we accessed everybody. So through that there is a really close network. It's a place where we feel safe. We all have that common bond and whatnot. So you know I think a few people have created friendships and whatnot over that and through that group.

PC: I imagine it's, thankfully, a small group in the sense that not many people are in plane crashes or not many people survive plane crashes, that bond must be incredibly tight between people who have that shared experience.

LINDY PHILIP: Yes it is. It is. We have about 90 members today.

PC: You heard my conversation earlier with Timothy Fern who survived this week's crash in northern Saskatchewan. What do you say to him and for other people who survived that crash or any other for that matter?

LINDY PHILIP: Well I mean I think you know talk therapy is really really important. You need to talk about it. It's definitely trauma and you know you think right after it happens that you're okay. But down the road you know the trauma is there and it will manifest in different ways. So I think it's really really important to you know talk to people go and get help for sure.

PC: Lindy Philip thank you.

LINDY PHILIP: Thank you very much.

PC: Lindy Philip is a plane crash survivor herself and she's also the co-author of Bracing for Impact True Tales of Air Disasters and the People who Survived Them. We reached her in Sooke, B.C. which is near Victoria. All right the CBC News is next and then the refugee crisis you have likely heard very little about. Every month thousands of Eritreans attempt to flee their repressive home country and many of them end up kidnapped and ransomed. And that's when they reach out to one woman Meron Estephanos. She's a journalist. She's an activist. And we will hear from her right after the news. I'm Piya Chattopadhyay. You're listening to the Friday edition of The Current. We're back in just a bit.

PC: [Music: Theme]

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How this journalist saves Eritrean refugees with her cellphone

Guest: Meron Estefanos

PC: Hi I'm Piya Chattopadhyay and you're listening to the Friday edition of The Current.

[Music: Theme]

PC: Still to come she's 26 years old and an Indigenous advocate who's been recognized by Amnesty International for her work. She's currently in critical condition in need of a liver transplant but strict Ontario rules say she can't receive one because she hasn't gone six months alcohol free. More on the story of Delilah Saunders in a half an hour. But first, another kind of lifeline.

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[Music]

Hello. Hello.

[Panicked woman speaking indistinct language]

Dear listeners, this is Meron Estefanos broadcasting from Stockholm, Sweden, Voices of Eritrean Refugees.

[Music]

PC: When her cell phone rings Meron Estefanos has no choice but to pick up. On the other end of the phone, as you just heard there are often desperate cries for help. She hears from fellow Eritreans who have fled their repressive home country in northeast Africa only to find themselves kidnapped, tortured and held hostage by traffickers in the Sinai Peninsula. Meron Estefanos left Eritrea 30 years ago for Sweden where she is a journalist and a refugee advocate, and where her phone never stops ringing; the kidnapped, their terrified families, even the kidnappers all have her number and they all use it. Since 2008 she has been fielding calls and doing everything she can to help save lives. The scale and severity of the flow of Eritrean refugees has been years in the making. More than 10,000 Eritreans have settled here in Canada mostly in Toronto and Calgary. Here's a snapshot of why.

SOUNDCLIP

According to the UNHCR 4000 Eritreans flee the country each month. Till today more than 300,000 Eritreans - over 5 percent of the population - have fled dodging Eritrean border guards with shoot-to-kill orders against people leaving without permission. The UN Human Rights Council has condemned what it calls 'the reported systematic widespread and gross human rights violations that have been and are being committed by the government of Eritrea; such as enslavement, imprisonment, enforced disappearance, torture, rape and murder'. Human Rights Watch has documented the torture of Eritrean migrants by Egyptian traffickers in the Sinai Peninsula through rape, burning and mutilation. Some are killed upon payment to ransom, others died from injuries. Since 2010 six hundred million dollars have been paid in ransom to traffickers of Eritrean refugees. Eritrea is one of the leading jailers of journalists in Africa and does not permit independent domestic media, non-governmental groups, or opposition political parties. It has never held elections and the government tolerates no dissent of any type.

PC: Meron Estefanos hosts Voices of Eritrean Refugees. It is a weekly radio program done from her kitchen studio in Stockholm, Sweden and that is where we have reached her. Hello.

MERON ESTEFANOS: Hi. Thank you for having me.

PC: Meron what kind of calls have you been getting on your phone today?

MERON ESTEFANOS: Ah all the phone calls today is regarding the refugees who are stuck in Libya. So it is say family members and the refugees themselves.

PC: And what are you hearing from the refugees who are calling you today and their families?

MERON ESTEFANOS: The ones who called me today is it's a group of 136 Eritreans who are being detained in an illegal detention. So it's now that they start realizing that it's an illegal detention because the militias holding them are asking 3,600 dollars each to pay them so that they could take them to the legal detention.

PC: And where have they gone? Have these people left Eritrea? When do they get to Libya? Tell me a bit about their story.

MERON ESTEFANOS: They being in Libya for, most of them, like over nine months. So these are people that are being sold and resold again and again and again some of them have paid up to thirty thousand dollars, each time the ransom was five thousand dollars. And now when they got arrested about eight weeks ago. So they were happy that they're at least in a legal detention and UNHCR will come and register them. But in this case they've been waiting for eight weeks and then they realize today when they were asked to pay additional 3,600 dollars. That's what they told me.

PC: Meron, what are they asking you when they call you?

MERON ESTEFANOS: What they wanted to know is if there is a way for me to contact the Libyan government or NGOs that could help them come and rescue them. But unfortunately there is no help for them. The only way is if they managed to escape or if they pay the money that they are being asked for.

PC: So what do you say to them?

MERON ESTEFANOS: I just tell them the way it is and I I still you know try to talk about them and I say "okay I'll do my best. But this is how it looks like". I tell them the truth.

PC: Take me back. Do you remember the first call that you ever got, back in 2008 I think it was when you started doing this?

MERON ESTEFANOS: Oh yes. The first call from a refugee was actually from Libya. Sadly it was during Gadhafi the same deal that European Union has made now is the current governments or militias in Libya. So there was another deal back in 2005-2006 with Gadhafi stop the refugee from coming to Europe. And at that time many Eritreans were stuck. The same thing like right now so it feels like history is repeating. So this was a group of people 400, I think 500 people who was imprisoned, mothers with their children. So they just nobody was talking about them, so all they wanted was not asking for help but they wanted people to know about their situation. So they asked to be interviewed and that's how I got involved with refugee issues.

PC: You host a radio show. I mean how have so many people found your phone number since back then and how has your numbers spread?

MERON ESTEFANOS: I mean at the beginning you know like the Eritrean community is a small community everybody knows everybody. Somehow one person knows the other person and that's how they get my number. But now the last since 2010 I've been announcing my phone number in case of emergency that people can call me or sometimes I do missing Eritrean program which many missed on on route on the way to Europe or elsewhere. So I always ask if you have any information regarding this person contact me on my number. So that's how most of them do save my number in case of emergency.

PC: Meron Estefanos, remind us why are so many Eritreans and why have they been fleeing their home country over the years?

MERON ESTEFANOS: Eritrea is a country. What can I say. We don't have a visible war but it's a country at war with its citizens where there is no any kind of freedom. There is no freedom of movement. There is no freedom of speech or freedom of religion or anything. So like even saying that you were starving c could be interpreted by the regime. like 'are you trying to claim that there is starvation in the country?' So anything you say can land you in prison and on top of that we have the so-called national service which I refer to as a national slavery where people from age 16-17 up to 50 have to serve in the military. So if you are a doctor as part of your military service then you will work at the hospital. If you are teacher it's also part of your military service. So the whole country is run - almost a quarter of our population is in the military. So that makes a fail state.

PC: When they escape where they are trying to go?

MERON ESTEFANOS: When they escape, so you go to neighboring countries like Ethiopia and Sudan. Sudan is no easier; a lot of people use Sudan.

PC: And where are they ultimately trying to head where are they trying to get to?

PC: At the beginning I mean it's no one really have any intention on going elsewhere. So most of the people they just want to flee. They are tired of the militarisation. They are tired of. They've seen their older siblings in the military. So if there are eight children in one house then eight of them are going to serve. The father is also in the military which leaves their mother stuck. So most of them do not have any plan you know to go further. So first the first thing that comes to your mind is just escaping from Eritrea, knowing that there is a shoot to kill policy at the border. So all you say is okay 50/50 let me try if I succeed then at least I'll figure it out once I get there.

PC: Where exactly, as you say you help people who are being trafficked some are being kidnapped. How are they so susceptible to being kidnapped and trafficked what is fueling that?

MERON ESTEFANOS: Once you escape from Eritrea the Eritrean government consider you're not Etitrean for their concern. I mean they are not concerned about you because you are a traitor you have fled the country. So whatever happens to you. Good. They don't really care. And the Sudanese government they don't have a good track of the human rights record as well. And then [unintelligible] I don't even know because the kidnapping happened right at the border because up to 6000 to 7000 Eritreans flee every month. And some criminals saw this as a business opportunity by kidnapping these people nobody is going to challenge you, nobody's going to talk about it because you're an African anyways. So then you get kidnapped and then you get sold to you know to Egypt or elsewhere.

PC: And I understand in addition to people who have escaped Eritrea calling you for help, from places like Libya, that also sometimes your phone rings and it's a kidnapper or a trafficker on the other end of the phone.

MERON ESTEFANOS: Yes was a work that I do you know somehow you do speak to traffickers or smugglers. Or for example if I'm doing a program on another one smuggler who abuse many refugees or whatever and that smuggler feels like he wants to defend himself. So it's often that they call me and want to be interviewed.

PC: Why would they want you to hear that abuse and that torture?

MERON ESTEFANOS: Well the traffickers, I mean that's what they want. It's to scare people. So when you called a hostage, somebody is being held hostage and the way they make people pay is by letting you listen as your loved one is being tortured, gang raped and burned and all kind of sadistic methods of torture. And the family listening as your loved one is creaming of pain and in order to stop the phone calls that's why you pay the ransom even though we know paying ransom is no good. But there is no other option. I mean you are left with 'you die or you pay'. This are the two options that we have. In order to make the families pay so they have to make you listen to the torture.

PC: And so when you get a call like that I mean there must be times when you answer the phone and you hear that stuff, you're all the way in Stockholm. What is that like to hear that?

MERON ESTEFANOS: At the beginning it was really tough. The first three months when I start talking to hostages my life was changed upside down like I became another person. I used to take my life for granted. I used to complain about small things you know. But listening to their cry, to their agony changes you as a person. And so it was like at the beginning if I did not answer my phone whenever they called it felt like they will die and it will be my fault. When I was eating I used to feel guilty because you would feel, you know they haven't eaten for six days, eight days and you are eating. So it just changes you as a person. It kind of I stopped being friends with most of my friends because the things that they think is a big thing is nothing for me because I'm talking to people that are dying. You know I could interview one hostage and then five minutes later and another hostage will tell me will calling me just to tell me "oh the person that you just interviewed just died on us". That kind of thing. It disturbs you. You know it's not like a normal job where as a journalist you interview and you're done and you go do another work. That wasn't the case in this case. You know I was stuck in it like there was no going out of it.

PC: Yes I bet. And when someone who's doing the torture, a trafficker, a kidnapper, when they call you what on earth do you say to them?

MERON ESTEFANOS: You just have to pretend to be kind to them because anything you say they're going to take it out on the hostages. So you know we suck up to them and which hurts because these are people that are kidnapping people, scaring people, auctioning people, torturing people, raping people and holding them for ransom. So it's a very difficult thing is like I hate that part when you're talking to them and try to negotiate prices. Sometimes you know you ask them "can you go down?" because we're talking about four children, four siblings that get kidnapped a week ago and they are being asked 50,000 dollars each and the family have to pay 200,000 dollars so you have to be nice. What can you do. It hurts but you have no option.

PC: You don't just help and get calls from people who have reached land. You get calls from the middle of the Mediterranean. I think the number that comes up on your phone when you get a call is 0 0 8 8 8 and that means that someone is calling from a satellite immobile on the Mediterranean, probably from a sinking boat of migrants. Yes?

MERON ESTEFANOS: Yes. Yes. I find the distress calls more disturbing than the hostage taking because with the hostage taking it's not something that you have to do urgently. The first phone call that I received from a boat in distress, I think it was in 2010, 425 people lost at sea and they do not have enough fuel or water or food, screaming saying you know that their lives depend on my hands which I did not want to take that kind of responsibility but they were giving it to me. They were saying after God like we're depending on you.

PC: What about the Italian authorities? Most of these people are trying to get to Italy. How responsive have they been?

MERON ESTEFANOS: At the beginning it was difficult because there was a bureaucracy when I called the Italian coast guards and they would tell me call them Maltese coast guard they are closer to Malta because nobody wants refugees. Rescuing them means giving them a shelter as well. So Malta will tell me call Italy. The first phone calls that I receive I actually waited almost 78 hours until they received help which was disturbing. I could not eat. I could not do anything because they're telling me 425 people are telling me I'm responsible whether they live or die. So it was very frustrating. So I had to use social media, journalists and things like that to pressurise them and at last Malta went and rescued these people.

PC: I want to ask you to tell me about a specific story and this is a boat and Eritrean priest that you tried to help when he had been kidnapped in the Sinai. Tell me what happened this priest.

MERON ESTEFANOS: His name was [unintelligible]. He was 36 doing military service for many years and then he decided he was fed up with the system so he decided to escape and finally made it out. Just when he crossed to Sudan at the border he got kidnapped and was taken to Sinai. So once he reached in Sinai he was being asked to pay 20,000 dollars and he comes from a very rural area in Eritrea. It's not a city. They don't even have a phone in order if we are going to call his family we have to wait three days. So when his ransom was 20,000 dollars his family could not pay the ransom because they owned only six goats or sheeps or something like that. That was all the belongings the family had. So the whole village sold everything they owned in order to save him. And it was not enough. So they went to their second village and begged for money. And the second village sold all their belongings and at last they had nineteen thousand five hundred dollars which they sent to the Bedouins in Sinai. And once the money was received the Bedouins did say "no we're not releasing him until we get the five hundred dollars remaining" which their family could not come up with five hundred dollars. So the sister had to go to the village collect, to beg for money. And that's when I called them and notified them that he had died in Sinai. So in order to rescue one person three villages that were very poor get poorer and sadly he was not saved.

PC: That must be so hard for you.

MERON ESTEFANOS: Yes it's very hard. I mean it's hard listening to the torture and also hard to notify families that you don't know, that you have never met but a person, that you have never met, to let them know that he has died. Because most of the times the torturers they demand money even after the person is dead. So they would tell their families yeah he's alive, pay up first and then we'll let you speak to them. So many families pay for a person that's already dead. So that's why I rushed to notify them that he's dead. And it's very difficult to notify a person you don't know.

PC: Your involvement in all of this, it has gone beyond picking up a phone and in Stockholm. You have gone further. You travel to try and find and rescue people yourself. You go to the Sinai to try and help that. That must be a risky adventure for you.

MERON ESTEFANOS: Yes going to Sinai was risky and at the same time stupid. You know I'm a single mother of two with has no father in the picture. Going there was a big risk for my life because these are traffickers that have threatened for years and to go there - It was something very difficult. I was trying. I had no idea what kind of area I was going to. Sinai is a demilitarized zone. There is no military that could help you. There is no police. It's just you know, there is no role. It's just anarchy. Every clan have weapons.

PC: When you when you get there what do the Eritrean people tell you? What kind of attitudes do you encounter?

MERON ESTEFANOS: I mean there is no Eritrean that I met in Sinai because all the urchins were being held hostage. So I was talking to them over the phone. And my hope was somehow trying to free them, or even if I get kidnapped that will bring more attention because no media outlet was writing about this issue or covering this issue. There was no interest like I tried for years trying to get like mainstream media to talk about these issues. But I couldn't. So my idea was 'Okay let me get kidnapped and then I'm Swedish, at least now the international media will talk about me because this time it won't be rich as being kidnapped. It would be a Swedish woman and the camera woman was French. So we had already thought of getting kidnapped.

PC: Wait a minute. Your idea of getting attention brought to this was I will get kidnapped myself, because I am a Westerner, that the world will pay attention to the crisis of migrants being kidnapped through Africa and into Europe.

MERON ESTEFANOS: Yes that was my idea when I went there.

PC: You didn't do that.

MERON ESTEFANOS: No I didn't. And only because the fixer that I hired which I did not know - I had just met him five minutes before - he happened to be a nephew of the torturers. So he was my safety because I was with him so that's why I did not get kidnapped. That almost three times I almost got kidnapped when they saw me filming outside of the houses.

PC: If you had to count, Meron Estefanos, how many calls do you think you have received over the last - almost - decade since you've been doing this?

MERON ESTEFANOS: I never count. You know it depends sometimes it's like 100 calls a day and sometimes it can go up to 500 calls a day especially when there is a boat in distress or a boat drown. So every family member of those people is going to call me, so it's a lot. So it's averages 50 calls a day, between 100-500 is a very normal thing on a day.

PC: And how do you keep track of all these people? Like you're getting 50 to 100 calls a day from sometimes the same boat that is going down sometimes from all over the place. How do you how do you keep track of who's who so to speak?

MERON ESTEFANOS: I don't know somehow you know they leave a special place in your heart that you cannot forget - some of the victims - I might forget family members but victims I mostly remember. So yes. And then they will remind you "we spoke about this issue or that issue". So you can't remember everybody but I do remember a lot of people.

PC: We have been talking and hearing the stories of people, of migrants escaping this past year and before, Meron. Do you see an end to this in the work that you do?

MERON ESTEFANOS: Not really. I mean for us it's a chance. It's like I think for most refugees actually unless you change the root cause, it doesn't really help you know. You can rescue people in Egypt, like in Sinai and rescue people in the Mediterranean Sea but that does not stop the migration. So to me it's like for us a chance to stop migrating the regime in Eritrea, there must be a regime change. That's the only way. That's what I believe. As long as this regime is there we will see - I mean like everybody is going to be wiped out. You know they probably a million have left in the last 15-20 years. And I don't know what we're waiting for you know because I see now the refugees that are fleeing Eritrea right now just like they are getting younger and younger each year. So I've met the youngest refugee along is unaccompanied child who are 7 year old, just left by himself and arrived in Europe by himself at the age of eight. So this is what's scary is because the older have left. The older generation and three generation almost have fled Eritrea. And I don't know who going to be left unless something changes in Eritrea. So I doubt things are going to change anytime soon. If you look at the crisis in the world right now and at the same time, if you look at countries like the right wing is on the rise. That doesn't help is there. There is no sympathy. There is no apathy when it comes to empathy when it comes to refugees these days. You know politicians are using them for their own whatever purposes as well.

PC: Meron Estefanos thank you for speaking with me today and also for the work that you do. Thanks.

MERON ESTEFANOS: Thank you for having me. Thank you.

PC: Bye bye.

MERON ESTEFANOS: Bye.

PC: Meron Estefanos is a refugee advocate and radio reporter who hosts Voices of Eritrean Refugees. She's in Stockholm Sweden. We requested a response from the consulate general of Eritrea here in Toronto. But we have not yet heard back.

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PC: That is the late Eritrean artist Abraham Afewerki singing that although Eritreans have seen oppression and hardship they still smile and that their strength is the size of the ocean. All right. Coming up saying 'no' to liver transplants from anyone who hasn't remained sober for six months. It may sound like a fair idea in the abstract but when you meet the realities, people in need of transplants, people like Delilah Saunders you may find that it is much more complicated. Her case and the ethics of denying transplants. That's coming up in just a bit. I'm Pia Chattopadhyay. You're listening to the Friday edition of The Current.

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Delilah Saunders needs a life-saving liver transplant. Ontario rules say she's ineligible

Guests: Jed Gross, Arthur Schafer, Rolf Barth

PC: I'm Piya Chattopadhyay and you're listening to the Friday edition of The Current. In case you're counting you've got just about a little more than a week till Christmas. And I want to take a moment to tell you about a story that is coming up on next week's show. It is the first Christmas season for Michael Morin in his new role as Santa Michael in Ottawa and he's doing it thanks to the gift of a vintage Santa suit. For Michael and a lot of Santas who have worn this suit. It's more than just a game of dress up.

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I have to finish my face before I start getting dressed. See. Like I said this suit is really warm. It's wool. It's shearling. It's 45 years old. It's really warm, so that goes on last. On the front porch of their house, Larry told us about the work he did. And that was the only conversation I ever had with Larry. It was about him in his work and I was fascinated. Then we came home and you know never thought any more about it. Of course it left an impression. I thought it was wonderful work that he did. But then I only found out about the suit, basically two years after he died. I had no idea. Well that was on his deathbed. He wheeled one of his suits to me because based on the little conversation we had on the front porch he basically chose me.

PC: Our documentary Becoming Santa is coming up next week here on The Current.

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PC: I'm Chattopadhyay and you are listening to the Friday edition of The Current.

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My name is Delilah and I started with the work that I'm doing. Mostly raising awareness.

PC: That is Delilah Saunders speaking out about two years ago urging the creation of the inquiry into murdered and missing indigenous women. It's an issue that is close to her heart. Delilah's Inuk originally from Happy Valley Goose Bay, Labrador, and her sister Loretta was murdered in 2014.

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DELILAH SAUNDERS: After she was murdered last year in February in Halifax. She was studying missing and murdered indigenous them and she was writing her thesis on the topic. And...[sobs] Sorry.

PC: It is a difficult subject but Delilah did speak this year at the federal inquiry into murdered and missing indigenous women and she has been speaking out a lot. The 26 year old recently received Amnesty International's Human Rights Award for her advocacy work. But last Friday she was feeling unwell and Delilah checked into an Ottawa hospital. She was diagnosed with acute liver failure caused by acetaminophen toxicity and she was told she needed a liver replacement to live. But because of strict rules in Ontario her alcohol use in the past six months disqualifies her from receiving a transplant. Her mom Miriam Saunders spoke with CBC Radio's As It Happens last evening.

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MIRIAM SAUNDERS: She has been off the bear for - She was in recovery for four and a half months and then after the murdered and missing inquiry she called me a few times saying that she felt so alone, and that she never had no support. There was no support put in place for her when she left the inquiry. So, she had had to slip a few weeks ago and a drink. So, that is the reasoning.

PC: Miriam Saunders says that both she - and several of Delilah's friends - have offered to donate their organs but to no avail. Which means that Miriam may lose a second daughter in the space of just a few years. I

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MIRIAM SAUNDERS: Didn't think I could hurt any harder than when I lost my baby. I told people I care no more, I lost my baby because those murderers killed her. But now to sit down and watch people who's supposed to be saving lives, watching my baby die. It's the same thing; the government is murdering my baby because they are capable of saving her life and many others, that they refuse who need a liver transplant because of alcohol.

PC: There are reports today that Delilah Saunders has now been airlifted to Toronto to get another further assessment. Well the agency that coordinates organ donations in the province of Ontario is the Trillium Gift of Life Network and it's had its strict sobriety rules challenged in the past. And a pilot project is set to begin next August lifting the six month requirement. The pilot project though will not be a first. There are several U.S. hospitals who have decided individually to do away with the six month sobriety rule for alcoholics. The University of Maryland Medical Center is one of those hospitals. Dr. Rolf Barth is the director of liver transplantation at the University of Maryland and he is in Baltimore. Hello.

ROLF BARTH: Hello.

PC: Why did the University of Maryland Medical Center get rid of it six months sobriety requirement for alcoholics needing a liver transplant?

ROLF BARTH: Well not necessarily our choice. The six month rule when we looked at it has origins that were relatively arbitrary, that the idea of someone quitting alcohol, who has had a long dependence for one month or three months or six months, turns out that it's not actually until about five years of sobriety could you reliably predict that someone would have an extremely low rate of relapse. We had a case approximately ten years ago of a young man in his 20s, who was a very functional active member in the community worked every day. But he was a heavy drinker and came into the hospital with his first episode of really severe liver failure. Our policies like many policies were not to even consult him from a transplant perspective and that's just not the criteria. It was the hospital's ethics committee that got involved at that time and suggested that this was a unique case and that there were mitigating factors that despite ongoing alcohol use that he would be expected to live a long and productive life. He'd already demonstrated the skills to be a productive member of society and that to restrict his access to an organ transplant that saved his life was not necessarily ethically justified. So we were actually happy to have that instruction from our ethics committee. He actually went ahead and got transplanted did fantastic and ten years later is living a productive happy life. So we at that point had realized that we would need to potentially look at cases individually without this blanket statement. And I think that's pretty common for senators to say if it's not six months come back when when you've been sober for six months. There are a lot of patients who may not survive to that point.

PC: And Dr. Barth you said at the beginning that the research shows that according to you that at least five years of sobriety is needed. Is that your understanding?

ROLF BARTH: Well I didn't say it's needed, but I would say that the idea is like a cancer the chances of relapse - what we call recidivism - We've just recently wrote and published a chapter in a book on the currents of liver disease. Liver disease comes from many different causes; viral infections, auto immune diseases, alcohol is one of them. And that disease can recur. And like any disease it can recur. The chance of recurrence decreases the further you are away from it. So a cancer that was removed from someone whether the chances of recurring in one year or if they are cancer free five years, are they cured. You know these are fairly similar to the use of alcohol that. You can't really be cured of alcohol dependency in a predictable way. The six months rule was set as one of the first criteria a long time ago. But the idea that people who quit for six months had relapse rates that were significantly lower than those who had quit for three months. There's no data to really support that.

PC: And at your hospital before that a man came in who was very active in your ethics committee said we should change our rules, how had you found your six month rule working?

ROLF BARTH: It's an arbitrary rule. It works only as good as any kind of rule. So generally for alcoholic liver disease the relapse rate is about 30 percent of people will return to using alcohol. Now the majority of those people who return to using alcohol don't use it honestly in ways that injure their liver. The patients that do start what we would call an 'injurious pattern' of alcohol use that damage their transplanted liver that can be detected by laboratory values and can really be alert to the clinical team that people may have started this pattern of behavior again. So I guess my point would be that we expected that six months of sobriety, still people are at risk to return to use alcohol. You know alcohol use is very prevalent and it turns out that people who get transplanted with livers for other diseases, that don't have anything to do with alcohol, also use alcohol despite recommendations that they should avoid it. So the prediction that someone will use alcohol in a non injurious pattern occurs about 30 percent amongst all patients. And to people who obviously that causes liver damage, this is where the ongoing kind of team approach to monitor them, to engage, to expect the chance for relapse. And then use our social workers and their substance abuse teams to really engage with those patients when we suspect that.

PC: And so now that your hospital has done away with the six month rule, what isthe process now for determining if a patient is a good candidate for receiving a liver transplant?

ROLF BARTH: Transplantation in the United States is a highly regulated process. Every week we have a committee of around 25 providers who make decisions on each case. This includes transplant surgeons, transplant haematologists, transplant nurse coordinators, social workers, psychiatrists, substance abuse nutritionists, financial advisers and really on a case by case basis we make a decision on 'does somebody need this organ transplant to live?' And 'will it extend their life?' A lot of the social basis for kind of qualifying this is 'could someone take care of a liver transplant?' Care of a transplant means taking medications twice a day, getting blood work regularly and being compliant with physicians.

PC: And is one of the questions that you ask within that team, is past alcohol abuse a consideration at all?

ROLF BARTH: Absolutely. I mean alcohol is like any other disease is the primary inciting event. So it is still a highly selective process. The other diseases that people get transplanted for including hepatitis C can be strongly associated with I.V. drug use. So in the transplant community it is very common to have patients with complex social histories that include I.V. drug use, alcohol use, that can include metabolic disorders including obesity that all have components of behavioral disease.

PC: And since you have changed the rules what have your outcomes in terms of transplants that you have done, liver transplants been like?

ROLF BARTH: Clinically the success rate per patient has acute alcoholic hepatitis is amongst the highest of any indications for transplants. So in terms of arguments a utility 'are we using these organs wisely and in a way that they're not being wasted?' our success rate with the surgical operation, the one year survival rates, are in the mid-90s. And that's about 10 percent higher than transplantation for other indications. So is it a successful cure? Absolutely. Now I want to make one caveat. If someone is healthy enough to go through six months of rehabilitation and counseling that is always our first approach? This is a highly selective approach. If we apply for a patient is too sick to go through these processes someone who would be dying within the next weeks. And this is a selective case where we don't think six months absolute absolutely is appropriate.

PC: Well I'm glad you bring that up because that sort of pertains to one of the cases we're dealing with here in Canada. And one of the arguments of critics, who say we need this six month rule, is there are a finite number of donated livers and that giving one to an alcoholic is taking it away from someone else who doesn't have a drinking problem. And Dr. Barth you would say what to that?

ROLF BARTH: Well I think there are considerations with every patient. We have one of the largest wait-list on the East Coast of the United States - almost 500 people on my transplant wait lists waiting for livers. But livers are allocated to the sickest patients. So if someone has an alcoholic hepatitis or liver disease from any other cause, their degree of illness is based on a calculated score. It's a mathematical formula. It doesn't take into account race, religion, gender or how they caught the disease. So this is a very objective formula that everyone uses and organs are allocated to those sickest people who will not survive. I think that patients who are at the top of the list, in terms of they're not that sick, they have time to go to processes, to wait on the list, to wait for the next orgasm. It's really these people with these very high scores who can't leave a hospital stuck in an intensive care unit that get these livers. And I think these are highly justified and the outcomes are excellent. I would say one other thing that's interesting, when you don't do this, when you say six months is the ironclad rule you don't learn about the patients and the diseases and the way they affect people. And what we've come to recognise in the last couple of years is that women are particularly disadvantaged when they are in these acute phases of alcohol hepatitis. If a female patient develops renal failure their kidneys start to struggle in these phases. They almost have a zero percent chance of survival within three months. Men have a little bit better are physiologic reserve. Finding that out has also informed our clinical team that we have to think of these patients differently. A male patient may have some extra time, may be able to get to a very ill period to be able to engage in simply dilatation, but that the female patients are particularly disadvantaged when it comes to this.

PC: Dr. Barr thank you for sharing your experience and learning with us I appreciate your time today.

ROLF BARTH: Absolutely.

PC: Dr. Rolf Barth is the director of liver transplantation at the University of Maryland School of Medicine. And we reached him in Baltimore. Well clearly there are some complicated ethical considerations behind these kinds of decisions. And I want to welcome two people now who have given them a lot of thought. Jed Gross is with the University Health Network in Toronto. He is a bioethicist and he's with me here in Toronto. And Arthur Schafer is founding director of the Center for Professional and Applied Ethics at the University of Manitoba. He's in Winnipeg. Hi to both of you.

ARTHUR SCHAFER: Good morning.

JED GROSS: Hello.

PC: Jed Gross let me begin with you. What is the rationale that justifies a sobriety requirement?

JED GROSS: Historically there were two reasons given. The one is that some patients who have acute alcoholic hepatitis, which typically develops before they would progress to alcoholic cirrhosis can spontaneously recover with medical management. So the thinking is that when we are allocating a scarce resource it would be preferable not to be transplanting patients who might recover on their own. And then the second rationale that has been given concerns transplant outcomes if people relapse into drinking in particular. I think originally the theory was that they might destroy the second liver. There's not a lot of evidence to support that but there are conditions in transplant recipients for example, they have an increased risk of cancer when they're on immuno-suppression that may be complicated by alcohol use.

PC: Okay, that's the thinking of how we got to today. What do you think of this, this quote unquote 'rule' today?

JED GROSS: Well I think that it's time to revisit it. I think that this was done in good faith. But what we're always trying to do is balance maximising outcomes and maximising access based on medical data. And this is a case where as often happens the data suggest that it may make sense for our criteria to evolve.

PC: Arthur Schafer where are you on this? How ethical is this kind of a requirement?

ARTHUR SCHAFER: Well I think it's reasonable when you're allocating scarce medical resource, indeed when you're allocating any medical resource even if it's not scarce, to ask the first primary question which is 'will the patient benefit from this treatment?' Obviously the treatments involve risks of harm to the patient, possible benefits. So if the patient can't benefit you shouldn't do it. It's just a futile. It's a waste of resources. Now most of the criteria for eligibility - to get listed for an organ transplant and a liver transplant in particular - most of the criteria ultimately come down to 'is your life so chaotic' or 'are you limited in such a way and without adequate support systems that you won't take the immuno-suppressive drugs without which your body will reject the organ, that you won't follow the proper diet, that you won't come for follow up visits and do the blood work?' So if as a result of alcoholism or some other condition perhaps a patient is psychiatrically unstable - if those people don't have support systems and aren't really committed to following the protocol then they aren't going to benefit. I think that is an ethically defensible criterion. Will the patient benefit? If the answer is their life is so chaotic that they won't benefit, then they shouldn't receive the organ. Maybe it shouldn't even be put to them as an option.

PC: Except for that we heard from the doctor in Maryland saying you know their rules change because of the patient who yes drank a lot and would be called an alcoholic but lived an otherwise healthy lifestyle and could do all these things. His argument is like let's not throw all these people under the same label. So do you worry about it coming down to a morality judgement over good medicine?

ARTHUR SCHAFER: I think underneath the rationale of 'will the patient benefit' lies the kind of doctor-as-priest or physician-as-moralist kind of mentality. And it's not just doctors, in general in society people tend to think that if you've got lung cancer because you were a heavy smoker, or you've got cirrhosis of the liver because of your heavy drinking, or if you've got heart disease because you're obese and didn't exercise that somehow you're at risk lifestyle means that you're blameworthy. You're responsible for your disease and maybe you don't deserve to be treated. I think that's a really inappropriate ethically indefensible approach. After all I'd invite listeners to consider. What if you're jaywalking and you're hit by a car. Well it's your fault. Should you be denied lifesaving care? I think doctors and health care systems and organ transplant systems shouldn't be asking, shouldn't be making moral judgements. They should be asking 'will this patient benefit? Will the procedure save their life?' And if the answer is yes I don't think we should smuggle in covertly moral judgements.

PC: Let me just clarify one thing Jed Gross. If a smoker wants or needs a lung transplant for example does the same kind of restriction apply to them?

JED GROSS: It really depends on what we're talking about. I would think that they are at most transplant centers there a requirement that patients abstain from smoking and in some cases even other forms of supplemental nicotine that may be linked to relapse into smoking. I don't know if it is as rigid as the criteria for alcohol.

PC: Okay so let us just you know get back to the liver transplant argument, which is six months of sobriety is needed or you don't get qualified to be on the waiting list. What other considerations should be taken into play, Jed Gross?

JED GROSS: For a patient who is waiting but has not reached that six month milestone, I think that like any other patient we want to look at factors that are linked to good long term transplant outcomes. So do they have social supports? Are there psychological factors that suggest that they would or would not be adhering to a rigorous immuno-suppressive regimen where there's not a lot of room to slip up? We may need to apply them in a slightly different way, or ask slightly different questions during the work up if the patient has a history of heavy alcohol use. But the basic approach would be the same.

PC: Arthur Schafer what questions should we be asking?

ARTHUR SCHAFER: Well I think just to go back to the moralistic approach, I think we should be very wary of judging people, judging patients morally. And if you look at the case of Delilah Saunders, she is an Inuk woman. And she comes from a community that has suffered great oppression. You'd expect that alcohol and drug abuse would be more common amongst the most disadvantaged people in society.

PC: And to that point, so many Indigenous communities see this requirement as discriminatory.

ARTHUR SCHAFER: Well I think it is. And I agree I agree with Jed that monitoring and support systems are important. Indeed that's a point that Dr. Barth made. So if a patient doesn't have adequate support systems within their community, within their life. I think part of the health care systems obligation is to provide that, to provide a social workers and nurses and other community workers who can make the operation a success. The idea that the most disadvantaged people then get doubly disadvantaged because we deny them life lifesaving transplants because we judge them to be not likely to succeed. It seems to me - first of all it's arbitrary - as Dr. Barth explained the outcomes aren't really well predicted by the six month rule. It should be scrapped and the one question we should ask is 'can this patient benefit?' Or 'can this patient benefit if we provide adequate supports for them?' If the answer is yes they should not be excluded.

PC: Here's the other thing some people are suggesting was make it on a case by case basis. Just assess the patient and then decide. The criticism to that if it is personalising case by case that you risk a lot of criticism about the fairness each time, that it's up to an individual medical practitioner to say "yes you were worthy" and another one to say "no you are not worthy". Jed Gross you say what?

JED GROSS: I think that's exactly right that some type of a mechanism to identify exceptional circumstances in which we might waive ordinary requirements makes a lot of sense in terms of procedural justice, but we have to be very careful to ask transplant programs to spell out the reasons for that exception. Because otherwise whenever you introduce discretion there's the possibility of prejudices creeping in or arbitrariness.

PC: And so to the case of Delilah Saunders which is now getting a lot of attention. Is there a risk - we know that Ontario is going to change its policy of this pilot project in August - Is there a risk that this sounds uncouth - and I don't mean it this way - that the high profile nature of this might get her the help that she desperately needs and should be assessed at a different mechanism.

JED GROSS: Sure there is. I think that with any public case or controversy it can bring attention to both the need for more organs and cases in which it makes sense to revisit existing policies. But there's always the risk that if the people making the listing decisions feel pressured by public sentiment or the glare of the spotlight that could lead to patients being listed, who otherwise wouldn't, which results in organs going to people where it may not be the most appropriate choice.

PC: Arthur Schafer what do you want us to be thinking about as we think about the Delilah Sanders case and also the pilot project that is set to begin next August and as a bioethicist?

ARTHUR SCHAFER: Well the first point I'd make is that good ethics requires good facts. And if the criteria are arbitrary and not supported by good scientific evidence then they should be scrapped. And I think the criteria we're using now, in particular the six month rule, is arbitrary and not supported by science. And then I just make one additional point. I think a lot of the denial of treatment to patients occurs without the patients even being aware because the possibility of a transplant may not be raised with a patient. If the physicians decide that they aren't going to benefit. And so if the physician is subject to common biases and prejudices that prevail in society, the patient may never even know that they were excluded and that they could have been a candidate. And I think that's something of which the medical community should be keenly aware.

PC: Arthur Schafer and Jed Gross thank you both lots to think about. Thank you.

JED GROSS: Thank you.

ARTHUR SCHAFER: Thank you.

PC: Jed Gross is a bioethicist with the University Health Network here in Toronto. And Arthur Schafer is with the Center for Professional and Applied Ethics at the University of Manitoba. Jed was here with me in Toronto and Arthur is in Winnipeg. I know you'll have things to say about this. So do get in touch with the current you can tweet us @TheCurrentCBC. You can post on Facebook, facebook.com/CBCthecurrent or if you prefer e-mail. Go to our website cbc.ca/thecurrent and click on the Contact Us link. Q is headed your way next and they'll be talking to the director of the all a buzz about film called Call Me by Your Name. Tom Powers speaks with director Luca Guadagnino. That is coming up. I'm Piya Chattopadhyay. Thank you for lending us your ear here on the Friday edition of The Current.

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