Should mental illness be a reason to get kicked off a transplant list?
Alice Zhang, a 45-year-old mother of two, has been on the kidney transplant list since 2009 due to having polycystic kidney disease. She was recently taken off the list, with doctors citing mental illness as the reason.
Zhang goes to Vancouver General Hospital three times a week for hemodialysis. She filed written complaints with the hospital because she thought the nurses were too rough with her injection site. She says this was the point that the transplant process was halted.
A note from her psychiatrist reads, "The main reason preventing you from nocturnal dialysis and being on the transplant list is an ongoing pattern of mis-representing the actions of the nurses on this unit in a paranoid way."
Her family, including her husband, from whom she is separated, says she has no history of mental illness. Zhang only speaks Cantonese, and her husband says she doesn't have the best social skills, but that doesn't mean she is mentally ill. Zhang believes her human rights have been violated.
Zhang was diagnosed with delusional disorder. A letter from the hospital reads, "You have not reached a level of recovery that would be necessary to assure the transplant team that you would be able to constructively participate in the rigorous transplant treatment plans."
Accoding to Canada's Clinical Guidelines for Kidney Transplantation, patients can be removed from the transplant list or put on "hold" status if they no longer meet the eligibility criteria. In regard to mental health, this would only be pertinent if the condition interfered with the patient's compliance with their therapy. In this case, it would apply if Zhang hadn't been compliant with her dialysis treatments, suggesting she might not be compliant post-transplant.
Despite her complaints and alleged inappropriate treatment of staff at the hospital, Zhang has faithfully attended all her weekly hemodialysis appointments, missing only three in the past year. Therefore, even if she were paranoid or suffering from mental illness, she has been compliant with her treatment.
The average wait for a kidney transplant for a condition like Zhang's is eight to 10 years. The hospital says she'll still be on track with that timeline assuming she successfully recovers from her psychiatric condition.
Should a patient's mental state be a consideration for a life-saving procedure? Particularly if her condition doesn't interfere with her ability to care for herself or adhere to a treatment plan? Hospitals have complaint procedures for a reason, and a patient should be able to use them without fear of being denied treatment or diagnosed with a mental disorder. Even if she does legitimately have a mental disorder, denying a medical procedure doesn't seem like a proactive way of helping her get the treatment she needs.