The Gosling Effect: How one man (and his liver) forever changed Canadian health care

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It was 5:30 a.m., still dark on an early spring morning in 2005, when Kevin Gosling and his wife Barbara walked across the parking lot toward Toronto General Hospital.

Gosling hadn’t slept well – he knew he wouldn’t – but he was too excited to be tired. This was the day he had been waiting for. He was about to donate his liver to a complete stranger.

It had been a long road for the then-46-year-old from Cornwall, Ont. For months, health officials wouldn’t take him seriously when he offered to donate the organ anonymously. We don’t do that here, he was told. Not only that, it had never been done before anywhere in Canada.

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Some top officials in Canada’s leading liver transplant program were adamantly opposed to Gosling’s proposal. They said it was unethical and immoral. They questioned his motives, even his sanity. But Gosling persisted, so far as to undergo months of physical and psychological testing and preparation.

After more than a year and a half, everything was set to go.

As he and Barbara walked toward the hospital doors, Gosling noticed a small family – two adults and a child – heading to the nearby Hospital for Sick Children. It made him think of the child who would also be in surgery that day at the children’s hospital next door, waiting for Gosling’s liver to be delivered for transplant.

Gosling didn’t know much about the recipient. He only knew that it was a child.

Inside the hospital, Gosling said goodbye to his wife and was led toward a room to prepare for surgery. He donned a hospital gown and was given support socks to wear post-surgery to prevent blood clots.

The hospital’s transplant coordinator came in to check in and make sure he was OK. Gosling was reminded that it still wasn’t too late: he could still change his mind, and that he should feel no pressure to go ahead with the surgery if he had any doubts.

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Gosling was a little anxious that the surgery go well. But he wasn’t nervous. And he had no doubts.

He answered the same way he had over and over again when transplant officials assured him he could pull out at any time.

“Nothing is going to stop me.”

Gosling’s stubborn altruism and unwavering belief that he could make a life-changing difference to someone in desperate need almost single-handedly changed Canada’s health-care system.

In the 19 years since that fateful day when transplant surgeons removed part of Gosling’s liver and transplanted it into the body of the very ill child, the Toronto General Hospital has completed more than 137 such operations involving people donating anonymously to strangers – more than any other hospital in the world.

Gosling challenged the system, encouraged others to do the same and allowed the program to expand and thrive. In some ways, it has helped change Canada. That is also part of his legacy.

He was a pioneer in an area in which Canada is now a world leader – the act of anonymously donating part of a liver – a phenomenon that continues to be met with disbelief in some parts of the world.

But as Gosling looks back at the moment they wheeled him into the brightly lit operating room, he remembers how he could not stop thinking about the child—and his or her family—whose life could be forever changed with his liver. His eyes started to tear up.

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Just before the anesthesia took hold, his final thoughts were: “Don’t worry sweetheart, I am coming.”

He chokes up as he recalls that moment nearly two decades later. “You think stupid things at the time, but it made me feel good.”

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AN ‘ANGEL-DONOR’

The first feeling Gosling had after his surgery was relief. He was soon told that the transplant had been successful.

But he was also told he would likely never learn any more about his recipient’s condition, even if problems developed down the road. That was the burden of being an anonymous donor.

Being the first in Canada also meant that his own identity was kept under wraps, even during his post-surgery hospital stay. Once he was transferred from critical care to a hospital ward, he was placed away from other donors, all of whom would have some relationship with their recipients.

Instead, he was given a bed near patients with liver disease, some recovering from transplants, some waiting. Gosling says he was shocked to see the pain and discomfort of patients waiting for transplants.

One day, while slowly walking the hallway trailing his IV pole, Gosling stopped to talk to another patient, also walking carefully with an IV. He was recovering from a liver transplant and asked Gosling if he had also been able to get a donation. “No,” Gosling said, “I am a donor.” The patient grabbed Gosling’s hand and began shaking it and thanking him, saying “You are one of those angels!”

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It was the first time Gosling really saw what a difference a liver transplant could make. Months later, Gosling learned more about the results of his donation.

In 2006, a year after that successful surgery at Toronto’s University Health Network, the hospital held a special event to thank him. They wanted to introduce Gosling to the public, and to talk about non-directed liver donations, which is the term for people who donate anonymously without a specific recipient in mind.

It was the first time the hospital made public the fact that it had completed a liver transplant from an anonymous donor.

There were lots of questions from media at the time, especially for the man who underwent a serious surgery in order to help a stranger. Gosling remembers sitting in front of a bank of microphones, television cameras and reporters during a press conference that day.

“It was really overwhelming. I felt a bit like my famous nephew,” he said referring to Hollywood movie star Ryan Gosling, part of his large extended family from Cornwall.

Kevin Gosling had come prepared with notes to read. But he wasn’t prepared for what came next. During that press conference, hospital staff handed him a letter from the family whose son was the recipient of his organ donation. It was the first time Gosling had seen it. He wept as he read it, cameras clicking away.

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The letter was signed only “Your recipient family”. Gosling never met them, but he treasures the letter that describes him as an “angel-donor” who gave their young son the gift of a normal life.

Their child, the letter said, lapsed into a coma five days after being born and was diagnosed with an enzyme deficiency that made daily life “a ticking time bomb.

“Imagine if your child had to take a special formula and medications every six hours – about 40 pills a day – and had to be on a severely restricted low protein diet – meaning no cake and ice cream, hot dogs, pizza or chocolate milk – foods that are favourites at many a birthday party, picnic or baseball game”

Their child, the letter said, was at constant risk of permanent brain damage, lapsing into a coma or even death just from eating an extra bit of protein.

“How do you live with that day in and day out?” the recipient family asked. “Where do you turn to for hope?

“Hope for us came in the form of an angel donor named Kevin who was willing to risk an operation which he did not need so that our child could begin to live a carefree and normal life.

“Without your extraordinary generosity, our child would still be leading a horribly restricted life with an uncertain future,” the family wrote. “Thank you Kevin, thank you Kevin’s family, for giving us a part of yourselves which we will treasure, cherish and nurture every day as we watch our child grow into adulthood because of your precious gift of life.”

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‘WHAT IS WRONG WITH THESE PEOPLE?’

Before Gosling went into surgery on April 19, 2005 at the Toronto General, living donations were strictly restricted to people who had a relationship with the recipient, biological or emotional.

A key argument was that those with an emotional attachment felt a moral obligation to take the risk of being a living donor, while strangers did not. That is why his offer to donate anonymously was initially met with so much pushback.

Anonymous living organ donations can be non-directed, like Gosling’s, leaving it up to health officials to choose the recipient. They can also be directed, donated to an individual who has made a public plea for an organ.

There have been several high-profile cases in recent years, including an Ontario family whose three-year-old twins needed liver transplants. Their dad could donate to one but there was no related donor for the second twin. Former Ottawa Senators hockey team owner Eugene Melnyk, who died in 2022, received a liver from an anonymous donor in 2015 after a public campaign for donors.

Meanwhile, programs that enable anonymous non-directed donors to give one of their kidneys to a stranger have also grown exponentially, especially since the advent of a national kidney paired donation program run by the Canadian Blood Services.

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It was Gosling’s act of unprecedented generosity that set a cascade of kindness into motion which has saved dozens of lives and changed many others. By being the first to do so, he paved the way for other donors like him.

A total of 2,936 organ transplants were performed in Canada in 2022. Eighty per cent of those transplants used deceased donor organs and 20 per cent used living donor organs. Fifty-two per cent of those living donors were related to the recipient. Forty-eight per cent were unrelated.

But while organ transplants have become more common and more routine over time, people continue to die while awaiting a donor. The growth of donations from living donors, mainly relatives or close friends, has made a difference. Organs from living donors, as opposed to deceased, are considered the “gold standard” by health officials.

Donating part of your liver is possible because the liver, unlike other organs, can regenerate.

And yet, outside of Canada, there is still a lack of understanding of how someone can be willing to give part of their organ to a complete stranger.

Dr. Nazia Selzner, who is the medical director of the live donor liver transplantation program at UHN, said she is frequently asked when he travels the world: “What is wrong with these people that they want to help someone else and go through a major surgery?”

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THE ALTRUISTIC STRANGER

It has been a long time since Gosling had thought about that extraordinary period in his life. Now a 64-year-old great-grandfather and retired from his career as a product developer with Kraft Foods, his focus has shifted closer to home in Cornwall. But the self-effacing organ donation pioneer remains grateful that he was able to make a difference.

For Gosling, doing so just made sense. A long-time blood donor who was on the list to donate stem cells, he was intrigued to learn about living organ donors – initially because of a family connection to kidney donation. When he found out that people could donate part of their livers to save lives, he began researching it, only to be told it wasn’t done in Canada unless donors have a relationship with the recipient. He couldn’t understand why.

When he approached his wife, Barbara, about donating, she was initially concerned about his health, but then put herself into the shoes of families waiting for a liver to save the life of a loved one. She considered doing so herself.

Gosling’s offer was turned down multiple times until he was eventually put in touch with the head of the multi-organ transplant program at University Health Network, one of only two hospitals in the country where living liver transplants are now routinely done. Along the way he met health officials who were adamantly opposed to the idea, even citing the Hippocratic oath. (Later, he was told by one staunch opponent that following Gosling’s case had made him change his mind.)

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Eventually, a plan was made.

First Gosling had to lose weight and change his diet. He lost 44 pounds before the surgery and says he “felt like I was training for a special event.” That wasn’t new to Gosling. He ran a martial arts training centre in Cornwall when he was younger and once trained himself to be able to endure being run over by a truck – literally – by strengthening his abdominal muscles. He saw the trick performed online and was convinced he could do it. (He learned long afterward that the person he watched perform the feat of strength died soon after.) Gosling survived the event staged inside a Cornwall shopping mall. But he didn’t try it again.

What was more difficult for Gosling was that he couldn’t talk about his planned surgery, outside of a small circle, because the hospital wanted it kept as quiet as possible.

His persistence led the hospital to set up protocols and policies and to better understand what makes people like him want to give such an extraordinary gift. Those findings were recently shared around the world.

In a paper published in the journal Gastroenterology in 2023, officials with UHN’s program addressed issues around anonymous living liver donation. The paper, titled “The Altruistic Strangers” mentions Gosling’s case.

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“Our involvement in ALLD (anonymous living liver donation) was prompted in 2005 by a man who questioned our practice of restricting living donation to those who had a biological or emotional connection to the recipient. He asserted his independent ability to make well-informed autonomous decisions about voluntary health risks in supporting the principle that saving lives is the most important human and healthcare system value,” a preprint copy of the paper reads.

It includes this extraordinary paragraph:

“Admittedly, we thought initially that this man must be ‘crazy’, however as we stopped to consider other high-risk activities that many humans engage in willingly and delved more deeply into his rationale and the nature of altruism, we began to question our own preconceptions and biases.”

Gosling describes himself as an ordinary person. But after several conversations with him at his Cornwall home, it becomes clear quickly that he, like other anonymous donors, is not. Research, much of it done at UHN, backs that up.

Despite Gosling’s claims to the contrary, anonymous organ donors are not like most other people. Sometimes called super altruists, they tend to be people who have built altruism into their lives. They are typically frequent blood donors, volunteers and highly involved in their communities.

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Altruism is a term coined by French philosopher Auguste Comte in the 1800s, according to the article “The Altruistic Strangers”. The article describes it as the “principle and moral practice of concern for the welfare and/or happiness of others. Throughout millennia, many examples of altruism exist and it is considered an inherent trait and the highest expression of humanity.

“Many anonymous donors have a well-documented history of altruism such as regular blood donation, stem cell donations, belonging to a stem cell registry and previous kidney donation,” according to the article.

Those exceptional altruists who donate both a liver and kidney are known as double donors. That exclusive group includes about 20 Canadians. Donating a kidney after his liver donation had been one of Gosling’s goals, but health issues made that impossible.

Personality tests have revealed that anonymous donors tend to be more conscientious and agreeable, more concerned about others and less neurotic than other people, according to the research paper.

Gosling says his values were baked in during his childhood. He came from a family of 13 kids. “We didn’t have much when I was growing up and a lot of us tend to understand and lean toward people who are not having such an easy life,” he said.

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He notes that his nephew Ryan, one generation removed from those 13 siblings, is known for his charitable work. Gosling said he doesn’t see his nephew often, but “he is doing a lot of good and I am proud of him.”

Nearly two decades after his historic organ donation, Gosling and his wife, post-retirement, are now raising their great-grandson. They have cared for the now nine-year-old boy since he was an infant. They officially adopted him when he was two. Gosling’s emotional reactions to acts of generosity and kindness are a source of amusement to his young adopted son, who makes a show of passing him tissues when they watch cartoons together and something comes on that might make Gosling get teary-eyed.

Gosling also helped out at a local seniors home – garnering the moniker of “the muffin man” after he began baking 85 muffins every few days and bringing them to residents to cheer them up, even after the family friend he visited passed away.

“I really got into doing that. I like talking to seniors and bringing them out of themselves in conversations,” Gosling said.

Selzner, the medical director of the living donor liver transplantation program at UHN and an author of “The Altruistic Strangers”, said anonymous donors tend to fit a general pattern.

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“We know these people in general are really, truly altruistic individuals who really want to help someone else,” she said. “And they don’t expect any compensation in exchange.”

‘WE ARE NOT PSYCHOPATHS’

Across Canada, other pioneers have brought more awareness to donating an organ anonymously.

The Ottawa Hospital had never done a transplant with a non-directed donor until Ottawa’s Louise Schwartz stepped forward several years after Gosling. Like Gosling, the act just made sense to Schwartz, but it took time before it was approved. It also led the hospital to set up policies and protocols to allow for such donations.

She also went through numerous assessments, including with a psychiatrist. Currently, anonymous donors are assessed by both a social worker and a psychiatrist, though program officials are now considering doing away with the latter.

Schwartz was certain that she wanted to donate a kidney to a stranger in need. The day after the surgery, while she was recovering in hospital, Schwartz received a dozen roses and a card from the recipient.

“It was lovely.”

Ottawa’s Heather Badenoch, who was the 55th non-directed liver donor at UHN (“We all know our number”), now plays a key role. She mentors other donors and works to spread the word about becoming a living donor. She is also part of an informal group of non-directed living liver donors known as the Chopped Livers.

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Selzner, the medical director of the live donor liver transplantation program at UHN, credits Badenoch’s tireless advocacy with helping the anonymous living liver donation program at UHN grow quickly and also for the disproportionate number of donors who have come from Ottawa.

Like other donors, Badenoch is a keen volunteer, someone who fosters and adopts rescue dogs, and runs a communications firm that only works for non-profits. She has also offered her services for free to help nearly 30 patients appealing for living donors.

Still, she says, “I think we are pretty normal folks. Having done it, it is not like we go around with halos on our heads.”

Badenoch said she laughs when she sees a slide that officials with the UHN program include in public talks about anonymous non-directed liver donors. Among the list of facts about anonymous liver donors is No. 4: “Desire to donate to a stranger ≠ psychopathology.”

“That slide always cracks me up – that they need to say we are not psychopaths for wanting to donate to strangers!” said Badenoch.

What is in it for donors, she said, is joy.

“There is joy to being part of saving a life. It was a joyful experience.”

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Badenoch keeps two things pinned to her bulletin board at home: One is a note from her surgeon on her “liver-versary” date – the anniversary of her organ donation – wishing her well and telling her that her recipient (a child) is growing and healthy. The other is a note from Selzner telling her the recipient is doing well and it would be an appropriate time to send an anonymous letter if she liked. It was the first news she had received on the wellbeing of her recipient.

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Dr. Anne Bugeja, who is the medical director of the living kidney donation program at The Ottawa Hospital, said she continues to be “blown away” by the altruism of non-directed organ donors.

“We all feel it is a privilege to work with kidney donor candidates. It never ceases to amaze us how many people are willing to give.”

To date, there have been 246 non-directed donors who have donated a kidney through the kidney paired donation program across Canada, said Bugeja.

Selzner of UHN said the altruism among organ donors in Canada continues to surprise many people around the world, but it is not surprising that people are curious, especially since some of the donors go on to donate one of their kidneys as well.

Studies done at UHN and elsewhere make it clear there is something special about the donors, she said. They tend to rank unusually high on personality traits such as generosity, openness, agreeableness and conscientiousness.

“This is a moral duty for them, a way to give back and acknowledge that they really have had a privileged life.”

The Canadian health system – which fully covers medical costs – helps, she said, as does the financial support donors receive to lessen any financial burden, something that was not in place when Gosling donated.

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Donating in Canada is now cost-neutral, meaning donors do not pay out of pocket for any expenses related to being a living organ donor, say officials. In Ontario, the Program for Reimbursing Expenses of Living Organ Donors is run by Ontario Health.

“The whole thing started thanks to (Gosling) and grows further thanks to him. He is the one who started this and a lot of credit should go to him,” said Selzner.

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THE STARFISH

Gosling remembers the time he was told that offering to give his liver to a complete stranger was simply too much. What’s the point, Gosling was asked.

He replied with a tale about a starfish.

In the story, a young man is walking along a beach occasionally stopping to pick up a starfish and throw it back into the ocean.

An older man interrupts the young man, telling him he is wasting his time because millions of starfish land on beaches and die in the hot sun. “Surely you don’t think you are going to make any difference by throwing a few of them back in?” the older man asks.

The young man looks up and replies: “I made a difference to that one.”

That story was part of a gift Gosling sent to the family whose son received part of his liver. It included these words:

“Sometimes a problem might seem so big that you might think that you cannot make a difference. This is how I felt when I learned that there are so many people who need transplants. So I thought to myself, I know how I can make a difference.

“I could help one person, and they could become my Starfish.

“My wife and I decided that our lives have been so truly blessed, that this is but one small way that we could give something back. This is our gift to you.”

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