The thought of society and the government believing they can presume consent over my body terrifies me. And yet, I believe they should. I believe that Canada should adopt an opt-out organ donation system.
Thinking about my own death, much less pondering the idea of my organs being removed from my body, makes me feel squeamish. I doubt I am the only one who feels this way. According to Trillium Gift of Life, the Ontario government agency that coordinates organ donation, there typically are more than 1,500 people on the wait list to receive an organ transplant in Ontario at any given time. In 2012, however, out of 3,088 people who met the criteria for being an organ donor, only 520 became donors. If I become a potential donor someday, I could be one of those missed 2,568 people, even though the organs taken from my body alone could benefit over 75 patients (through tissue transplant) and save eight lives. These numbers show how much bigger the issue is than my own feelings of discomfort.
These statistics became personal to me when my friend’s mother needed a liver transplant. She had to wait almost two years before finding a donor with a match. I could see the struggle her family was going through during the torturous period of waiting. This prompted me to research organ donation in Canada, and over the years, I learned the gravity of the organ donation shortage in our country. It is heartbreaking that more than 250 Canadians die each year while waiting for an organ transplant!
In Canada’s organ donation system, each province and territory has jurisdiction over almost all aspects of the process. Ontario requires all hospitals with mechanical ventilators to notify the Trillium Gift of Life Network when a patient dies or when a physician believes the death of a patient is imminent. Mechanical ventilators maintain a potential donor’s breathing and preserve their organs’ viability until transplantation can be arranged. This process narrows down the number of potential donors to a very limited pool of individuals and excludes people who have died from cardiovascular death. Additionally, hospitals identifying a patient for potential organ donation requires initiative and appropriate referral under a restricted timeline.
Once a potential donor has been identified, Trillium contacts the Ministry of Health and Long Term Care to determine whether the person had registered their consent to be a donor on a registry maintained by the ministry. Irrespective of their status, a Trillium staff person and/or a health-care practitioner (such as a doctor or nurse) at the hospital must perform the difficult task of asking the next of kin for consent to donate. This can be a challenge for health care practitioners who may lack training and experience in this regard. Ultimately, the patient’s relatives determine whether or not the patient’s organs are donated. Even if the patient had registered their consent, their family has the ability to veto the patient’s donor status.
If consent is received, Trillium identifies the next potential recipient on the wait-list for each organ, and the process reaches its conclusion once the organs are removed from the donor’s body and transplanted into the recipient/s.
The gaps throughout this process—for example, the limitations in who qualifies as a donor, the requirement that family members consent to donation—lead to only 17 percent of potential donors becoming actual donors. Ultimately, donation is dependent on the hospital’s ability to identify viable organs, and on whether consent is received from relatives. In addition, the system only allows organizations like Trillium to campaign to increase the number of registered donors, but these efforts do not necessarily increase the rates at which potential donors are converted to actual donors.
“Countries with opt-out laws have rates 25 to 30 percent higher than those in countries requiring explicit consent,” wrote Alejandra Zuniga-Fajuri in a study conducted for WHO. Wales introduced the opt-out system in 2015 and found that the number of transplants rose by a third. Spain, the leading country in organ donation, has an opt-out system. However, it is important to acknowledge that Spain’s large number of donors is also likely the result of the efficiency of their organ donation system. This includes transplant coordinators who develop proactive donor detection programs, and training for all professionals involved in donation, directly or indirectly.
An opt-out system would force our organ donation process to become more efficient. In a system where organ donation is the norm, health care practitioners would be trained to recognize and report all potential donors, and would be more likely to consider organs donated after cardio-circulatory death and from older donors. When suitability for organ donation is established, health care professionals would also likely find asking the family if they want to opt out easier than they do in the current system. Since an opt-out system ensures that donation is the default, they would not feel as though they were asking families to make an exception by donating.
Currently, the choice of donation is not entirely ours to make—even if we opt in, this decision can be reversed by our next of kin after we die. We would similarly not have control in an opt-out system without leaving explicit instructions, and this can be a frightening thought. It is true that in the current system, communicating with our relatives and our doctors about our end-of-life wishes increases the chances of our wishes being followed. But many people dislike thinking and talking about their own deaths, and with the current opt-in system, this squeamishness costs lives. Switching to an opt-out system with thoughtful planning and monitoring will likely increase the donor pool, since all patients will be treated as potential donors. In doing so, we create a society in which organ donation is the norm.
Canada has a long list of patients waiting for an organ donation, and 90 percent of Canadians say they would like to donate. In order to maximize the number of lives saved, organ donation should not be perceived as a gift, but rather, should be considered a right. By freely giving up our organs, we allow everyone to benefit. After all, since we are so willing to receive organs, we should be just as willing to give.
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Hi Deirdre, my name is Abigael and I am journalism student at Carleton University. I am writing an article about organ transplants and the opt-out system, and I think you and your friend’s voice would be a strong contribution to the story. Please let me know if you feel like talking, I would really like to hear your take!
In a perfect world where the good deed was always done for the true deed the right to harvest organs would be acceptable. However, the money value on black market organs as well as the pressure to give up those organs in a valid hospital setting will put accident victims and their next of kin in a position of blind trust. The possibility of recovery because of the lucrative value of those organs has the potential to be over looked. There is too much room for dishonesty and greed for organs that could be taken from patients in a system where consent is Not required. This is also based on a system that assumes everyone knows that they have been made
a donor unless they Opt out. The results of this system Will show its ugly head in the form of patients being taken off life support by misinformation to family members for the sole purpose of using the victim for an open smorg of donation. It is unfortunate that dishonesty happens. There is the potential for unlimited $ value on those organs. When a family member is in a critical state the actual truth can be clouded by the potential of acquiring those organs. Automatically making everyone a donor Unless they have opted out is a deception in itself. Government should never have the ability to give any health facility the ability to own our organs making us borrowers obligated to return them to the system when we finish using them.
Thank you for this very comprehensive paper on organ donation. I can’t wait for Canada to adopt the “Organ donation by default” system.
The number of people not wanting to donate their organs will be the same number of people opting out for the organ donation. What difference if this going to make? How is implied consent helpful for parents and relatives going through stages of loss and just not ready or want to share organs of their deceased, is the government really going to force them?
Question: How would a person who does not want their organs/tissues/DNA etc., to ever be used for reproductive/fertility purposes (e.g. a Pro-Choice supporter) prevent such things from happening without removing themselves completely from the Organ Donor registry?
I am scarcely able to get decent health care as it is, and have been pressured into having a test done I would not have, had I known what was going to happen. I have written on my blog, Sue’s Views on the News, about some of these situations, and the more I write, it seems the worse it gets for me.
I have taken my name off the donor list, once I realized that some patients would be considered more worthy than others.
Great article! As I write this comment, Nova Scotia is passing a bill to make opt-out the norm in their province. Way to go!! I hope the other provinces follow this lead. It is a tricky subject. People can get very emotional with their bodies and view this as another example of the government taking over. The controls should be in place to ensure that people who do not want to donate are not violated. The option not to donate is always there for people, so there is no need to panic. Also, the government should be ready to deal with mis-information that is likely to spread.
I am in full support of the opt-out program. It works in Spain and in the U.K. I had a heart transplant that saved my life at the age of 20, about three months ago. Organ donation is so important and the stats are mind-boggling. The wait is too long and thousands of people are dying every day. Being an opt-out nation allows us to give a second chance at life to those in need. Plus, organ donation does not cause any harm to the soul and does not kill any one. The process is done after the person is pronounced deceased already. Having an opt-out system doesn’t force anyone to do anything. It simply gives them the chance to decide whether or not they want to donate their organs or tissues. The opt-in system is a failure as a result of lack of awareness. It’s easier to get people to opt-out than to opt-in in my opinion.
I can’t think of a better gift to leave this planet. Opt-out would allow such bequeaths!
It is wrong to assume anyone will take or receive organs. Some people refuse blood and organs and that is their right. There is a thing called informed consent and it took a lot of heart ache to achieve that. It is sad to see so much pushing for harvesting and such little effort being put into creating new organs from the patients own cells.
Hi Sneha, this was an interesting read. I am a journalism student at Carleton University, and I am writing an article about organ transplants, and would like to ask you additional questions about your opinion to contribute to the story. Let me know if you are willing and available to talk!
Thank you for sharing your thoughts on our organ donation system! I do agree on the point that we do not make organ donation easy and efficient. However, I also feel that automatic opt-in to donate our organs does not adequately provide an process for informed consent. I believe there needs to be more public awareness of this topic so each of us gives it more thoughts to decide what we want to do.
Everybody gets a taste (physicians, OR nurses, transplant programmes, drug companies, hospitals etc) except the patient (donor) . There should be tax credits wrt donations, ie. if I donate to a kidney and am off work/out of commission for 6 wks, I lose earnings, QoL at home etc. another ie. let my next of kin write off my funeral expenses – I submit there will be a significant rise in donations
@ Rick Sanchez : My concern is that once you monetize organ donations through any mechanism (including tax credits) – you may be going down a slippery slope. In a public healthcare space, where I am hoping I will get an organ donated to me if I need one, the onus is on me to give back as well. Who knows, someone near and dear to me may benefit through a system where we are all donating by default. The opinion in this piece is something worth considering for sure.
I had surgery without informed consent four years ago. I think it was an accident, though I’m not sure. I was listed as an organ donor up until this time, though I’ve since changed it and don’t want anyone doing anything to me without consent. Don’t assume consent.
@ Elizabeth Hopkins : you are correct, one should not assume consent. But in the current situation we are assuming there is “no- consent” unless someone fills up a form – not sure if that is correct either. Having said that, even in an opt-out scheme, it gives people the option to actually opt out if they do not want to donate. There is no compulsion that everyone must donate against their wishes. The default would be the assumption that everyone is a donor- people can choose not to give if that is their wish.
Don’t you think that it is sad though that many people would be first in the line-up if they have to receive, and yet would not be willing to donate to help others?
Hi Elizabeth, my name is Sherlyn Assam and I’m a journalism student at Carleton University. I would like your input for my in-depth class article on organ transplants. Please let me know if you are willing to talk more about your experience!
I agree, Elizabeth. I had something done to me without my giving consent with no pressure. Waiting until 5 minutes before the procedure was putting pressure on me to accept the suggested change in procedure.
Couldn’t agree more! I have a friend who received a heart transplant. He almost died while waiting. Until such time as we have a better system, I encourage everyone to sign up online to be a donor. It takes two minutes: http://www.beadonor.ca. There is potential for so many of us to give the gift of life.
Hi Deirdre, my name is Sherlyn and I am journalism student at Carleton University. I am writing an article about organ transplants, and I think you and your friend’s voice would be a strong contribution to the story. Let me know if you are willing and available to talk!
Sherlyn I wish I had responded to this article sooner. We weren’t vocal enough in our objection.
How this could ever pass is beyond me, to have people have to sign to opt out. It puts too much pressure on people and I cannot see how anyone, except the feeble-minded wealthy, would want this change in policy.
Was a pacemaker not an option? Are they testing animal hearts in humans yet? See when it comes to supply and demand people do crazy things and we need better options than using people as commodities or it literally turns into one person going and taking the life of another for profits. Very quickly I might add
Mike, I’m sure if the person almost died from waiting for a heart transplant, doctors must have exhausted all options ESPECIALLY something as easy as a pacemaker. Secondly, an opt-out system does not use people as commodities, rather it maintains our moral duty and altruism of helping others in need as long as it does not bring harm to us. Opt-out systems allow you ‘opt out’ of being a donor when you die, no one is going to forcefully take your organs out without the permission of you or your family, who can actually veto your decision to be a donor once you have passed away. Also, when you say “profit”, this is a completely altruistic system, who is getting any reimbursement or incentives for being a donor??? Being an organ donor whether it be through an opt-in or opt-out system is purely altruistic unless you decide to travel to Iran or China and willingly participate in paid organ trades or organ harvests. Paid organ markets are very illegal in most countries as well as incentivised donations, so I’m not sure who you’re talking about when you claim people “go and take life of another for profits”. Also xenotransplantation is still such a big bioethical issue considering there are chances transplants could result in new animal viruses to evolve and infect human tissues. It’s simply not ethical to impose an unknown risk on the community for the sake of the benefit of individuals.
I want to open out being donated of my organs. please get back to me. wandjenny344 @gmail.com
Mike. Yes!
Why don’t you go online and sign your name, then, just to make sure you did it right.
An opt-out organ donation system would pair poorly with Bill C-14 (Medical Assistance in Dying). We would soon be hearing that MAiD ought to be presumptively administered. Consent should never be presumed. The public is already generally in favour of organ donation. They just need to be reminded, and reminded again, to opt-in.
Paul, I’m not sure why you are trying to connect opt-out organ donation with medical assistance in dying. MAID absolutely requires a person’s consent and cannot be done otherwise. What are you trying to say?