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.