Changing the Canadian organ donor system

McGill Tribune

In 2008, there were 4,330 Canadians on waiting lists for organ transplants, and 215 of them died before receiving the potentially life-saving surgery they needed. At the moment, there are 1200 people on the waiting list in Quebec alone.

Looking at these numbers, it’s clear that the legislation proposed last Thursday by Quebec Health Minister Yves Bolduc, designed to make the Quebec organ donation system more efficient, is an important step in the right direction. The proposed changes would have the province join the Canadian Live Donors Registry, a federal program launched last year to help facilitate kidney transplants from live donors, and would also revamp the province’s system for postmortem donations. The current system, in which individuals who wish to become donors sign the back of their health cards, would be replaced with one where interested donors indicate their interest when they renew their health card every four years. The names of potential donors would then be entered in an electronic provincial registry, which doctors would be required to call when one of their patients dies.

While any effort to increase donation rates is significant, the entire country should be looking to larger systemic changes if the waiting list for organ transplants is to be significantly reduced. Canada should follow the lead of other countries such as Spain and Australia, and implement an opt-out system of organ donation. In such a system, every individual would automatically be considered a donor unless they indicate otherwise.

While research shows that the majority of Canadians support organ donation, only a small minority have actually signed donor cards or registries. In an opt-out system, the organs of those who have not bothered to opt-in, who don’t know how, and those who do not have their donor cards with them at time of death and have not made their wishes clear to their families, would not go to waste but would instead help to save the lives of as many as eight people. In addition, research has indicated that the increase in donors that such a system would likely provide could help to stem the growing black market for organs.

Of course, there are individuals and groups with moral or religious opposition to organ donation. To help ensure that these people would be able to indicate their convictions, the opt-out system would need to be simple, accessible, and available to even those who are illiterate or don’t speak French or English. It would also need to be accompanied by a large public information campaign to inform individuals of their right to opt-out as well as instructions on how to do so.

An opt-out system is not about coercion or deception; it’s about ensuring that the organs of interested donors who currently fall through the cracks are utilized effectively. This method rests on one major assumption: that most Canadians would be willing to help save the lives of others if given the choice.

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Some of us, however, though in agreement with the recent Quebec legislation, don’t believe Canada should switch from an opt-in donor system to an opt-out one. We believe that in discussing such important issues we must use a vocabulary other than the merely utilitarian. While we understand the horrible reality that Canadians die every day for want of organ donors, it’s too drastic a step for the government to declare ownership over every person’s corpse barring an explicit request from that person or their family that no such assumption about their wishes be made. It’s too easy to conceive of possible circumstances in which something could go wrong. When you’re dealing with an issue as important and irreversible as what happens to someone’s body after they die, there’s no room for error.

The idea that a person should have to explicitly state that they don’t want their organs removed after they die—even if for humanitarian and unquestionably good purposes—seems to us too dystopian to be taken seriously as a nationwide proposal. To make it the law of the land would be to effectively disparage the “moral or religious opposition,” to declare the government’s avowed support for those in favour of donation and its disapproval of those opposed.

The resources that would go into a nationwide campaign informing people of their right to opt-out could and should instead be used for mobilizing a massive campaign to inform people of why they should and how they can opt-in to the current system. If done properly, this could probably achieve the same result of increasing donor rates among those who would indeed wish to donate their organs to medicine after they die, but are too uninformed about how they can sign themselves up.

There’s no sense in compounding the tragedy of Canadians waiting for organ donations by risking that something be done with a person’s dead body which they would not want to have done. Assuming Canadians would want their organs donated to medicine unless they explicitly state otherwise does exactly that. There’s room within the current opt-in system for improvement, as Quebec’s proposed changes demonstrate, and we support whatever allocation of federal funds is necessary to ensure that voluntary—and only voluntary—organ donations increase dramatically.

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