Organ donation rates across Canada are dismal, really. Canada consistently ranks in the bottom half of industrialized countries where transplants are performed.

Many factors affect donation and procurement rates. Spain, Portugal, France and Austria have high organ donation rates because these countries have adopted a ‘presumed consent’ framework whereby organs and tissues are essentially considered property of the state unless one actively opts out during his/her lifetime. Why does the U.S. outperform Canada here? One would not necessarily anticipate such a disparity in donor rates between Canada and the United States, since we seemingly enjoy healthcare practices of similar quality.  Be that as it may, what sets the size of our donor pool apart is actually our lower rates of road accident and gunshot wound fatalities. Clearly some contributing factors can be controlled and others simply cannot. In order for Canada to move the needle on donor rates in any meaningful way, individual provinces are going to have to craft bold strategies. In this regard, Nova Scotia will be first out of the gate.

Four years ago, in Nova Scotia, Bill 121: An Act Respecting Human Organ and Tissue Donation was passed by the (then) NDP government, but was never proclaimed. Last week, however, NS Health and Wellness Minister Leo Glavine indicated that Bill 121 will be proclaimed in the coming months. Once enacted, the language of the Bill would eliminate the right of family members to veto organ donation where consent has already been given. Consent to donate one’s organs will thus be binding.  Bound, by law.  This framework is referred to as ‘first person consent‘. People are often surprised to discover that in Canada, there are currently no policies in place to prevent a family from halting the organ donation process.

The ability of family members to veto a donation has long been one of the more hotly debated impediments to higher donor rates, and thus the proclamation of Bill 121 will mark a pivotal shift in policy. The statistics are difficult to pin down, but approximately 10% of families refuse to transplant a registered donor’s organs.  Five thousand Canadians are in queue for an organ donation, 250 of whom will die this year, waiting. Every potential donation counts. Aside from shrinking the donor pool, allowing families the power to veto treads on both moral and ethical turf. On the face of it, not accepting a donor’s gift is a violation of their autonomy. Further, some firmly believe that doctors have a professional obligation to honour a prior expressed wish to donate.  According to bioethicist David Shaw:

To respect a family’s veto when the patient was on the organ donor register is a failure of moral imagination that leads to a violation of the dead person’s wishes and causes the death of several people (and all the sorrow consequent to this), and many family members who stop donation come to regret their decision.

It will be interesting to see if the rest of Canada will follow Nova Scotia’s legislative lead. With a rate of only 15 deceased donations per million population, every increment of effort to narrow the gap between organ supply and demand should be applauded, and loudly so. Kudos, Nova Scotia.

Jennifer Hartman, guest blogger


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