An MLA in Manitoba has drafted legislation to make everyone in that province a potential organ donor unless they opt out. The policy, called “presumed consent,” would reverse the existing situation, in which people who wish to become donors must opt in.
If the draft statute is passed, Manitoba would be the first province in Canada to adopt presumed consent, though several European countries already use this approach.
The objective is to remedy a long-standing problem: Too few Canadians become organ donors.
In Spain, 36 residents per million donate organs, in the U.S., 26, but here at home, only 18 do. And yet in 2015, 4,631 Canadians were waiting for a transplant, and 262 died before an organ became available.
So is presumed consent the answer? While opinions are divided in the medical community, it probably can’t hurt.
But the main challenge is not a shortage of donors. It is a systemic failure to fund programs and, more important, harvest organs that are already available.
In 2012, 3,711 Canadians who had signed consent forms died in hospital with transplantable organs. Of those, organs were collected from only 542. Tissues from the other 3,169 were never recovered.
There are several causes of this fearsome wastage, among them the objections of family members who might oppose the procedure. While hospitals are legally entitled to follow the donor’s wish, they are usually unwilling to go against family desires.
B.C. has taken an aggressive approach to overcoming this obstacle. Trained staff stationed in hospitals work with family members to explain how their consent could save someone else’s life.
And it has produced results. Since the program was introduced, the number of transplants, provincewide, has grown from 295 in 2010 to 423 last year — a 43 per cent increase.
Yet the basic problem remains. Far too many Canadians die each year waiting for organs that were there for the taking, but were not collected.
Here, too often, is what happens. When a patient who has signed a consent form lies dying in hospital, it is the duty of the attending medical staff to inform the hospital’s donation team.
Time is of the essence. A suitable transplant candidate must be found and quickly prepped. An operating room and surgeons must be readied. But too often, the donation team is not alerted, or other elementary steps are left untaken, and the moment is lost.
It’s believed roughly half of the hospital deaths that could have afforded a transplant option fall into this category of missed opportunities. Yet a corrective measure is readily available.
Canadian Blood Services has a mandate to co-ordinate organ donation across the country. If hospitals were required to report their transplant outcomes to CBS, it would soon become apparent which facilities were making a real effort to improve performance.
If information of this kind were publicized, it would generate the kind of pressure that gets results. No one wants to look bad in comparison with peers.
And the means exist to do this. Hospitals already report on critical incidents such as medication and IV errors. So why is there no compulsory reporting on transplant outcomes?
There are several reasons, but they all come down to the same causes — inertia, foot-dragging and parochialism among the provinces.
In a sense, organ donation, despite its critical role, is an orphan service. It lacks the weight of numbers to secure a higher priority.
None of this detracts from the excellent work done by groups such as the B.C. Transplant Agency.
But until hospitals and health authorities are required to report their transplant outcomes, patients will continue to die waiting for an organ that could have saved their lives.
