Second Opinion

Forget the forms; organ donation should be automatic

September 1, 2005

Many failings are ascribed to our health-care system, but it has, progressively and systematically, prolonged the lives of many, many people.

Diseases that once killed quickly and cruelly are now chronic conditions that can be managed with technology, drugs and surgical interventions like transplantation.

Organ transplants are the closet thing we have to miracles of modern medicine. People, from babies to seniors, are now literally reborn thanks to new hearts, lungs, livers, kidneys, and pancreases.

Organ transplantation has truly earned its moniker, the gift of life. The challenge today is to make the gift of life available to all who need it.

There were, at last count, 4,004 Canadians waiting for an organ transplant, according to the Canadian Organ Replacement Registry.

Yet, last year, a mere 414 of the Canadians who died donated their organs -- in total, they provided 1,317 organs. (There were another 468 living donors, principally people who gave one of their kidneys to a family member.) It doesn't take much mathematical acumen to figure out there is a problem: There are simply not enough organs to go around, particularly organs from cadavers.

This so-called "transplant gap" is, for the growing number of people suffering from kidney failure, heart failure, cystic fibrosis, cirrhosis of the liver, and various other chronic illnesses, an ongoing source of frustration and suffering.

We need to ask ourselves what can be done to alleviate their pain and, more fundamentally, how we can obtain more organs.

Currently, organs are harvested from patients who are brain dead, and only if they and their loved ones specifically consent to the procedure.

In most Canadian provinces, there is a question about your willingness to donate included in the paperwork for a driver's licence and/or health card. About half of us sign these forms. By contrast, in polls, 90 per cent or more say they support organ donation. This "donor gap" is troublesome. The fact that it is resulting in viable organs being wasted when the need is so great is unacceptable.

In the current system, most citizens don't express their desire to donate (or not) and, even if they do, their wishes can be overridden by family. What's more, there is little incentive for hospitals to promote donation, and too few resources to do so properly. In short, the current system is not working. It is time for the provinces to embrace the concept of presumed consent.

What that means is assuming that everyone -- should they be in the unlikely situation of being brain-dead -- wants to donate their organs unless they specifically say no in advance.

About a dozen countries -- including Spain, France, Italy and Sweden -- have taken this route. In almost every case, the number of organs available increased markedly.

A 1999 Commons committee report on organ donation looked at the idea of presumed consent and dismissed it out of hand, saying the approach would not be accepted by most Canadians.

Well, why not?

Presumed consent is actually a more just and ethical system than the one we have in place. Presumed consent recognizes the desire of the majority of people to donate their organs, while the current system results in those wishes being systematically denied.

Presumed consent may make some people a little squeamish, but it would alleviate the suffering of many, while harming no one.

Of course, presumed consent is not a policy that should be implemented in secrecy or in a vacuum. Education campaigns about the benefits of organ donation are woefully lacking. They need to be undertaken. And every opportunity must be provided to those who wish to opt out of donating.

We also need to entertain other approaches, such as harvesting organs from not only brain-dead patients but from non-heart-beating patients (those who die of cardiac death), and tapping into the pool of potential living donors.

And, regardless of whether we adopt an approach like presumed consent, we need to figure out just how many potential organ donors there are out there. Right now, countries tend to compare their number of donors per million. (In Canada, it's 13.1 donors per million, one of the lowest figures; Spain has twice as many.) But that number is largely meaningless. What we need to do is require hospitals to report "eligible deaths" -- patients who die of causes that could theoretically end in organ donation -- an approach recently adopted in the United States.

Last year, 224 Canadians died while waiting for an organ transplant. Most, if not all, of those deaths were unnecessary. That this is occurring because policy-makers do not have the backbone to implement policies like presumed consent is a travesty.

apicard@globeandmail.ca

Waiting . . . to live

In 2004, 224 Canadians died waiting for an organ transplant. This year's waiting list includes:

2,872 who need a kidney
667 who need a liver
177 who need a lung
125 who need a heart

Source: Canadian Organ Replacement Registry

This article posted September 22, 2005.

Second Opinion

Forget the forms; organ donation should be automatic

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