Should all Canadians be automatically considered organ donors?
With dozens of Canadians dying every year while sitting on organ transplant wait lists, and so few signing up to be donors, some say the solution is to flip the system so that everyone is automatically considered a would-be donor unless they explicitly say they don't want to be.
Such a system, called a "presumed consent model," is already in use in more than 20 countries in Europe, where organ donation rates are consistently much higher than in Canada.
If Canada made that shift too, say advocates, the country could boost its donation rates, which is one of lowest in the developed world. Only 13 out of every million Canadians becomes an organ donor, compared with 20 per million in the U.S., and more than 31 per million in Spain, which has a presumed consent system.
The Canadian Liver Foundation is one group that wants to see a presumed consent system, arguing that unless such a model is adopted, there will be no improvements in the number of people who die waiting for a liver transplant.
While many Canadians say they're in favour of organ donation, many fail to ever formally record their wishes. In the country's most populous province, Ontario, only about 20 per cent of citizens have joined the province's organ and tissue donor registry.
But Versha Prakash, vice-president of operations for the Trillium Gift of Life Network, Ontario's central organ and tissue donation agency, says there are a lot of good reasons why our country doesn't have a presumed consent system.
The first one is that Canadians are simply turned off by the idea.
Ontario had a panel of experts look into ways to increase organ donation a few years ago, which found that neither the public, nor doctors, were comfortable with the idea. Similar polling by such groups as Canadian Blood Services has also found that a large segment of the population doesn't like the idea.
"In Canada and North America, people really value autonomy and the right to choose. That really became clear in the consultations. Canadians said they wanted to be able to make a clear expression of their intent of their wish to donate," Prakash says in a phone interview.
"[Canadians] view organ and tissue donation as a gift. It is a positive step that needs to be taken, rather than an assumption that is made."
If the public has the perception that doctors or the government will just help themselves to our organs unless citizens take the time to fill out forms saying they don't want them to, there is the risk of a backlash against the whole organ donation system, Prakash says.
The other reason why Canada doesn't have a presumed consent system is that even in places that do have such systems, research has shown that their systems end up being not that much different from the way we do things here in Canada. Organs are not harvested any quicker, and doctors still need to get the approval of family members before organs can be transplanted.
"There are many countries that have presumed consent models, but they're a ‘soft' model. So doctors still talk to the families about what the loved one would have wanted and at the end of the day, abide by the family's wishes," says Prakash.
Because it's the surviving family that ultimately has the biggest say about whether organs are donated, organ donor groups always encourage prospective donor to talk to their families about what they would like to happen to them when they die, so that families can feel comfortable they're making the best decision for everyone.
Prakash adds that she's not so sure that Canada's organ donation rate is as low as it appears.
She explains that only patients who are on ventilators in hospital can become organ donors, because oxygenated blood needs to be kept moving through the organ for as long as possible. That means that only about 1 to 2 per cent of people who die in hospitals even have the potential to become organ donors.
Typically, such donors are those who have been declared brain dead, sometimes from a stroke but more usually from an accident or car crash.
Prakash says it may be that there are simply more of those kinds of patients in those countries that have higher donor rates.
"Here in Canada, we live in a very safe country so there are fewer traffic accidents and homicides and accidents that lead to deaths that lend themselves to organ donation," she says.
Prakash says the likelihood that organ donation will ever become mandatory is pretty slim.
"Our focus is now on how to create a strong donation culture," she says. That means making changes in the hospital system so that potential donors are flagged more quickly, increasing awareness, and getting more Ontarians to register as potential donors at BeADonor.ca.
She says since her province brought in an online registration system and amped up public information campaigns, they've increased registered donors by 23 per cent over last two years.
Other provinces have seen great success in increasing registration by asking for consent when people renew health cards or when they renew their driver's licence.
The system isn't perfect, Prakash says, and there are always improvements to be made. But it's one that's based not on compelling everyone to become a donor, but one of respecting the wishes of all Canadians who choose to give the gift of life.