Life and death issue of active organ donor registration

More Canadians united in support for active organ donation system

In 1979, Spain implemented what was considered at the time a radical policy to facilitate organ and tissue donation after death. The European nation created an “active donor registration” (ADR) system, where every adult was deemed an organ and tissue donor unless he or she specifically requested not to be included in a registry.

The proposal was not devoid of criticism. In a country that was still deeply religious and just four years removed from a brutal dictatorship built around dubious interpretations of morality, there was opposition to the idea that a foreign organ could occupy a place in another person’s living body. The nascent democratic government pursued the policy regardless.

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More than four decades later, it is clear that Spain’s course of action on organ and tissue donation was correct. The European country is the undisputed global leader on this endeavour. In 2018, 6% of all organ and tissue donations took place in Spain – an outstanding statistic for a country that makes up just 0.6% of the world’s population.

In Canada, organ and tissue donation has operated under an “opt-in” system where individuals had to specifically and unequivocally state that they wanted to become donors. This places Canada at a disadvantage. In nations like Austria, waiting lists for kidney transplants have practically disappeared since ADR became the norm.

The latest Canadian Institute for Health Information data shows that more than 2,700 organs were successfully transplanted in Canada in 2018. However, 4,350 Canadians were still on a waiting list for a suitable organ when 2019 started, and 223 died while anticipating a transplant that never materialized.

In spite of these grim statistics, things are slowly changing in Canada.

Last year, Nova Scotia became the first province, and the first jurisdiction in North America, to abandon the opt-in system and establish ADR for organ and tissue donation after death. The Human Organ and Tissue Act was passed unanimously in the House of Assembly and was mentioned this month by outgoing Premier Stephen McNeill as one of the highlights of his tenure.

The law, which will come into effect on January 18, 2021, makes every person who has lived in Nova Scotia for at least a year a potential organ and tissue donor after death. Residents who do not wish to be donors can opt out of the system.

While the effectiveness of Nova Scotia’s decision cannot be measured yet, other provinces are already considering a similar course of action. Legislation that outlines a form of ADR for organ and tissue donation has already been proposed in Alberta, Ontario and Prince Edward Island.

When Research Co. and Glacier Media asked Canadians last year if their province should move to an ADR system for organ and tissue donation after death, 63% favoured the change. In 2020, the proportion of supporters has risen to 70% countrywide. Large majorities of men (74%) and women (67%) are in favour of this modification, as well as most Canadians aged 18 to 34 (75%), aged 35 to 54 (67%) and aged 55 and over (69%).

Federal political allegiance does not affect views on this issue.

More than two-thirds of Canadians who voted for the Liberal Party of Canada (76%), the New Democratic Party (NDP) (74%) and the Conservative Party of Canada (67%) in last year’s election to the House of Commons would welcome ADR in their province.

In the two large provinces where the discussions about amendments have been more prevalent, support for ADR increased markedly since 2019.

In Ontario, it climbed to 68% from 57%, and in Alberta to 74% from 66%. The level of support for this change reaches 73% in Quebec, Atlantic Canada, Manitoba and Saskatchewan and 65% in British Columbia.

Over the past 12 months, the views of Canadians on the regulations that govern organ and tissue donation have become clearer. A larger majority supports a move to an ADR system. Even with the challenges that provincial governments are encountering on account of the COVID-19 pandemic, this is an issue where most Canadians are supportive of action that could have enormous benefits.

In Spain, Austria and other countries around the globe, turning every adult into a potential organ and tissue donor has extended the lives of thousands of people. The time has come for Canada to follow suit.

Mario Canseco is the president of Research Co.

Results are based on an online study conducted from August 7 to August 9 among 1,000 adults in Canada. The data has been statistically weighted according to Canadian census figures for age, gender and region in Canada. The margin of error – which measures sample variability – is plus or minus 3.1 percentage points, 19 times out of 20.

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