Tuesday, February 21, 2006

More Thoughts on Organ & Tissue Donation in Ontario

The new system that went into effect in Ontario this January, (See recent post) is very similiar to the one that's been in effect in the Philadelphia area (with a population about the same as Ontario). They have a donor rate of 33.1 per million population compared with Ontario's 13 per million. It's the most successful program in the U.S. and is called the Gift of Life.

Many readers responding to the recent post about a new system of Presumed Consent proposed for Ontario said they liked the idea, mainly because there is a shortage of tissues and organs and too many people are dying while on the waiting list for a transplant. Some quote Spain's example where over a 10 year period organ donation in Spain rose 146% to 33.6 donors per million population. People automatically assume that Spain has an "opt out" system similiar to the one proposed for Ontario. But Spain's "presumed consent" system is not enforced. In fact, Spain’s laws and practices respecting organ donation are similar to those in the U.S. and Canada. Following brain death, organs can only be retrieved after obtaining consent from the family, and no compensation can be provided for donated organs.

The increase in organ donation in Spain was not driven by statutory changes, and there has not been an increased reliance on living donors to fill the donation gap as in Canada and the U.S. Almost all – 99 percent – of organ donations in Spain are from deceased donors. Spain’s success can be attributed to the creation of the National Transplant Organization (ONT) in 1989, and its network of specially trained physicians who are paid to work as hospital transplant coordinators. These physicians work part-time as transplant coordinators while they maintain their medical practices –primarily as intensivists or nephrologists. These physicians are responsible for identifying potential donors, managing donors and approaching families.

The law in Pennsylvania stipulates that every death in a hospital must be referred to Gift of Life in order to determine if the person's organs are suitable for transplant. It is not up to medical staff – doctors and nurses – to persuade families to allow relatives' organs to be used for transplants. If there is a suitable donor, a trained co-ordinator from Gift of Life visits the hospital to seek the family's approval, but only after the attending physician has told the family the patient is dead.

The "presumed consent" or "opt out" system being proposed for Ontario doesn't sound very ethical to me. What if someone for religious reasons, for example, does not want their organs removed? They may not know of the requirement to sign a document saying they do not want their organs removed in the event of their death.

Now that Ontario's organ and tissue donation agency, Trillium Gift of Life Network, has in place a program similar to Philadelphia's in many ways, why not give it a chance to become successful with the potential to achieve the same organ and tissue donation rates? This way, families will not be taken out of the decision making and can still be involved in the donation of their loved one's organs and tissues. I think it's a win-win situation for all concerned.

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