Thursday, July 31, 2008

Canada needs organ-donation system before considering presumed consent: expert

This article addresses the need to assess every death for its organ potential. I am very impressed with the eICU program, a hi-tech approach recently initiated in Illinois to monitor vital signs continuously over satellite in real time to identify organ donors. See my Recent post for complete details.

From The Canadian Press:

TORONTO — Canada's organ donation system "desperately needs" a revamp to tackle the growing number of people dying on wait lists, an international expert said Tuesday.

Some Ontario legislators want to rekindle the debate over whether everyone should be considered a would-be organ donor unless they explicitly indicate otherwise, but Dr. Francis Delmonico said until the system is reformed, there's no point.

The Harvard University professor, who is also medical director of an international organization called the Transplantation Society, said Canadian hospitals need to assess every death for its organ potential and notify organ donation agencies.

He also called for a national system to allow provinces to share organs.

The concept of presumed consent, which the Ontario NDP (New Democratic Party) is calling for, would make eligible people in Ontario automatic organ donors upon their death unless they specifically opt out ahead of time.

But Delmonico said that without data on potential donors who die, it's impossible to know whether the organs available are even being used, let alone whether there's a need for more.

"There is no organized structure," said Delmonico. "Until we have every death referred ... we don't know. The mission of the hospital is to say, 'If we miss a donor, four or five people might die."'

While presumed consent has yet to win much public support anywhere in Canada, a pair of New Democrat politicians are taking one more shot at making their private member's bill the law of the land in the country's largest province.

"As we speak, good organs are being burned or buried across this province because the province insists on maintaining its presumption system," said NDP member Peter Kormos, who has twice before introduced the legislation unsuccessfully.

"New Democrats believe that there isn't a fair-minded Ontarian who doesn't want his or her organs upon their death to be used to ignite, to reignite, life."

This fall, the NDP will introduce the bill again, hoping to provide an urgent solution to the nearly 1,700 people waiting for organs in Ontario, Kormos said.

Across Canada, there are about 4,000 people waiting for an organ transplant; between 140 to 250 of them die each year before they get one.

Still, a report commissioned by the Ontario government last year concluded that there's little public appetite for a presumed-consent system.

Andres Cotic, 60, who has been waiting for a liver for three years, pleaded Tuesday with Canadians to start showing support for the concept.

Several years ago, a colleague donated half his own liver to Cotic, but it's now failing, he said.

"I'm struggling to survive," said Cotic, an architect and urban designer who immigrated to Canada from Argentina decades ago.

"We cannot let our fellow Canadians (die) in silence when we have all these things at our disposal."

Dave Smith, president of the Canadian Transplant Association, said anything that makes the public more aware of the need for organ donation is a good thing. But presumed consent wouldn't necessarily increase the number of available organs, he added.

The process of harvesting organs is complex and requires properly trained staff who can handle organs, assist in the transplant process and consult with family members about donation issues, Smith said.

"I just wonder if a lot of (organs) are missed because the whole system isn't all together," he said. "It all depends on what's in place when tragedy happens."

Smith said before improvements can be made, the shortfalls have to be identified.

According to the Canadian Medical Association Journal, presumed consent is practised in various forms in Europe, including Austria, where people who refuse to donate organs get the lowest priority in the event they suddenly need one.

Debates about whether it is ethical or helpful are ongoing in the United States as well.

Mark Nesbitt, a spokesman with the Ontario Health Ministry, said there aren't any plans to have further discussions on implementing the system following a report by a citizen's panel.

That report found that while Ontario residents are willing to debate the issue, they're generally not comfortable with the concept, he said.

"We accepted their suggestions on that, that it's not appropriate at this point," Nesbitt said. "It was a very divisive topic."

Under the current system, people who want to donate their organs can fill out a donor card to notify family members of their wishes. Family members are asked to provide the final consent.

Nesbitt said the province is working on implementing recommendations in the report, including the creation of a registered donor list.

B.C. has roughly 700,000 people on its donor list, said Ken Donohue, communications manager of the B.C. Transplant Society.

It relies on a system of "first-person consent," where people register themselves.

"In the rest of Canada, they still sort of rely on consent from family," Donohue said.

"We would do that as well if the person hadn't registered. But if the person has made a decision about organ donation, we want to respect that decision. ... Whatever decision you made will be respected."

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives through organ donation and enhance another 50 through cornea and tissue donation

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