New Brunswick moves toward 'deemed consent' organ and tissue donation

New Brunswick has moved a step closer to becoming the second jurisdiction in Canada to adopt a "deemed consent" model for organ and tissue donation.

A bill introduced by the Official Opposition received second reading Thursday and was referred to a legislature committee — two years to the day after a previous version of the bill received first reading.

"We will be making sure that this bill moves forward and that we follow the necessary legislative steps," vowed government house leader Glen Savoie.

It's expected to take at least two years before the new model can be implemented, according to the Health Department. 

Under the proposed amendments to the Human Tissue Gift Act, all adults who are not exempt will be presumed to agree to donate their organs when they die — unless they opt out. 

People who have lived in the province for less than a year would be exempt, along with those with an intellectual disability, and anyone 18 years old or under.

Right now, New Brunswickers can give their consent for organ and tissue donation when they apply for or renew their Medicare card, by checking the appropriate box.

Will require 'significant investment'

"We have gone down this road before, but I think … the outcome will be different than the last time," Health Minister Bruce Fitch told the legislature, referring to the initial Opposition bill in 2021, which was referred to the law amendments committee for further study.

That bill had gaps, he said. The latest one is almost identical to Nova Scotia legislation, which passed in April 2019, making it the first jurisdiction in North America to adopt presumed consent.

"In principle we're going to allow it to go forward, but we also know that there's some things that need to be examined and understood fully," Fitch said.

He expects a "significant investment" would be required to implement the proposed changes. That includes setting up a registry to record consents or refusals.

New Brunswickers would be able to register a decision to consent to donate all or some organs and tissues, known as express consent, or opt out of donating.

Those who choose not to register a decision will be considered potential donors, with a few exceptions. This is referred to as deemed consent.

"We need to drill down deeper as we go through the process in order to understand fully the scope and the resources that need to be dedicated to that, and if in fact, are there other resources that would have to be shifted from where they are now," Fitch said.

He also noted New Brunswick now relies on Nova Scotia's multi-organ transplant program to perform many of its transplants and might need to provide more support.

The Health Department could not provide any estimates. "New Brunswick has been studying the changes made in Nova Scotia, and is looking at how those changes impacted their existing system," said spokesperson Sean Hatchard.

"It will take some time before New Brunswick would be ready to implement these changes — at least two years," he said in an emailed statement. "The Department of Health wants to ensure the program is launched in a safe and effective manner."

Nova Scotia saw increase in donations

In Nova Scotia, the law change was passed in 2019 but didn't take effect until January 2021, once supports were put in place to handle the anticipated increase in donations.

During the first year, 28 people donated their organs, according to statistics from Nova Scotia Health. In the decade leading up to the new law, the province typically saw 20 or fewer organ donations per year. Nova Scotia also had 155 tissue donors in 2021, an increase of 40 per cent over 2020.

Nova Scotia Health was unable to provide more recent statistics on Friday.

Liberal health critic Jean-Claude D'Amours, who introduced the bill, said 59 New Brunswickers are on the wait list for transplants.

Most New Brunswickers support organ donation, he said, but they don't get around to indicating their consent. 

About 82 per cent of New Brunswickers have indicated their wishes when it comes to organ donation, according to Fitch.

Of those, 46 per cent intend to donate their organs, and 36 per cent do not, he said. The remainder have yet to share their choice, or are unaware they can share their choice.

Will save lives

The World Health Organization says countries with presumed consent legislation have donation rates 25 to 30 per cent higher than those that require explicit consent.

Green Party health critic Megan Mitton said it's important New Brunswick make the switch to "save lives, to … shorten periods of illness, [and] to give hope to those who are facing medical challenges."

The New Brunswick Medical Society "strongly encourages" the switch to deemed consent, said president Dr. Michèle Michaud.

"Enacting this legislation combined with patient education could convert over 400,000 New Brunswickers into organ donors," she said in an emailed statement.

"With a single donor able to save or improve the lives of up to 80 people, physicians believe enacting this legislation is in the best interest of all New Brunswickers."

The Heart and Stroke Foundation also "endorses a presumed consent policy for organ donation because of the potential to save lives and reduce the burden on the health care system," said CEO Kurtis Sisk.

'Avery's Law'

The only proposed amendment to the bill, Human Organ and Tissue Donation Act, was a name change.

Michelle Conroy, the Tory MLA for Miramichi, suggested it be called Avery's Law, in honour of  Avery Astle, 16, who died after a crash in Miramichi in April 2019, along with three other teens.

Avery's parents wanted to donate his organs and tissues, including his eyes, but were told no one from the donation team run by Horizon Health was available to retrieve his organs.

"This [bill] finds its origins in the heart of a grieving mom," said Conroy, her voice strained with emotion. Her son Travis worked with Avery at Canadian Tire, and was with him that night, as they left work together, she told the legislature.

"Avery was well known for his kind heart, his beautiful smile, and his beautiful blue eyes," Conroy said.

The Grade 11 student who loved hockey and cars, and dreamed of becoming a linesman, had a personality "that left an impact on all who crossed his path," said Conroy.

"Avery, you are so missed by everyone that knew you. You will never be forgotten, and today we honour you."