Nova Scotia's opt-out organ donation move sparks mixed reaction

Nova Scotia's decision to make all adults in the province potential organ donors unless they opt out has sparked a backlash from some Canadians.

The goal is to increase organ donations from deceased donors to save lives of more recipients. Nova Scotia is striving to raise donation rates above 20 per cent, levels found in European countries such as Spain, officials said. About 90 per cent of Canadians say they support organ and tissue donation but less than 20 per cent have made plans to donate.

Under presumed consent, the default decision is to donate organs on death. But families would continue to be approached to confirm the donor's wishes, said Dr. Stephen Beed, medical director for Nova Scotia's critical care organ donation program.

If a family member can't be consulted in a timely manner, the person will be presumed a donor.

"We want to respect the population who say, 'I don't want this,' but most people do," Beed said in an interview with CBC Radio's As It Happens.

The question is whether it's a good fit for Canadian society, said Kerry Bowman, a bioethicist at the University of Toronto.

"My first concern would be, this is a multicultural society and there are cultures and religions that really have a lot of concern about either organ donation or the steps before organ donation or the definition of death," Bowman said.

For instance, Bowman said, the Catholic Church is very supportive of organ donation but sees presumed consent as problematic because it reduces the autonomous decision to give.

On CBC News' Facebook, Vicki Rewakoski shared a similar sentiment. "Although I am an organ donor, I don't believe that this is right! It takes away a person's right to choose. The government should not be able to impose this on the people."

In a comment on the news story announcing the province's decision, Rhiannon Simms said, "Active consent — something we have been talking about for over a decade. Government should NEVER assume consent about anything to do with our bodies, including after death. … Opt-in is the only way to ensure that a person wishes to be a donor. What happens the first time someone who opted out ends up being a donor because a document was lost or overlooked? Massive lawsuit (at our expense) by the family."

In contrast, some family members of those who've received organs supported the change.

"My daughter is an organ recipient. I am happy with this decision," Lise  Lecompte wrote on Facebook. "It takes one signature to consent to organ donation but people do not automatically sign up and sometimes it is too late to do so. If you don't want to donate then you can refuse. Makes sense to me since so many people are on the transplant list."

Look to Europe's experience

Canadian Blood Services works with Canadian and international organ donation and transplant communities. Dr. Sam Shemie, the group's medical adviser for deceased donation, congratulated Nova Scotia on the move.

Shemie said CBS isn't directly advocating for presumed consent because the experience from other countries suggests it doesn't work until there are investments in "the foundational elements" that improve donation.

He said those elements include:

•  Having a system to identify potential donors and refer them to the provincial organ donation organization.
•  Having the personnel to counsel families "during an awful time in their lives."
•  Managing the complicated logistics of making sure the organs work properly and go to recipients in need, with surgical and transplant capacity to do it.

Shemie said CBS is also looking to the experience in the United Kingdom. So far, Wales has a presumed consent system, which is being expanded.

"The real test for us will be how it goes in England and in particular London that has a large, multi-ethnic community," Shemie said.

Elsewhere in Europe, countries such as Spain and Belgium have explicit opt-out laws.

In Singapore, a World Health Organization document noted that if a person objects to donating their organs upon death, they give up priority for receiving an organ should they need one.

Nova Scotia Premier Stephen McNeil said the hope is that presumed consent will help people who want to become organ donors. Some of them don't talk about it, don't sign their driver's licence or don't register and then suffer a catastrophic illness that ends their lives before they can make their desire known, Shemie said.

"At the same time, you have to protect people who don't wish to donate. There are legitimate reasons, personal, philosophical, religious for not donating and any presumed consent or opt-out system needs to accommodate those people who do not wish to donate. And that's been the experience in Wales as well is that it's not shoved down people's throats," Shemie said.