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

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 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."'

NDP politicianswants private member's bill passed

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 140and 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."

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.

Ethical aspects under debate

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.