Should organ donation be automatic? Nova Scotia thinks so and doctors call for close scrutiny
Recent law in Nova Scotia to increase organ supply makes consent to organ donation automatic, but at least one study shows automatic consent does not actually improve donation rates
The Canadian medical community must carefully monitor a new organ donation procedure in Nova Scotia where a law has come into force that states that unless a person specifically opt out of organ donation, it will be considered that the person consented to organ donation at the time of their death.
Nova Scotia’s Human Organ and Tissue Donation Act came into effect in January.
A commentary published this week in the Journal of the Canadian Medical Association (CMAJ) reports that Nova Scotia’s new law is the first of its kind in North America and is bound to garner a lot of attention and scrutiny.
The CMAJ article is written by Matthew J. Weiss of Transplant Quebec; CHU de Québec – Laval University Research Center and Jade Dirk, Nova Scotia Health Authority, Halifax, NS
“In discussions about the deceased organ donation policy, few topics generate more debate than presumed consent, often referred to as presumed consent or denial. Although there are variations, the basic definition of presumed consent is that all competent members of a jurisdiction are deemed to have given their consent for the donation of deceased organs, unless they have explicitly registered otherwise. “, they wrote.
The Nova Scotia Department of Health website described the importance of the new law.
“Organ and tissue donation saves lives and gives hope to those waiting for life-saving and improving transplants. One donor can save or improve the lives of over 80 people. Donated organs – such as the heart, liver, kidneys and lungs – Donated tissues – such as skin, bones, tendons, heart valves and corneas – can restore sight and mobility, help people to recover from cancer surgery and save the lives of burn patients and those in critical condition. suffering from heart disease, ”the ministry said.
The law applies to persons 18 years of age and over, to those with the capacity to make decisions and to those who have lived in Nova Scotia for more than 12 months.
The law is viewed as progressive by those who actively promote organ donation programs. In other provinces, there have been regular campaigns to encourage residents to enroll in organ donation programs. In Ontario, residents are asked about their organ donor preferences when renewing their driver’s license or provincial health card.
The Nova Scotia program is seen as a way to speed up the process by increasing organ and tissue donation to save more lives.
The authors wrote that similar programs in international jurisdictions have had mixed results.
“A 2019 systematic review concluded that countries with presumed consent had 20-75% higher donation rates than countries using other consent models. “
However, only one of the six studies included in the review showed that the pattern of consent was the main factor influencing donation rates. Instead, national health care spending and the number of potential donors (closely related to vehicle safety and stroke incidence) were more closely correlated with donation rates.
In contrast, a 2019 analysis of databases from 35 countries did not show a “statistically significant advantage for donation or transplantation over presumed consent,” the authors wrote.
In a study, reported by Science Direct, based on data where 17 countries were listed as opt-out from the donor program, while 18 countries were listed as opt-in.
“Overall, no significant difference was observed in the rates (per million population) of kidney transplantation (35.2 vs. 42.3 respectively), non-kidney (28.7 vs. 20.9, respectively ) or total solid organ transplant (63.6 versus 61.7, respectively), ”the study said.
“Our data does not demonstrate any significant difference in solid organ donation or transplantation activity between opt-out and opt-in countries,” the Science Direct report continues.
The authors of CMAJ have suggested that the issue of consent itself is not all that proponents expect it to be.
“Consent models do not affect the pool of eligible donors, change the number of people in need of a transplant, or create rapid access to operating rooms. Indeed, the success of the consent model would be best measured using parameters such as the identification and referral rates of eligible donors, the number of planned approaches that appropriately integrate the possibility of donation into conversations. end of life and the consent rates of families approached. These measures would ensure that systems assess how often and to what extent donation opportunities are incorporated into end-of-life care. “
Despite this, the authors said that presumed consent “holds a special place among the general public, clinicians and legislators who hope to improve the performance of donation, and its impact in Canada needs to be measured.”
The authors of CMAJ said the Nova Scotia model will need to be monitored and evaluated over the next several years and that timely checks will be used to measure the results.
“Specialized training on how to approach families to discuss donation and recruiting hospital-based donation champions to develop and implement hospital procedures that facilitate donation are additional key interventions that have been associated with improvement ; they will also be integrated and evaluated, ”said the CMAJ report.
The authors also noted that a research project was initiated to monitor Nova Scotia’s consent program “not only to compare quantitative results across provinces, but also to rigorously assess the attitudes of healthcare workers and of the general public regarding these changes. being taken to reach out to historically under-represented groups who may have particular reasons to be wary of the concept of presumption of consent for donation. No one knows exactly what the impact of the presumed consent policy will be in Nova Scotia, but, upon careful study, future debates about Canadian consent models will be based less on presumptions and more on data. “