Since its adoption, the CMA Policy on Organ and Tissue Donation and Transplantation (OTDT) has been revised several times. Because of the rapidly changing landscape of OTDT in Canada, the policy in its current structure requires constant revision and no longer aligns with the policies and practices of leading Canadian OTDT organizations. The new draft policy identifies foundational principles to address the challenges surrounding deceased and living donation. It is accompanied by a backgrounder that provides context on the landscape of OTDT. The new draft policy has been reviewed by the CMA Committee on Ethics. In addition to this, stakeholders were invited to share their feedback on the draft policy between Jan. 14 and Mar. 6, 2019.
The aim of this policy is to provide guidance to physicians on key ethical considerations relevant to the practice of OTDT in Canada. Although there are areas of overlap, organ donation and transplantation (ODT) and tissue donation and transplantation (TDT) are characterized by different processes and unique challenges. The policy focuses on ODT because many of the ethical challenges associated with donation and transplantation are specific to organ recovery and donation; however, concepts may also apply to TDT. This policy is intended to address OTDT in adult populations. The challenges, considerations, legislation and policies surrounding pediatric and neonatal OTDT are unique and deserve focused attention.
The CMA acknowledges and respects the diverse viewpoints, backgrounds and religious views of physicians and patients and encourages physicians to confront challenges raised by OTDT in a way that is consistent with both standards of medical ethics and patients’ values and beliefs.
OPT-IN VERSUS OPT-OUT
As part of this policy update, the CMA was interested in hearing your views on the “opt-in” versus “opt-out” system when it comes to OTDT. Currently, all Canadian jurisdictions use an opt-in system of organ and tissue donation, whereby the default assumption is that patients do not wish to donate their organs unless they expressly consent to doing so, in accordance with the relevant provincial or territorial legislation.
In some countries, including Austria, Belgium, the Czech Republic, Spain, Finland and France, an “opt-out” (or presumed consent) system is used, whereby consent to donate organs and/or tissue is presumed unless a person explicitly stated during their lifetime that they did not wish to be an organ donor after death. Some argue that an opt-out consent model would increase organ availability rates and have called for Canada to adopt this model. On the other hand, evidence suggests that adopting such a model alone may not be sufficient to radically increase donation rates. Other factors that influence donation rates include the availability of potential donors, transplantation infrastructure, health care spending, public attitudes, familial consent and donor registries.
The consultation period is now closed. Please visit the community engagement platform for updates on the status of the policy in the coming weeks.