Background

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.

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Scope

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.

Feedback

The consultation period is now closed. 

 

  • I had trouble submitting the forms (internet problems), so I will try to submit my comments under the articles. I think the idea of opting out rather than opting in is great. I think that, although the information suggests it may not be significant, even the small increase in donors that this policy could initiate would be beneficial.

  • I an pro opting out and second Roger’s reasoning. 

    I agree with the draft policy.

    I wonder though what safe-guards would be in place to protect a recipient from receiving diseased organs as not all issues are checked in an urgent situation. I guess receiving an organ in a life-threatening situation is still better than not, but what if the donor had HIV or some other serious illness? It should be assumed that all medical records of the donor are accessible, but as of yet this is not possible in all areas of the country. We must ensure patient safety as well. 

     

  • I support an opting out model. I second Roger’s reasoning that most people do not fill out a form, but mostly because many organs could be harvested that would save lives if organ donation was a given. Therefore, it is most effective to have people who are very much opposed to the matter opt out. 

    However, I have concerns about the potential of transfer of hidden or unknown infections in this model. Most people are NOT screened for potential communicable diseases and testing takes time, while in an emergency situation there is no time to properly vet a potential donor for organ suitability and safety. Patient safety must be first. 

    I support a balancing act and the ability to make decisions as needed and to leave these decisions in the hands of the physicians. Non-maleficience must be a guiding principle. 

    I support and agree with the remaining principles and find them valid and suitable. 

  • CMA should support an opt out model 

  • A few thoughts for consideration:
    1- While "opt in" has value and seems like a reasonable policy direction, I am concerned about cultural, religious and ethnic considerations from our diverse Canadian population and wonder if that has been explored enough as part of this policy discussion. 
    2 - CMA could play a more active role in supporting stronger awareness campaigns re: organ and tissue donation. Public awareness and understanding are still not high among all Canadians. 
    3 - While this is an important discussion for CMA PV, I feel these types of specific policy discussions should also encompass targeted populations of persons with specific lived experience, i.e. here the opportunity for the CMA to engage in more public conversations with patients (with guidance from PV) to engage on specific policy issues.