NDP proposes opt-out organ donation system to increase donor rates

NDP health critic France Gélinas tabled a bill that would register Ontarians as organ donors by default — instead of them having to opt in — with the goal of saving the lives of hundreds of patients waiting for donations.

"It is a bill whose time has come," she said Wednesday morning.

Currently, Ontario uses an opt-in system in which citizens must give explicit consent to donate their organs after they die. The bill would introduce a "soft opt-out" system, where if a person has not explicitly opted in or out of organ donation during their lifetime, they are presumed to have consented — but their family must approve the donation after their death.

While 2018 was a record-breaking year for organ donation in Ontario, there are currently 1,684 people on the province's wait list for organs. In 2017, 290 people on the wait list died while waiting for a transplant, Gélinas said.

"Those people could be helped, could receive an organ that will change their lives, that will save their lives, if we can move forward with the opt-out system," Gélinas said.

When asked, 85 per cent of Ontarians say they'd like to be a donor, Gélinas said, but only about 34 per cent opt in. That number is even lower in Toronto, with a rate of 24 per cent.

Nova Scotia is the only province in Canada with an opt-out system, which was passed in April. While it's too early to tell what the effects of the new law will be in Nova Scotia, opt-out countries in Europe provide a glimpse of the potential benefits.

In Austria, which uses an opt-out system, over 90 per cent of citizens donate their organs after they die — a staggeringly high rate, especially compared to neighbouring Germany, which uses an opt-in system and has a registration rate of less than 15 per cent.

Health Minister Christine Elliott said it's important to get organ donation rates up, but that she isn't sure an opt-out system would be the best solution since it could lead to "fights" and, potentially, lawsuits with families who disagree with their deceased relative's choice. She said a better option would be a public education campaign on the benefits of organ donation.

"I have no problem with more education," Gélinas said, "but the body of evidence is there." In opt-out countries, "you see the difference that it makes. It makes many more organs available and it shrinks the wait list."

Ontario has done educational campaigns in the past and seen an uptick of 2 or 3 per cent in donor rates, Gélinas said — "but we're still a long way from 85 (per cent)."

Gélinas said respecting the wishes of families is what the soft opt-out system is "all about." After a death, she said the family will be asked whether the person ever talked about not wanting to be an organ donor. "Their wishes will be respected," Gélinas said.

George Marcello, an organ donation advocate who has received transplant surgery and is now waiting for a kidney donor, was more blunt.

"Those are the same talking points that have been used time and time and time again for 25 years," he said about Elliott's comments. "How many people have to die before they get it?"

If this bill passes, "the chances of me getting that kidney would soar," said Marcello, adding that he is a registered PC member. "Of course, there's no guarantee ... but the chances would increase considerably."

To Premier Doug Ford, he asked: "Would he treat his brother like this?"

He added: "What's stopping you from saving more lives?"

Recent double lung transplant recipient Gary Marin said his operation has given him "a new lease on life."

"I definitely support this bill. I think everybody should have a second chance in life if they can get it," he said, stifling tears after he made his case.

Aside from organ donation rates being higher in opt-out countries, studies have shown that making people opt out rather than opt in increases donation rates.

Stanford social psychologists who interviewed citizens of opt-in and opt-out countries found that those living in the United States, an opt-in country, view organ donation as an act of "extraordinary altruism," whereas in Austria, participants considered it "ethically trivial and inconsequential," leading the researchers to conclude that the "default view" of a given country has a strong impact on end results.

Another pair of researchers confirmed this view by asking people online whether they would like to become an organ donor, telling some that the default was not to donate, and others that the default was to be an organ donor. Only 42 per cent of participants who had to opt in did so. But among those who had to opt out, 82 per cent agreed to be donors.

Another option to increase organ donation rates is "mandated choice," where a person is asked whether they want to register, and required to make a yes-or-no decision. The state of Montana has achieved an 82 per cent donation rate by asking people whether they want to be an organ donor or not when they sign up for or renew their driver’s licence.