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The ‘opt-out’ system of organ donation- why it is a good idea

By Ira Samir Rasam



Introduction “Donate your body to science.” While a noble thought, more often than not, it is not a reality. Organ donation worldwide is an imminent demand in the market of healthcare due to its ability to perpetuate successful treatments of a wide range of diseases through transplants. According to the Canadian Organ Replacement Register (CORR- an information system for organ failure in Canada), 3,014 organ transplants of all types of organs occurred in Canada in 2019. One person’s organ donation after death has the power to improve as many as 75 lives. Despite this, according to the Canadian blood services, 250 patients in Canada died in 2019 awaiting an organ transplant, an increase from 2018 with 223 deaths. In December 2019, 4,400 patients were found still awaiting a transplant.


If the answer to so many people’s ailments is a simple agreement from another person to donate their organs after they have passed away, then why do so many people suffer or die waiting for said donations? There are many answers to this question, but one of the most prominent ones is that there simply aren’t enough donors! It is evident that the demand for organs is higher than the supply. This gap in supply causes a shortage of organs for patients in need. In such a case, an opt-out system for organ donation will help curb the gap between the demand and supply for organ donations and will help save thousands of lives each year. The opt-out system An opt-out system of organ donation is a system where all individuals are automatically considered organ donors after death unless they chose to unenroll or - yes, as the name suggests - opt out. In fact, the province of Nova Scotia in Canada uses this system of organ donation.


The opt-out system not only helps save numerous lives through successful transplants but also gives individuals the right to opt out of donating organs. It acts as an advancement in the field of medical treatments by curbing the gap in the supply of organs while also protecting the human rights of the donor. Individuals have the right to refuse donation just as they would otherwise have had the right to register for donation in the commonly used opt-in system (the opt-in system is where individuals register themselves as donors instead of being automatically considered). This ensures a larger willing sample of organ donors.

According to the Trillium Gift of Life Network, only one in three people in Ontario are registered to donate even though over 85% of Ontarians are in favour of organ donation. This demonstrates how several potential, consensual organ donors are lost merely because they may be unaware of the need to register or may have delayed registering. This loss is a grave dent in the treatments of patients in need of organs. An opt-out system ensures that consensual donors are not lost to delay in registering for donation, thereby causing an increase in the number of organ donors.


Additionally, families often refuse to consent to donations by their deceased, registered loved ones, causing further loss of potential donors. An opt-out system ensures that such losses of consensual organ donors are avoided or compensated for, helping reduce the waitlist for organ transplants.


Organ donations require tissue typing, without which the recipient’s body may reject the transplanted organ, triggering an autoimmune response and often causing death. A rejection from the recipient’s body can cause life-altering effects on their body and may lead to heavy reliance on immunosuppressants (drugs that suppress the immune response) in order to sustain the transplant. While immunosuppressants help ensure that the transplanted organ remains in the body, they greatly degrade the immunity of the patient and make the patient vulnerable to all kinds of diseases that their body could have, under natural circumstances, fought off. Finding a close match is important in organ donation, and the probability of this is low. The opt-out system greatly increases the probability of finding a good match because the total number of donors increases. This is beneficial as it leads to a greater number of successful transplants and allows for faster transplants due to easier means to find the best matches.


However, there remains much debate on this system, and an argument against the opt-out system is that it can be vastly misused. Since it is public knowledge that all individuals, unless opted out, are donors, corruption in terms of bribery in hospitals may take root. The opt-out system may foster an increase in the number of deaths of potential donors who are hospitalized. It may also cause people to attempt to hasten the death of terminally ill patients in order to procure organs for transplantation for their loved ones. Additionally, a lack of awareness about this system can lead to people being unaware of the fact that they are organ donors unless they withdraw consent. It is unethical, and to an extent, a violation of an individual’s rights if they die without knowing that they have donated their body for medical purposes.


This system is not without its flaws. But it can be countered that hospitals can appoint an ethical committee to examine transplants in order to reduce the bribery or the cases of the hastened death of the terminally ill. For example, in Nova Scotia, statistics show that at any given time, more than 100 Nova Scotians await a transplant. In a population of more than 900,000, a few hundred organ transplants can easily be monitored, and chances for corruption can be curbed. Additionally, since tissue matches are not found easily, perpetuating the hastening of a potential donor’s death may not be a viable option. In regard to the lack of awareness in citizens and subsequent abuse of their rights if the opt-out system is put in place, this can only be battled by increasing awareness campaigns and informing citizens through mass-marketed advertisements or mentions in healthcare plans. Without active attempts to inform the population, the opt-out system can be argued to be unethical and loses its point of being able to save more lives while preserving the rights of individuals.

Overall, the opt-out policy for organ donation is beneficial as it helps save several lives, hastens transplantation procedures, and aids faster donor-recipient matches, all while preserving the consent of the people. Awareness must be spread if this system is perused in a province so that non-consensual individuals may withdraw while consensual individuals no longer need to take the pains of registering for donation. If administered well, this system can help reduce the deaths caused by a lack of supply of organs for transplants. References https://atlantic.ctvnews.ca/nova-scotia-organ-donation-presumed-consent-law-takes-effect-1.5271098 https://www.blood.ca/en/stories/data-offers-hope-patients-waiting-organ-transplant#:~:text=Sadly%2C%20the%20number%20of%20people ,compared%20with%20223%20in%202018. https://www.statista.com/statistics/792645/waiting-list-organ-transplants-canada-by-organ-type/ https://www.statista.com/statistics/569870/population-estimates-nova-scotia-canada/#:~:text=Population%20estimates%20for%20Nova%20 Scotia%2C%20Canada%202000%2D2020&text=This%20statistic%20shows%20the%20estimated,people%20living%20in%20Nova%20S cotia. https://mjlh.mcgill.ca/2020/04/07/presumed-consent-in-organ-donation-a-silver-bullet-for-nova-scotia/ https://medlineplus.gov/ency/article/000815.htm#:~:text=Tissue%20typing%20ensures%20that%20the,twins%2C%20have%20identical%2 0tissue%20antigens.&text=Hyperacute%20rejection%20occurs%20a%20few,the%20antigens%20are%20completely%20unmatched. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/organ-donation/art-20047529 https://www.cihi.ca/en/organ-replacement-in-canada-corr-annual-statistics-2020

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