REALity July 2019

 The vast majority of Canadians agree that organ donation is a good idea, and are willing to help others in this regard.  However, only about 20% of individuals actually sign up to be organ donors. As a result, Canada has one of the lowest organ donation rates in the developed world.

One of the reasons for the low donor rate is that such donations are not a simple matter.  There are religious and ethical objections to this practice.  Also, whether correct or not, there is in some cases, a distrust of the medical establishment.  Some fear that if they are brought into a hospital emergency room and if there is a patient who needs an organ transplant at that time, they may find themselves to be considered a whole lot deader than they expected.  This fear has been greatly increased in recent years with physicians’ participation in abortion and assisted suicide procedures, which indicates that the sanctity of life isn’t always uppermost in some physicians’ minds while attending to their patients.

The province of Nova Scotia has decided to get around the problem of the low organ donor rate by introducing legislation, on April 12, 2019, that provides for those over 19 years of age to be regarded as automatic organ donors unless they indicate otherwise. The Nova Scotia legislation providing for presumed consent for organ donation is the first of its kind in North America.

Although the idea behind the presumption of consent is to increase the number of donors available, which is positive, it does raise some troubling moral and ethical problems.  For example, it is a significant intrusion into people’s bodily integrity and intent.  The decision to donate organs should be made consciously, rather than by having the state play the role of decision maker for the patient.  In effect, by this automatic donation of organs, individuals relinquish their bodies to the government’s disposition by default, providing they have not specifically raised objections to it, since the government is taking their body parts to distribute to others. Looked at from this perspective, taking organs by way of a presumed consent is a dehumanizing, utilitarian policy.

Organ Removal With Presumed Consent Does Not Always Achieve More Donations

There is evidence that the automatic removal of body parts, under presumed consent, does not automatically increase the number of organ donations.  Luxemburg, Sweden, and Bulgaria, for example, have presumed consent laws, similar to the one in Nova Scotia, but their donation rates are even lower than that of Canada.  This may be due to the fact that the patient’s family may refuse the donation.  In any civilized society, it is not acceptable to ignore the wishes of family members, especially in regard to the sensitive issue of organ donation. A decision by the family creates a layer of uncertainty and confusion which results in a reduction in the number of donated organs.

Organ Removal and Assisted Suicide

The problem of organ harvesting also raises concern in cases of assisted suicide, which adds another wrinkle to organ donations.  The problem is that the organs need to be harvested quickly after the patient dies:  the less stress the organs undergo, the better their condition for transplant.  This need for “fresh” organs has led to the invention of the concept of “brain death.”  “Brain death” is not a true natural death, but rather a medicolegal construct for the main purpose of removing organs from deeply comatose, but still living patients.

The “brain death” interpretation can lead to pressure on families of such patients to give consent to remove the organs – pressure that family doesn’t need at such a difficult time.

Further, individuals who donate their organs after assisted suicide must undergo uncomfortable and inconvenient medical tests to see if their organs and tissues are viable for transplant.  Such patients also have to be in a transplant capable hospital, close to an operating room, with a waiting medical team to remove the organ once death is declared.  This process does not leave much time for the patient to ensure friends and family are provided with fond memories of the “event”.  It is reduced to a quick, efficient medical procedure – not a meaningful, gentle ending to a life as depicted by the Death with Dignity organization.