Questions about automatic opt-in for organ donation

On January 18 The Nova Scotia Human Organ and Tissue Donation Act comes into effect. That means that, unless people specifically opt out, any or all organs and tissue can be harvested for transplant purposes. 

This may seem like a benign, apple-pie idea, with no downside since it can help many people on waiting lists. For some civic-minded people opting out seems mean-spirited. But I don’t think this has been well-enough communicated to the public. It may be one of the issues shuffled to the government back-burner by the more immediate needs of dealing with the pandemic.

As I think about this I wonder if you become too old to donate? Is it wise to put the healthy lungs or heart of a 70-year-old in a 30-year-old? 

Are there automatic exemptions for adherents of religions which require bodies be intact and unaltered to have burial in their faith and cemeteries?

And then I wonder about disease transmission. We had a family member who, in retrospect we realized received tainted blood. At the time of the transfusion and to the end of their life no one spoke of tainted blood. It was only after their death did that scandal make headlines and begin to explain the rapid decline and multiple illness which dominated their final years.

If blood can carry diseases and illnesses, can organs and tissues also be carriers? The province should address this.

The province directs those with questions to the Canadian Blood Services (CBS) website for answers. CBS has a page titled the ABCs of eligibility to donating blood. Find it here:

https://www.blood.ca/en/blood/am-i-eligible/abcs-eligibility

CBS only requires you to be at least 17 years old and meet certain height and weight measures to donate blood. There is no top age for donation.

And you can’t be drunk when you donate blood, but there is no mention of the eligibility of those dealing with long-term alcoholism to be organ and tissue donors.

There are a number of illnesses and geographic reasons which might prevent you from being eligible from donating blood for specific periods – if not forever. Travel to certain countries or for prolonged periods to parts of the UK, France and Europe between 1980 and 1996 can make you ineligible as a donor. How many residents, students who studied abroad and immigrants will think to check this to see if it applies to them or their family?

Where I live we employ thousands of migrant workers to harvest the crops. Should they have an accident and die, would their organs and tissue be automatically entered into the transplant pool? I’m not saying they aren’t healthy, but there is much about their medical history we wouldn’t know and their countries of origin, their travel and other issues might render them ineligible to donate blood. So who is monitoring the tissue and organ harvest?

The CBS website has a separate heading for HIV/AIDS. The Red Cross stepped into a PR problem early in that AIDS pandemic when it automatically banned gay men from donating blood. Now CBS says:

“You should not donate blood or plasma if you:

  • Have HIV
  • Ever had a positive HIV test
  • Have done something that puts you at risk for becoming infected with HIV.

“Several activities put people at a high risk of acquiring HIV/AIDS. These can indefinitely defer a person from giving blood. Examples of HIV high-risk activities include, but are not limited to: 

  • A person who has taken money or drugs for sex since 1977.  
  • A person who has used intravenous street drugs. 

“If you have participated in any of the above-mentioned examples of high-risk activities, you are not eligible to donate blood or plasma.  

“Men who have had sex with a man more than 3 months ago, and who meet other screening criteria, may now be eligible to donate blood or plasma. Learn more about our policy on HIV/AIDS risk-related activities reading our Men Who Have Sex with Men info page.”

CBS has cleaned up their wording so they don’t sound homophobic. HOWEVER, their three-month celibacy requirement seems a subtle way of saying thanks, but no thanks to gay and bi-sexual men as well as those men who don’t consider themselves gay or bi-sexual, but who occasionally have sex with other men.

What people do and who they do it with is up to them, but if you can’t donate blood, shouldn’t the province clarify whether or not you should opt out of being an organ/tissue donor? 

Not everyone has a family physician, so medical records may not be complete. And even those with a personal physician may not have discussed their sex life with their doctor. Married men having an affair or occasional sex with other men are not likely to advertise or share that with their doctor. And they certainly wouldn’t share this information with their spouse, so are we introducing a flood of normally disqualified body parts to the transplant pool? Extending this a bit more, if a partner in a relationship is cheating, doesn’t their exposure extend to their partner/spouse?

I think someone needs to mount a massive – and quick – information campaign to inform people of the many issues to consider before allowing automatic opt-in to the donor program. 

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2 Responses to Questions about automatic opt-in for organ donation

  1. buddyboy546 says:

    You raise some interesting and important issues. It is an issue which is far more complex than at first glance.

  2. Pierre Schmit says:

    Good Morning,

    This organ donation program raises several issues.

    The most ethical one is the fact that for the first time in healthcare, consent and assent by not answering a question is assumed. I am a healthcare professionnal, for every act that I performed on patients I had to ask for permission, for every important act, I had to ask for written consent. On the other hand, the organ donation program lacks of donors… but this is not a valid excuse to “assume” consent, consent should be asked and given (or not).

    The second issue is that not only gay men are discriminated for organ donation (and blood donation). I was born in Europe and lived there at the time of the mad cow / Kreutzfeld Jakob variant disease, because of that when I came to Canada and attended a blooddrive I was denied of the possibility to give my blood. The organ donor program do not touch on the geographic origin of the donor. I opted out on the basis that, if my blood was “not good enough” for Canadians, then my cornea, bone marrow, bones, skin, liver, kidneys, heart and lungs are not good either.

    The law makers were blindsided by their desire to increase the number of organ donors and in doing so ignored the most elementary rule of medical ethics and some simple public safety guidelines…

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