By Ashwin Sritharan and Simi Juriasingani
Canada faces an ever increasing need for organ donations considering the persisting demand for transplants. According to the Government of Canada, over 4300 people were waiting for organ transplants in 2018, with 223 people succumbing to organ failure during the wait for a transplant. Given the rarity of registered donors, it is important to look deeper into the barriers that stop individuals from registering as organ donors and discuss the cultural and/or personal stigmas that may be factoring into their indecision.
1) Religious discouragement due to the sanctity of the human body
Religion can be strongly tied to one’s identity, influencing one’s beliefs and morality. Views on organ transplantation are no exception. While no religion formally condones or condemns organ donation, certain groups may discourage organ donations within their community. A scientific review published in 2008 reported that Roma Gypsies, Confucians, and some Orthodox rabbis were found to discourage transplantation from deceased donors. Furthermore, some South Asian Muslim Ulemars (scholars) and Muftis (jurists) have expressed their disapproval of donations from both living and deceased donors on the grounds that the human body is a blessing from God and accepting such donations would desecrate it. Additionally in addressing participants at the XVIII International Congress of the Transplantation Society in 2000, Pope John Paul II suggested that organ donation and transplant procedures “must be considered morally unacceptable, because to use the body as an object is to violate the dignity of the human person.” While we live in a society where everyone is free to make decisions based on their own thoughts and beliefs, working with reluctant religious groups could help change such mindsets. Addressing their concerns and educating them about the societal and medical benefits of transplantation could open dialogue and broaden our nation’s pool of organ donors.
2) Indigenous groups and their contentious history with the state
Certain indigenous groups have expressed their discouragement of transplantation from deceased donors in a recent cross-sectional survey that evaluated the presence of cultural influences on the willingness to donate. A recent study revealed a common trend of mistrust in the local health system for a variety of reasons. This mistrust is certainly warranted given the past history of Pasteurian care forced upon Indigenous communities by external bodies. Further efforts focused on developing trust and bridging the gap between health systems and Indigenous communities would increase patient satisfaction and better health outcomes for these communities. The need for organ transplants is steadily increasing in most communities across the nation. Thus, it is more important than ever to include Indigenous communities in these conversations and address their concerns to achieve a representative national pool of organ donors.
3) The underrepresentation of Chinese Canadians
The underrepresentation of Chinese Canadians in the organ donor pool appears to be mainly due to lack of education and outreach. When studying the opinions and beliefs of Chinese Canadians towards organ donation, there was a noticeable trend of not having enough information, and being unaware of what the organ donation process consists of. Furthermore, another study found that most Chinese Canadian participants had little to no knowledge about organ donation and transplantation, but were eager to learn more about the topic. This common trend shows a rare opportunity to increase the inclusion of a group of individuals that show promise as eager organ donors. Public health measures to educate Chinese Canadians about the process and impact of organ donation could facilitate more donor registration from this group. This would greatly aid other Chinese Canadians and Canadians from other backgrounds who are waiting for transplants.
4) LGBT+ underrepresentation and barriers faced by gay men
There has been a noticeable underrepresentation of LGBT+ individuals, particularly men, from organ donation for reasons outside of their control. While it is not discouraged, gay men have to go through additional barriers to become registered organ donors than other groups. In the case of living donors, doctors may question them about their sexual history to see if they have engaged in any sexual activity within a certain period of time. One such strategy to determine sexual activity is an invasive perianal condyloma to look for evidence of anal intercourse. Leading up to Prime Minister Justin Trudeau’s 2015 election, the Liberal Party ran an “End the Ban” campaign, claiming that they would repeal regulations surrounding gay men. However, these promises only extended to donating blood. So far, the only legalized measure has been to reduce the deferral period. These organ donation policies have been criticized as being discriminatory and promoting dangerous stereotypes around gay men. They serve as barriers, based on sexual orientation, for individuals who may want to donate organs. Reforming discriminatory policies would go a long way in facilitating organ donor registration and promoting inclusivity, which is crucial for achieving a diverse donor pool.
Call to Action
While Canada’s population is diverse, its donor pool, unfortunately, is not. In Ontario, diverse areas like the Greater Toronto Area have a 14% organ donor registration rate, with Caucasian donors making up a larger proportion of the donor pool. A more representative, inclusive and diverse donor pool is needed to help as many patients as possible who are currently on waiting lists. Registering as a donor can help those who need it the most, regardless of ethnicity. One donor can save up to eight lives, so it’s up to each of us to make a conscious decision. Those living in Ontario can register online at https://www.ontario.ca/page/organ-and-tissue-donor-registration. Remember, registering as a donor is the primary way to ensure that your decision is known, but it’s also important to make your wishes known to your loved ones so that they can advocate for you if/when the time comes.