By Molly Friesen and Katarina Zorcic
In Canada and other developed countries, organ donation rates have been relatively low. Despite national efforts, “supply has not kept pace with demand” (Caplan, 2016). Compared to other countries like Spain and the US, Canada’s organ donation rate is low. In 2019, the country’s deceased organ donor rate was 21.8 donors per million population. This number represents an increase since 2010 (Canadian Institute for Health Information, 2020). However, to ensure that demand does not outweigh supply, this number must increase.
A pressing question for the Canadian government and public health system is, “how can we increase the number of donors”? Luckily, there are effective ways that have been proven to increase organ donation rates. Two effective ways include increasing education and facilitating incentive programs. However, with incentivizing organ donation comes questions of medical ethics. Throughout this article, we will discuss each of these strategies and their implications in greater detail.
Organ donation can be a difficult or uncomfortable topic for some. Especially when faced with the decision of whether to donate the organs of a recently deceased loved one. Some of the reasons for resistance to donating one’s own organs or those of a loved one include suspicion or distrust of the medical community, traditionalist views, and/or a lack of knowledge surrounding organ and live tissue donation (Cantarovich, 2004). A 2006 study in Michigan, found that high school students’ participation in a web-based organ donation intervention increased the likelihood of registering as an organ donor (Vinokur et al., 2006). Canada has yet to implement any kind of official organ donation education programming. In its outline for 2019, Health Canada’s Organ Donation and Transplantation Collaborative listed several initiatives aimed at increasing organ donation rates. The list included maximizing donor identification in hospitals, identifying underserved populations and improving access to post-transplantation care in remote communities, increasing living donation as a preferred treatment option, and providing more professional education (Parliamentary Information, Education and Research Services, 2022). However, no efforts for educating the public have been made. Implementing education initiatives within the general population would likely increase donation rates as it has in countries like the US.
Organ Donation Incentive Programs
Incentives are often thought of as payments or financial benefits. However, it is widely accepted within the medical community that financial incentives for organ donation are unethical, no matter how much it may increase donation rates. In fact, there are laws in Canada and the US that prohibit the buying and selling of organs (Caulfield et al., 2014). Incentives do not have to be financially based. There are many ethical incentives provided to organ donors and their families, which not only increase donation but spread awareness of the good that organ donation does. Examples of these ethical incentives include donor medals of honour, paid medical leave, and “donor exchange” programs (Delmonico & Youngner, 2002).
Donor medals of honour are given to live organ donors and the families of deceased organ donors. These awards of recognition are given out by hospitals and organ-procurement organizations such as the Kidney Foundation of Canada (Delmonico & Youngner, 2002). Being recognized for donating an organ(s) not only makes the donor and/or their family feel good, but it raises awareness about organ donation in general, which indirectly increases donation rates.
Risk of losing money or even employment can be a reason why someone chooses not to be a live donor (Delmonico & Youngner, 2002), even when they know it could save someone’s life. Employment insecurity is a major problem in Canada and worldwide. By providing paid medical leave after organ donation, countries like Canada ease the anxiety surrounding taking time off work to recover.
Lastly, some countries have implemented “organ exchange” programs to increase organ donation rates. Organ exchange programs allow “an exchange of organs from two living donors or from one living donor and one deceased donor” (Delmonico & Youngner, 2002, pg. 2003). This addresses the problem that may arise when a family member wishes to donate but is incapable due to incompatible blood type or other immunologic barriers (Delmonico & Youngner, 2002).
The organ donation rates in Canada are not high enough with the increase in demand for organs. To increase the rates of registration, Canada can implement various programs and policies or strengthen those currently in place. These programs and policies include education interventions for the public and ethical incentives such as paid medical leave, organ exchange programs, and donor medals of honour. By introducing these strategies, as a country, we may be able to increase donor registration rates and save a lot of lives.
Organ replacement in Canada: CORR Annual Statistics, 2020. CIHI. (n.d.). Retrieved April 6, 2022, from https://www.cihi.ca/en/organ-replacement-in-canada-corr-annual-statistics-2020#:~:text=For%20all%20solid%20organs%2C%20the,the%20same%20as%20in%202010.
Caulfield, T., Nelson, E., Goldfeldt, B., & Klarenbach, S. (2014). Incentives and organ donation: what’s (really) legal in Canada?. Canadian journal of kidney health and disease, 1, 7.
Delmonico, F. L., Arnold, R., & Youngner, S. J. (2002). Ethical incentives–not payment–for organ donation. The New England Journal of Medicine, 346(25).
Research publications. Strategies to Optimize Organ and Tissue Donation and Transplantation.(n.d.). Retrieved April 6, 2022, from https://lop.parl.ca/sites/PublicWebsite/default/en_CA/ResearchPublications/202029E
Vinokur, A. D., Merion, R. M., Couper, M. P., Jones, E. G., & Dong, Y. (2006). Educational web-based intervention for high school students to increase knowledge and promote positive attitudes toward organ donation. Health education & behavior, 33(6), 773-786.