New organ and tissue donation rules, but will it mean more people donate?

Organ Donation
Have a heart: Alberta has new organ and tissue donation rules, but will it mean more people donate?

Bryan Saunders / bryansaunders@vueweekly.com

Though no one likes thinking about death, Albertans may want to consider what happens to them a little more thoroughly, in light of recent events. At the beginning of August, the Alberta government's new Human Tissue and Organ Donation Act came into effect, replacing the old Human Tissue Gift Act of 1973, and bringing with it some changes to how organ donation in the province works.

From now on, whenever someone dies in the province of Alberta, the medical practitioner making the determination of the patient's death must consider and document the deceased's suitability for tissue and organ donation—a new step called "mandatory consideration" which is intended to increase the number of organ donations. If the doctor determines that the deceased could be a tissue or organ donor, the deceased's family must then decide whether or not they want to allow the donation to proceed. Legally—even if someone has already signed their organ donor card—it is still ultimately up to the family of the deceased to decide what happens.

As Heidi Erisman, the executive director of the Kidney Foundation of Canada's Northern Alberta and Territories branch, points out, the new mandatory consideration rule makes it more important for people in the province to not only sign the card, but also to speak with their family about the issue.

"We want to make sure that we're doing what our loved one wants," Erisman emphasizes. "If I want to be an organ and tissue donator, I have to passionately let my family know that so, when the time comes, they will not go against my wishes. Or, if I don't want to be, they'll also know not to go against my wishes."

Mike Bentley, the patient care manager with Transplant Services at the University of Alberta Hospital agrees.

"It helps if people have thought about this before," he adds. "Because, of course, when someone has passed away, it's a very shocking and upsetting time. If they've never considered organ and tissue donation before, it's very difficult for the families to know what to do. Whereas if they've talked about it before, they know what their loved one's wishes were and it makes their decision a lot easier—because, ultimately, it's the family that decides if donation proceeds."

Bentley points out that out of all of the people who die, only about two percent die in a way that could lead to organ donation. Living donation—most often from a relative—is possible for organs like livers, kidneys and lungs, but when it comes to deceased donors, potential donors have to die in a way where brain death has occurred but where the organs to be transplanted are still healthy and intact. There are also medical conditions like HIV or metastatic cancer that can exclude someone from being an organ donor.

Such issues explain why transplantable organs are so hard to come by, and why the waiting list for organs like hearts, livers, lungs, kidneys and pancreases in Canada is so long, with nearly 5000 Canadians currently awaiting organ transplants.

In addition, Bentley points out that organ transplant surgeries are becoming more and more common because they're often successful when all other treatments have failed.

"And so the waiting lists are growing and the donor pool does not grow," Bentley says. "This legislation will help because it will help us maximize our potential donor pool, but there's always going to be shortages as long as you're going to be doing transplants."

The legislation should also have a positive impact on tissue donations, which while less selective than organ donation still sees a gap between the number of people donating and those in need of donations.

"Pretty much anyone who dies can be considered for tissue donation [provided their family consents]. There are lots of people waiting for tissue transplants but if we were able to maximize the tissue donor pool, I don't think we'd have much of a gap at all. I think we could close that gap and just about fully meet the needs for tissue grafts if that donor pool was maximized because there are so many more potential tissue donors out there."

Transplantable tissues include heart valves, bones, tendons, skin and the cornea and sclera of the eyes. Skin tissue donations can help repair the bodies of burn victims burnt too badly to regenerate enough of their own skin, cornea and sclera donations can restore the sight to those rendered blind, bone tissue and tendons donations can be used in the reconstructive surgeries often required after, say, a severe car accident and heart valves are used to repair heart defects in babies and toddlers.

In addition to the obvious individual benefits, Kidney Care Services Manager Barb Foxall notes that a higher level of organ donation also has the potential to save the health care system significant amounts of money. While kidney dialysis might cost $50 000 a year and a patient might be on dialysis for several years, she says, a kidney transplant costs in the neighborhood of $20 000, and the kidney often lasts the patient the rest of their lives.

"It's much, much cheaper, and the patient's quality of life skyrockets," Foxall notes.

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