Presumed consent for organ donors must come with systemic changes: Quebec College of Physicians

Quebec is considering changing how consent around organ donations works, but Quebec's College of Physicians warns the health-care system needs to be more efficient first.

Presumed consent seems an obvious solution for saving more lives, as people would have to opt out of being an organ donor instead of opting in. Though it agrees in theory, the College of Physicians raised concerns in a brief submitted to the health and social services committee of the National Assembly.

It says measures must be put in place to improve the organ and tissue donation process in the province first, like staff training and better organization and public information.

According to the professional order, the change does not guarantee an increase in the number of donations. For example, family members can veto organ donation if there isn't a record of the deceased person's last wishes.

According to Transplant Quebec, 26 per cent of refused donations in 2022 were the result of a family veto.

A public information campaign would be necessary to help people understand what organ donation entails, it says.

Kept artificially alive for days

And even with an increase in donors, "this would not mean that the number of organs available for transplant would increase," said the college of physicians.

The memo says the current organization of the health-care network makes the availability of operating rooms at the time of donation or transplantation uncertain.

In some cases, the deceased may have to be kept alive artificially for several days while waiting for the organ to be removed. This takes away available beds in the intensive care unit, and "there are reports of open conflicts between caregivers," according to the memo.

The professional order recommends there be trained staff dedicated to organ donations to ease some of that pressure. Before adopting the presumption of consent to organ donation, it calls on Quebec to put guidelines in place to develop a protocol for prioritizing donor cases, as well as all other urgent cases.

"There is a risk of taking more organs than can be transplanted. The risk of wasting organs. We don't have that luxury," says the memo.

Streamlining processes

The current model of consent for organ donations is convoluted, says the professional order. A single registry would streamline the process and make it easier to find a compatible recipient for organ donation, it says.

"Have you ever tried to register your wish to donate an organ upon your death on the RAMQ website? You've got to try it: it's quite an adventure! There are several stages, and it's a real obstacle course," reads the brief.

Otherwise, people need a notary or to sign a sticker on their health cards, which might not be accessible at the time of death.

André Fortin, the Liberal health critic, put forward Bill 194 last year, which sought to reform the model of consent for organ donors.

About 50 people die while waiting for an organ transplant every year and there are currently about 900 people on the waiting list.

"I think we owe it to those people to do everything we can to improve our system," he said.

He admits there have to be changes in the health-care system along with the change in consent.

"That's why we have consultations, to hear from experts," he said.

"We need to have larger conversations in our society, people should talk to their loved ones about being organ donors so we know people's last wishes."

Consultations on organ donation are starting at the National Assembly Tuesday.