Radical New Measures Suggested to Improve Organ Donations
THE SYMPTOMS weren't severe enough for 16-year-old Gordon Denison to give them much thought. It was 1996, and Denison was living in rural Ormstown, Que., 50 km southwest of Montreal. His hands and feet would grow cold, and there'd be pins and needles. His legs felt heavy. He had headaches. His father suggested a visit to the doctor. "It turned out my blood results were off the scale," recalls Denison, now 25 and living in Montreal. "When the doctors saw my numbers, they were shocked - I should have been comatose. Had I waited another three weeks before being seen, chances are I would have been dead."
It turned out Denison's kidneys were too small. He'd need dialysis, but the only long-term solution was a transplant. And for that, he was told, he'd have to wait three to five years. Why? Canadians are widely recognized as among the most reluctant organ donors in the developed world.
In an attempt to change that, some observers suggest expanding the definition for eligible donors beyond the current, restrictive criteria. Others are demanding more radical change. Everyone, they say, should automatically be considered a donor. In other words, if you die, and haven't indicated otherwise, your organs are fair game. It's called presumed consent. Peter Kormos, the New Democratic Party's house leader in the Ontario legislature, says it could be a simple matter of a doctor visiting a website and punching in your name and date of birth to see whether you've opted out. If you're not listed, the doctor would have done his or her due diligence, says Kormos, "and then they can go to town, harvest that organ and save a life."
The Canadian Organ Replacement Register says 4,054 patients currently require a transplant. Last year, 224 of them died waiting. The reason is maddeningly simple: only 1,317 organs were harvested, from 414 dead donors, in 2004 (another 468 living donors gave a kidney or part of a liver). For the past decade, the number of deceased donors has remained stagnant, hovering in the low 400s.
Presumed consent is practised in several European countries, including Spain, France and Austria. Kormos has authored a private member's bill to usher in similar reform. It has no chance of being adopted in Ontario, but the MPP hopes it will spark a broader debate. "We should be as generous with organs that are no longer of value to us," says Kormos, "as we are with used clothing, toasters, and things that our great-aunt gave us on our wedding day that we're never going to use."
Toronto activist George Marcello is one of those rare, incredibly lucky men who have had not one but two liver transplants. Through his charitable organization Step By Step, Marcello has waged a dogged battle to increase organ donations in Canada. He is convinced presumed consent is the way to go. In the countries that have adopted it, he says, organ donations have increased anywhere from 20 to 50 per cent. In Austria, adds Marcello, if you indicate you do not want to be an organ donor, and down the line you need a transplant yourself, you automatically go to the bottom of the waiting list.
There's a simpler way than presumed consent to increase the number of donors, argues Dr. Sam Shemie, an intensive-care specialist at the Montreal Children's Hospital. Currently, only patients who are declared brain dead can donate, but a national forum held in Vancouver last February looked at ways to increase the pool of organ donors by including patients who die from cardiac arrest (a report is due this fall). The United States, Japan and parts of Europe allow organ recovery from patients who are "heart dead," but not Canada. "If the death is inevitable, and if families want to help other families who are facing preventable deaths," says Shemie, "then we should do everything we can to achieve that."
Denison eventually got his kidney. He was lucky. "It's been a gift, a second chance at life," he says. Kormos wishes more people could have Denison's experience. "All I know is that thousands of bodies are being buried to rot in the ground or being burnt every year," says Kormos. "Surely, among those thousands, there are some harvestable organs. End of story."
See also TRANSPLANTATION.
Maclean's September 19, 2005