As part of the latest addition to the arts colloquium series, sociology professor Lindsey McKay shared her decade-long research on organ donation in Canada and addressed the severe lack of organ supply nationally. She explained how the common understanding of organ donation comes down to scarcity and lack of consent.
“Our common understanding is to think about scarcity being the problem, so that means supply, the supply of organs is the problem,” she said. “Scarcity is also caused by lack of consent, sometimes you hear talk of possible efficacy so the ability for physicians and nurses and the whole system to get the organs, but I’m going to focus on consent because that’s the other crucial piece.”
Canada uses an ‘opt-in’ system for organ donation consent, meaning a donor has to state their consent explicitly. This has translated to less than 20 per cent of the population registering as an organ donor. Some European countries like Spain, Austria, Wales and France, use a presumed consent system or ‘opt-out’ system, providing for some of the highest organ donation rates worldwide. Despite this disparity in donation rates between both systems, McKay argues there isn’t enough evidence to suggest that one system is dramatically better than the other.
“The problem is there’s actually no evidence. This is incredibly popular, it’s been introduced in Wales, there’s a report in Scotland I looked up the other day saying, ‘Well actually, there may not be a lot of strong evidence,’” she said. “It’s true that the countries with good national donation rates like Spain have the opt-out system but it’s actually not backed up by evidence.”
McKay expresses how the conversation about organ supply is often from the perspective of the organ recipient and rarely from the organ donor. She suggests the discourse should be focused on risk management and ways to reduce or prevent the demand for organs rather than finding ways to harvest more.
“It’s always from the position of someone who needs the organs, we don’t see the other side, she said. “It’s a form of power, it shapes the organization of this exchange and focuses entirely on supply, so you don’t think about how someone comes to need an organ and whether there are alternatives to reduce the demand, you’re simply invited to think about the need for more organs.”
Since the beginning of organ transplantation procedures, there has always a polemical debate on the eligibility of deceased donors within the medical community, essentially defining whether death is determined by the heart or the brain and rules around that. In all Canadian provinces and territories, brain death is legally defined as “according to medical practice” and it’s really up to the individual hospital to determine the point of death. This has left much ambiguity emphasizing the cruciality of consent. Despite this uncertainty, according to McKay’s research, even if the entire pool of potential organ donors were to be converted successfully, it still wouldn’t be enough to fulfill the demand for organs. At the end of the day, consent is critically important, but it is only as good as the pool size of potential donors.
“This really shows that maybe we have to look at this from another way, maybe we have to reduce the [organ donation] waitlist and think about demand,” she added.