Would an opt-out system increase organ donations? Experts say Quebec has work to do first

In 2021, Nova Scotia became the first jurisdiction in North America to introduce a policy automatically designating all adults as organ donors upon death, unless they had opted out of the program when they were alive. 

The idea is called presumed consent, and four years after its implementation in Nova Scotia, the law has led to a significant surge in organ donations.

"It's been incredibly successful," said Dr. Stephen Beed, medical director of Nova Scotia's organ and tissue donation program, in an interview with CBC News.

"We have just about doubled our donation rate and we expect to have somewhere in the 35, maybe even approaching 40 donors per million rate at a time when most of Canada would be in the high teens or the low 20s." 

New Brunswick also moved to adopt a presumed consent policy in 2023, known as Avery's Law, which is expected to be implemented in 2025. 

Despite other provinces moving forward with this policy that has proven successful, Quebec has repeatedly been told it isn't ready to take that step. 

This week, an all-party committee at the National Assembly recommended that Quebec shelve the idea as the province prepares to table a new bill to facilitate the organ donation process.

"There are really base elements that we need to improve [before having] that discussion about presumed consent," said Catherine Blouin, a committee member and the parliamentary assistant to the health minister.

Experts agree.

While presumed consent may seem like a straightforward solution to save more lives, experts say its absence isn't what's hindering Quebec's organ donation efforts. Rather, it's the lack of key measures the province must implement that would make the policy worth adopting.

Beed says while presumed consent is what made headlines, he attributes little of Nova Scotia's success in increasing organ donation rates to the policy itself.

He says often overlooked is the fact that the province's outdated organ donation program was rebuilt "from the bottom up" when the legislation was passed in order to make it effective. 

"It's that system change that has dramatically increased our donation more so than a particular component of the law," Beed said.

He said the revamp included more training for front-line health-care workers, better communication with hospital administrators and a new database to track donor status.