Organ Donation and Transplantation: Considering International Policy Options for Canada

Organ donation is the most cost-effective, if not the only, option for the treatment for end-stage organ failure. End-stage organ failure is an epidemic, costing the Canadian healthcare system over $35 billion dollars per year. As organ donation and transplantation (ODT) is the most cost-effective solution, it is in Canada’s best interest to maximize the number of donors to allow for the maximum number of transplants. Canada currently lags behind most developed countries and the literature describes most of the world being in an “organ shortage”, with demand for transplants far exceeding the supply of viable, donated organs. Current efforts are improving donation rates, but not at the same magnitude that demand is increasing. Other jurisdictions use different operating principles to guide their ODT systems and achieve better results. Canada operates under a requested consent operating principle, where donors are required to volunteer their organs to be considered for transplantation. Many nations in Western Europe operate under a presumed consent operating principle, which reverses the onus and assumes everyone is a willing donor and individuals must specify their desire to not be considered. New and innovative operating principles have also been put into practice around the world. Israel operates under a reciprocal altruism operating principle where individuals who are willing donors, or are first-degree relatives of willing donors, are given priority ranking on the waiting list if they are ever awaiting a transplant. Iran operates under a legitimate market-based operating principle, allowing individuals to sell their kidneys (legalizing the clandestine practices that currently occur worldwide). These operating principles are assessed for their ability to be implemented in Canada, as measured by their viability in the current political regime, their compatibility with the current policy framework, their legal viability and their ethical considerations. The operating principles are also assessed for their efficacy in improving the supply of donor organs. The reciprocal altruism operating principle carries too many legal and ethical barriers to be viable for implementation, and lacks strong evidence of efficacy. The legitimate-market based operating principle shows strong results (Iran is the only jurisdiction in the world without a waiting list for kidney transplants), but ultimately carries ethical burdens that would not conform with the values held by the majority of Canadians. The presumed consent system is highly championed in the literature, and is well suited to the Canadian political and legal environment, but evidence suggests it would require changes in how it is applied (changes that run contrary to any country currently under that operating principle) in order to have any impact on the number of transplants performed. The province of Saskatchewan is the poorest performer in Canada by a large margin. Thus it is thoroughly assessed to pinpoint failures in existing policy and to find efficiencies that can be gained through greater co-operation among the provinces and through the co-option of best practices used by the topperforming provinces.

Name thesis:degree_name

Master of Public Policy (MPP)

Level thesis:degree_level

Master's

Grantor dc:publisher

Faculty of Graduate Studies and Research, University of Regina

Year dc:date.issued

2012

Author dc:creator

• Sherar, Michael Wakeham

Advisor dc:contributor.advisor

• Marchildon, Gregory

Committee member dc:contributor.committeemember

• McNutt, Kathleen

Language dc:language.iso

en

DOI

https://doi.org/10.82465/5109

OAI identifier oai:identifier

oai:uregina.scholaris.ca:10294/3759