OPINION: Presumed Consent For Organ Donation


By Peter Chow

The shortage of organs available for transplant has been a serious worldwide problem since such surgeries were made feasible and safe several decades ago.

In Canada and the US, the system for organ procurement operates under a model of expressed consent, the “opt-in” system. This means that an individual will not be an organ donor unless he or she explicitly states otherwise. The desire to be a donor is typically noted on a driver’s license, in an advance directive, or by a surrogate with decision-making responsibility. While maintaining the autonomy of potential donors, the expressed-consent model has not been shown to be effective in providing the supply of organs at a level anywhere near that of the demand.

In contrast, more and more countries have relied on the method of presumed (rather than expressed) consent for organ procurement. This model takes the opposite assumption for granted – individuals are presumed to want to donate their organs upon brain death unless they have expressly objected to doing so, “opting out”.

In all forms of the presumed consent model, consent can be presumed only when individuals are properly informed of the policy and given the opportunity to easily opt out of donating.

In Canada, five people waiting for organ transplant die per week, or one death every 30 hours, that could have been averted if they had a viable donor.

A strong majority of Canadians (84%) say they are willing to donate their organs for transplantation after death.

But while most would like their organs donated in the event of their death, only half (54%) carry documentation that indicates they would like their organs donated. Furthermore, four in ten (39%) have not talked to their family about their wishes when it comes to organ donation. As a result, 20% of opted-in potential organ donors do not end up donating their organs because of objections of next of kin.

In New Zealand, everyone who applies for a driver’s licence must indicate whether or not they wish to be a donor if they die in circumstances that would allow for donation. The question is required to be answered for the application to be processed, meaning that the individual must answer yes or no, and does not have the option of leaving it unanswered.

Israel has an interesting wrinkle. Signing an organ donor card in Israel provides a potential medical benefit to the signer. If two patients require an organ donation and have the same medical need, preference will be given to the one that had signed an organ donation card. This policy was nicknamed “Don’t give, don’t get”.

More and more countries are legislating presumed consent for organ donation. They include France, Spain, Belgium, the Netherlands, Luxembourg, Norway, Sweden, Slovenia, Hungary, Croatia, Turkey, Greece, Austria, and England and Wales.

Nova Scotia announced that its new Human Organ and Tissue Donation Act will come into effect on Jan. 18, 2021, making it the first jurisdiction in North America to have a presumed consent law.

The province launched an awareness campaign in July to inform residents of the upcoming Human Organ and Tissue Donation Act.

“This change will help more people get the good news they have been waiting for and ensure more potential donors have the chance to save and improve lives,” said Premier Stephen McNeil in the release.

Presumption of consent for organ donation is ethically sound and morally justified in organ retrieval for transplantation, provided information on the opt-out process is readily available in easily comprehensible formats.

The medical need for it is real. Presumed consent for organ donation is the future.

Better sooner than later


  1. Peter Chow has highlighted a remarkably important public initiative … I am not a medical expert, but the publicly available data suggests that 1 year of kidney dialysis for a single patient (treatments for people who need a kidney, but cannot get one) – costs over $250,000 … and thousands of Canadians need dialysis every year. Think of all the places where these healthcare monies – many, many millions of dollars – could be used to help other people in need – if we had a presumed organ donation consent law…

    We all die – why not be the human organ gift that keeps on giving!

  2. No government ever “should presume intention”. I will opt for expressed intent, otherwise we will slide into “presumed DNR” at the whim of government rationalization.

  3. Thank you Dr. Chow for this, you are absolutely right. I am alive today thanks to the beloved donor who gave me the gift of life with his/her organs. I thank God every day for my donor and donor’s family. Live, love, and be happy!
    “Don’t take your organs to heaven, heaven knows they’re needed here!”

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