Our Position on Organ Donation

The following statements reflect the Foundation's position on a variety of issues pertaining to organ donation. They serve to support our advocacy work to ensure that health practices and policies are in place that will optimize organ donation in Canada.

Leadership, Coordination and Funding

The Kidney Foundation of Canada calls upon the Federal/Provincial/Territorial Conference of Health ministers to implement a national strategy and oversight to ensure every potential deceased donor is identified and referred, and that every person awaiting transplant has equitable access to organ transplantation across the country.  This includes implementation and monitoring of best practices, public and professional education, and the development and coordination of an advanced inter-provincial organ sharing and data monitoring system. The strategy should be developed in collaboration with a broad range of stakeholders including government, health care, and the public and voluntary sector.

Public Awareness

The Kidney Foundation of Canada promotes activities which increase awareness of the importance of organ donation, encourages people to indicate their intent and inform their families of their wishes.

Deceased Donation

Intent to Donate
The Kidney Foundation of Canada supports upholding the individual’s right to make known his/her decision regarding organ and tissue donation and to have it carried out at the time of death.  This could include an opt-out consent system whereby an individual’s wishes can be recorded.

The Kidney Foundation of Canada is in support of effective mechanisms that record, in advance, an individual’s intent to donate organs and tissues at the time of death and of the donor’s family to uphold that decision.


Proxy Consent
In situations where there is no advance communication of intent to donate, The Kidney Foundation of Canada supports proxy consent, whereby the proxy decision maker will be approached for consent before removal of a donor organ.

Opt-out (Presumed) Consent
The Kidney Foundation of Canada supports opt-out consent when it is part of a comprehensive strategy to improve organ donation and transplantation systems in Canada, and to educate Canadians on how to register their choice. A successful system would include implementation and monitoring of best medical practices, public and professional education, and the development and coordination of an advanced inter-provincial organ sharing and data monitoring system.

Donation after Cardiac Death (DCD)
The Kidney Foundation of Canada is in support of organ donation after cardiocirculatory death (DCD), in controlled settings where an unhurried consent discussion can be held, and recommends that hospitals develop the required internal policies and procedures based on the national recommendations of the Canadian Council for Donation and Transplantation.

Living Donation

The Kidney Foundation of Canada supports living organ donation. Organ transplantation from a live organ donor is an ethically acceptable practice providing the person who gives consent to be a live organ donor is competent to make the decision to donate, willing to donate, free from coercion, medically and psychosocially suitable, fully informed of the risks and benefits as a donor, and fully informed of the risks, benefits, and treatment options available to the recipient.
 
The Kidney Foundation of Canada supports promoting living donation through public awareness and by reducing the barriers to living donation for the donor and recipient, including practices and adequate resources to reduce the amount of time it takes for a potential donor to be screened and for the surgery to take place.
 

Live Donor Database
As live organ donation is a voluntary act of giving, The Kidney Foundation of Canada supports the principle that live organ donors should not personally bear any costs associated with donation. This includes reducing barriers to living donations such as improved financial support for living donors and continued support of living donation programs such as Kidney Paired Donation program and Living Organ Donor Expense Reimbursement Programs (LODERP).

Financial Barriers to Live Donation
As live organ donation is a voluntary act of giving, The Kidney Foundation of Canada supports the principle that live organ donors should not personally bear any costs associated with donation.

Commercial Trade of Human Organs
The Kidney Foundation of Canada condemns the practice of buying and selling organs for transplantation.  The Kidney Foundation does not support:

  • Economic incentives to individuals to donate an organ for transplantation. (However, this does not preclude the reimbursement of reasonable expenses incurred by a donor during the donation process).
  • Advertisement of organs for sale.
  • Brokering the movement of organs, donors, recipients or transplant professionals for the purpose of organ trafficking, or transplant tourism, as defined in the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, 2018.
  • Use of organs suspected to have been obtained through commercial transaction.

Definitions:

Organ trafficking consists of any of the following activities: (a) removing organs from living or deceased donors without valid consent or authorisation or in exchange for financial gain or comparable advantage to the donor and/or a third person; (b) any transportation, manipulation, transplantation or other use of such organs; (c) offering any undue advantage to, or requesting the same by, a healthcare professional, public official, or employee of a private sector entity to facilitate or perform such removal or use; (d) soliciting or recruiting donors or recipients, where carried out for financial gain or comparable advantage; or (e) attempting to commit, or aiding or abetting the commission of, any of these acts.1

Trafficking in persons for the purpose of organ removal is the recruitment, transportation, transfer, harbouring, or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability, or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of the removal of organs.
 
Travel with the goal of transplantation becomes transplant tourism, which is defined above as unethical, if it involves any of the following conditions:  trafficking in persons for the purpose of organ removal; trafficking in human organs; and/or if the resources (organs, professionals and transplant centres) devoted to providing transplants to non-resident patients compromise the country's ability to provide transplant services for its own population.
 

Individual Appeals to the Public for Living Organ Donors

Insofar as individual appeals to the public for living donors may increase the number of kidneys available for transplantation, The Kidney Foundation of Canada is in support of appeals that enable potential organ donors and recipients to connect for the purpose of living organ donation.
 
The role of the health care team is essential in determining suitability of the living donor/recipient match and the Foundation supports the use of rigorous evaluation protocols to ensure protection of both the living donor and transplant recipient.
 
The connection between the potential donor and transplant recipient must not include an economic incentive to the living organ donor. (see Organ Donation Position Statement, Commercial Trade of Organ Donors)

Xenotransplantation

The Kidney Foundation does not recommend that Canada proceed with xenotransplantation involving humans at this time as there are critical issues related to safety and efficacy that first need to be resolved. Health Canada must continue to inform and involve the public in discussions about the future of xenotransplantation. Before clinical trials are permitted in Canada, stringent and transparent legislation and regulations must be developed. The Kidney Foundation encourages further research at the pre-clinical level in order to gain further knowledge about the potential health risks and viability of xenotransplantation. Alternatives to xenotransplantation should be further explored.

1 Organ trafficking and transplant tourism and commercialism: the Declaration of Istanbul (2018 Edition). February 2019. Volume 103,  Number 2

 

 

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