Citizens Panel Recommends Changes to Address Ontario's Critical Need for Transplant Organs



    TORONTO, April 19 /CNW/ - Ontario can increase the number of organs
available for transplant by encouraging more living donations through
increased public education and providing supports to make it easier for people
to give the gift of life, says an expert panel appointed by the Minister of
Health and Long-Term Care.
    As well, the Ontario government should make the province's organ donation
system more transparent, responsive and effective; build public confidence in
the system's capacity to respect their wishes and act on them; and ensure
hospitals place a high priority on organ donation, according to the report of
the Citizens Panel on Increasing Organ Donations, released today.
    "Ontarians view organ donation as a vital method of saving lives. They
understand the critical need for transplant organs and find it unacceptable
that patients are suffering and dying while on the waiting list," said Dr. Ted
Boadway, the panel's chair.
    "During our consultations, Ontarians clearly told us the system should
uphold a person's expressed consent to donate organs. Our recommendations
focus on how best to make this happen. To meet Ontario's need for transplant
organs, the system must become more transparent, responsive and effective. But
it must always respect the wishes of individual Ontarians," Boadway added.
    
    In its report, the panel makes a total of 26 recommendations aimed at:

    -  Providing living donors with job security and establishing a fund to
       reimburse them for reasonable expenses such as travel, accommodation
       and childcare.

    -  Confirming a patient's wishes by requiring Ontarians to state their
       organ donation preferences on certain government forms, such as the
       OHIP card and driver's license renewal.

    -  Registering organ donation preference information in a central
       database and making that information available to families and health
       care providers at the appropriate time.

    -  Educating the public on how the system will respect their donation
       wishes, and doing more to educate Ontario's youth about organ
       donation.

    -  Encouraging religious leaders to engage in dialogue with their faith
       communities, to address myths and misinformation about religious views
       on organ donation.

    -  Instituting policies to promote greater use of donation after cardiac
       death in Ontario's transplant hospitals.

    -  Addressing issues faced by Ontario hospitals, to ensure hospital
       systems and processes support organ donation and reflect provincial
       priorities.

    -  Providing sufficient resources to enable Trillium Gift of Life Network
       to deliver an expanded mandate and role as Ontario's agency to promote
       organ donation.
    

    Currently in Ontario, the need for organs far exceeds supply. More than
1,750 patients are waiting for an organ transplant. Since 1994, Ontario's
transplant waiting list has increased by two-thirds. Patients on the waiting
list are very ill. Most are too sick to work. Some die while waiting for a
transplant.
    Health and Long-Term Care Minister George Smitherman created the citizens
panel in November 2006. The panel used a range of consultation approaches to
hear the views and opinions of Ontarians. It also met with experts and
reviewed previous reports on improving organ donation and transplantation.
    "Our recommendations reflect the ideas, input and advice gathered through
our consultations about the urgent need to increase organ donations in
Ontario," said Boadway. "We thank everyone who contributed to this process.
    "We urge the Ontario government to move quickly to implement our
recommendations, so that more Ontarians on waiting lists can have a new chance
at life," said Boadway.

    The panel's report is available online at
www.panelonorgandonations.on.ca.

    Disponible en français.



    
                                                                Backgrounder

                 Citizens Panel on Increasing Organ Donations

    On November 24, 2006, Health and Long-Term Care Minister George Smitherman
announced the establishment of a panel of eminent citizens to consult with
Ontarians on how to increase organ donations in the province.

    The six members of the Citizens Panel on Increasing Organ Donations are:

    -  Dr. Ted Boadway (chair), former director of health policy at the
       Ontario Medical Association

    -  Alvin Curling, former MPP and Speaker of the Ontario Legislature

    -  Peter Desbarats, print and television journalist, and former dean of
       the journalism school at the University of Western Ontario

    -  Reverend Dr. Brent Hawkes, human rights activist and pastor of
       Metropolitan Community Church Toronto

    -  Gisèle Lalonde, community activist and former mayor of Vanier, who
       served on the board of directors of the Montfort Hospital and the
       Montfort Hospital Foundation

    -  Joan Neiman, lawyer, activist and former Canadian Senator
    

    The panel's mandate was to consult Ontarians on organ donation issues and
develop recommendations for increasing organ donations in the province. From
November 2006 to February 2007, the panel held public meetings and discussion
groups in communities across the province. More than 2,000 people responded to
the panel's opinion survey. The panel also met with experts and reviewed
previous reports on improving organ donation and transplantation.

    Summary of the Citizens Panel's Recommendations

    On April 19, 2007, the panel released its report, which includes a total
of 26 recommendations to the Minister of Health and Long-Term Care for
increasing organ donations in Ontario. A summary of the panel's
recommendations is provided below.

    Meeting the Need

    During its consultations, the panel heard strong support for enduring
consent - a model that upholds the wishes of those who agree to donate their
organs upon their death.
    The panel recommends the Ontario government increase the number of organs
available for transplant by improving how the system collects information,
ensuring that it respects a person's decision to donate and can take action on
that choice.
    In addition, the Panel believes the Ontario government should also
provide financial support to encourage more living donations, undertake more
public education, and ensure hospitals place a high priority on organ
donation.

    Education

    During its consultations, the panel learned that many Ontarians are
misinformed about organ donation. To dispel the myths and misperceptions about
organ donation, the panel recommends:

    
    -  Implementing a public education campaign to assure the public that
       their donation wishes will be respected and informing them how this
       will be done.

    -  Increasing education about organ donation in Ontario schools and
       creating a youth-oriented website about organ donation.

    Role of Religion

    Many Ontarians told the panel that religion strongly influences their
attitudes and decisions about organ donation. Although all major religions
officially permit organ donation, many Ontarians said their faith leader had
spoken against it.

    The panel recommends that the Ontario government:

    -  Bring together religious leaders to engage religious schools on organ
       donation and to establish a National Donor Sabbath, like the one
       observed in the United States.

    Living Donors

    Living donations save health-care dollars for expensive treatments such as
dialysis. They restore organ recipients to productive members of their family
and of society. Yet living donors face significant financial costs, and some
living donations are lost because of anticipated financial hardship.
    The panel recommends that the Ontario government provide financial support
to living donors, including;

    -  Enacting legislation to provide living donors with job security,
       similar to maternity leave.

    -  Reimbursing living donors for reasonable expenses, such as travel
       costs, accommodation and childcare expenses.

    -  Expanding the Northern Health Travel Grant Program to living organ
       donors, to address challenges faced by Ontarians living in the north.

    To facilitate paired exchanges - a process where two separate, willing but
incompatible donors are matched with each other's intended recipient - the
panel recommends that:

    -  Ontario establish and maintain a provincial database of living donors,
       to be housed at Trillium Gift of Life Network.

    Donation After Cardiac Death

    The panel heard from experts that donation after cardiac death is emerging
as a promising source of transplant organs, offering the potential for Ontario
hospitals to increase the number of organ donations by up to 25 per cent. The
panel recommends that:

    -  Every hospital in Ontario that provides donors should institute
       policies for donation after cardiac death, consistent with the
       national recommendations developed by the Canadian Council for
       Donation and Transplantation.

    Hospital-Specific Issues

    The panel recommends a number of measures to address issues faced by
Ontario hospitals. They include;

    -  Establishing a provincial fund, managed by Trillium Gift of Life
       Network, to reimburse Ontario hospitals for reasonable costs paid to
       American hospitals for U.S. organs.

    -  Allowing Trillium Gift of Life Network to collect reasonable costs
       from U.S. hospitals for Ontario organs.

    -  Including organ donation as part of Ontario's Critical Care Strategy,
       and addressing the planning and resources needed for an increase in
       organ donors to more than 300 per year and for widespread use of
       donation after cardiac death.

    -  Commissioning a study of intensivists' compensation for donor
       management. These professionals currently undertake a range of
       demanding tasks in the transplant process, many of them not covered by
       the OHIP fee schedule.

    Local Health Integration Networks

    The panel's report notes that Ontario's system of 14 Local Health
Integration Networks, or LHINs, provides an opportunity to achieve balance in
meeting the diverse needs within Ontario's organ donation and transplant
system. The panel recommends that:

    -  Accountability agreements between the Ministry of Health and Long-Term
       Care and the province's 14 Local Health Integration Networks, or
       LHINs, place a strong emphasis on supporting and facilitating organ
       donation and transplantation.

    -  Accountability agreements signed by each LHIN with its local hospitals
       should reflect provincial priorities for organ donation and include
       practical steps for increasing organ donations.

    Trillium Gift of Life Network

    During its consultations, many people told the panel that they were
confused by the name Trillium Gift of Life Network. The panel recommends that:

    -  Trillium should be allowed to change its name to something less likely
       to be misunderstood and more in accord with its mandate.

    Because its report envisions a significant increase in responsibilities
and mandate for Trillium Gift of Life Network, the panel also recommends that:

    -  The organization should be given additional resources to carry out its
       new role and responsibilities.

    The panel's report is available online at www.panelonorgandonations.on.ca.

    Disponible en français.



                                                                Backgrounder

                              Models of Consent

    Enduring Consent

    Enduring consent is a model that upholds a person's preferences regarding
organ donation. With enduring consent, a person's expressed wish to donate
organs endures after their death and cannot be contradicted by a family
member.
    During its consultations, the Citizens Panel heard strong support for
enduring consent. The panel recommends a series of measures designed to build
public confidence in the system's capacity to respect their wishes and act on
them. They include:

    -  Amending the Trillium Gift of Life Act to require tangible proof, in
       writing, that a person has withdrawn their consent to donate organs.

    -  Requiring Ontarians to state their organ donation preferences on such
       government forms as the OHIP card or driver's license renewal.

    -  Recording this information in a database and sending it regularly to
       Trillium Gift of Life Network, which would disclose it to families and
       health care providers at the appropriate time.
    

    Presumed Consent

    Presumed consent is a model whereby an individual's consent to donate is
presumed, unless a person has expressly indicated otherwise during his or her
lifetime. It is also known as the opting-out system.
    During the panel's consultations, the topic of presumed consent stirred
strong opinions and lively debate. The panel heard support for presumed
consent chiefly from those who have an attachment to organ donation - that is,
people who are recipients, living donors, donor families or on the waiting
list. But most Ontarians who are not attached to organ donation issues told
the panel they were uncomfortable with presumed consent.
    Currently in Ontario, organ donation is a gift from one person to
another, a positive and freely taken step. With presumed consent, an organ is
no longer given - it is taken. Many Ontarians told the panel they are
uncomfortable with this and some feared it might generate a backlash against
organ donation.
    The panel also heard that the effectiveness of presumed consent is not
clear-cut. Although some countries with presumed consent have donation rates
that are higher than Ontario's, others are well below.
    Other presumed consent nations use the "soft" model where physicians
still consult with family members. This gives doctors the opportunity to
explain the law to the relatives and to ask them if they know whether the
patient had an unregistered objection to organ donation. Panel research shows
physicians do not proceed with organ retrieval against a family's objections
on any grounds.

    The panel's report is available online at
www.panelonorgandonations.on.ca.

    Disponible en français.





For further information:

For further information: Doreen Thibert, Citizens Panel Secretariat,
(416) 214-3494

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THE CITIZENS PANEL ON INCREASING ORGAN DONATIONS

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