The Nova Scotia government is considering becoming the first province to make organ donation automatic unless people opt out before they die, a proposal that could reignite the debate about whether presumed consent laws should be enacted elsewhere to help the thousands of Canadians awaiting a transplant.
Health Minister Leo Glavine said he is preparing to ask the province's deputy health minister to lead an online public consultation asking Nova Scotians whether they would support a "reverse onus" law that would compel people to register their opposition if they do not want their organs harvested after death.
"It would make available additional organs each and every year," Mr. Glavine said in an interview. "[Reverse onus] is a considerable step to move from where we are, but one that Nova Scotians have expressed a desire for us to investigate. As a government, we're prepared to now go down that path."
The consultation is expected to take a few months, he added.
Advocates of presumed consent say the approach could increase Canada's deceased donor rate, which has inched up in the past decade, but remains low compared with other developed nations. Opponents warn it could deprive people of the right to control what happens to their bodies after death without guaranteeing an uptick in organ donations.
Canada had 15.5 deceased donors per million in 2012, according to a report released in February by the Canadian Institute for Health Information (CIHI.)
In France, Italy and the United States, the rate is between 20 and 30 per million. Spain, which has a presumed consent law, has more than 30 deceased donors per million.
Spain's success is not necessarily proof presumed consent works, said Ronnie Gavsie, president and chief executive of Trillium Gift of Life Network, which co-ordinates deceased donations in Ontario.
"We do see that people instinctively feel that presumed consent would be a silver bullet, that we'd automatically have a greater number of donors if by default everyone was presumed to have agreed to donation unless they took an action to opt out," she said. "Empirically, however, we've learned from other jurisdictions that that doesn't seem to be the case."
That appears to be because the families of the deceased still have the final say, regardless of presumed consent laws, she added.
Denying families the last word can be difficult. Nova Scotia passed legislation in 2010 that would prohibit relatives from blocking organ donations by people who signed donor cards before their deaths, but the legislation has yet to be enacted because the province is still hammering out the definition of a family member, Mr. Glavine said.
Prince Edward Island began looking into a reverse onus law in 2012 and the idea is still on the table, according to Angela Carpenter, the province's new organ and tissue donation and transplant manager. But PEI is not pursuing such a law, she said.
Ontario convened a citizens' panel on organ donation in 2007 that rejected presumed consent. "A number [of participants] argued it was a violation of civil rights and said this negative option approach was not acceptable in Ontario. The major concern focused on doubts that the government would properly inform everyone, especially new Canadians, those whose mother tongue is neither English nor French, and those with mental disabilities," the panel said in its report.
Ontario Health Minister Deb Matthews said in an interview Thursday that her province has no intention of revisiting the issue.
Alberta's health minister emphasized that his province launched a voluntary online donor registry earlier this week.
"We're not looking at this [presumed consent] at all," Fred Horne said. "Our view is that people need to be willing donors and they also need to be informed donors."
In 2012, there were 4,432 people waiting for organ transplants, the vast majority of whom needed a kidney, according to CIHI. The institute said 230 people died waiting for organs the same year.