A family gathers in a hospital room where their daughter lies brain dead, the car accident that killed her leaving her organs viable for transplant. Through grief unimaginable, they face a question: will they donate her organs so others might live? A man on dialysis waits for a kidney, his name on a list of thousands, the call that would change his life not yet coming. He wonders if he will live long enough to receive the gift he needs. A woman donates a kidney to a stranger, the altruistic choice meaning surgery and risk for herself but life for someone she's never met. A liver recipient celebrates ten years post-transplant, the decade of life he's been given traced back to a family's decision in their worst moment. A transplant surgeon weighs allocation decisions, the too-few organs against the too-many patients, the impossible arithmetic of who receives and who waits. Organ donation and transplantation, the transfer of life from those who have died to those who might live, involves medicine's most profound exchanges. How donation is encouraged, organs allocated, and transplantation performed shapes who lives and who dies waiting.
The Case for Donation Promotion
Advocates argue that organ donation should be increased. From this view, the gap between need and supply is preventable tragedy.
People are dying on waitlists. Hundreds of Canadians die each year waiting for transplants. Each death represents failure to find organs in time. More donation would save these lives.
Donation rates can improve. Other countries achieve higher donation rates. Public awareness, system improvements, and policy changes can increase donation. The current gap is not inevitable.
Presumed consent may help. Opt-out systems where donation is default unless declined show higher donation rates. Canada could adopt presumed consent to increase supply.
From this perspective, organ donation should be increased through: public awareness campaigns; health system improvements; consideration of presumed consent; and support for living donation.
The Case for Ethical Boundaries
Others argue that donation must respect ethical limits. From this view, how organs are obtained matters.
Consent must be genuine. Family decision-making in grief is complex. Ensuring true consent, not just compliance, matters. Pressure on families is inappropriate.
Presumed consent raises concerns. Opt-out systems may not reflect actual wishes. Donation should be gift, not default. Consent models deserve careful consideration.
Commercialization is unacceptable. Buying and selling organs is prohibited for good reason. Incentives must not cross into commodification. The gift nature of donation should be preserved.
From this perspective, organ donation should be voluntary, gift-based, and carefully regulated.
The Consent Model
How consent for donation is determined matters.
From one view, presumed consent (opt-out) systems increase donation. If donation is default, more organs become available. Those who object can opt out. The result is more transplants and lives saved.
From another view, consent should be explicit (opt-in). Donation is personal decision that should require active agreement. Default assumptions about what people would want are problematic.
How consent is structured shapes donation rates.
The Allocation System
How organs are allocated raises ethical questions.
From one perspective, allocation should maximize lives saved. Organs should go to recipients most likely to benefit. Medical criteria should determine who receives.
From another perspective, equity matters alongside effectiveness. Wait time, geographic access, and other factors deserve consideration. Purely utilitarian allocation may disadvantage some groups.
How allocation works shapes who receives transplants.
The Living Donation
Living people can donate kidneys and partial livers.
From one view, living donation should be encouraged. It addresses organ shortage directly. Outcomes are often excellent. Donors should be supported.
From another view, living donation involves risk to healthy people. Donors must be carefully evaluated and supported. Pressure to donate - especially within families - must be prevented.
How living donation is supported shapes this avenue of organ supply.
The System Capacity
Transplant system capacity affects how many transplants occur.
From one perspective, transplant program capacity should expand. More transplant surgeons, more operating time, more ICU capacity for recovery would enable more transplants.
From another perspective, capacity is limited by organ supply. Expanding capacity without more organs doesn't increase transplants. Focus should be on donation.
How capacity is developed shapes system throughput.
The Canadian Context
Canadian organ donation rates have improved but lag some other countries. Provinces manage organ donation agencies. National coordination exists but varies. Consent models differ - some provinces have considered opt-out but none have implemented it. Living donation is encouraged but rates are limited. Wait times for transplants can be years. Indigenous patients face particular barriers. Xenotransplantation research continues. Public awareness campaigns exist. The system generally functions but the gap between need and supply persists.
From one perspective, Canada should take more aggressive action to increase organ donation.
From another perspective, ethical constraints must guide any efforts to increase donation.
How Canada approaches organ donation shapes who receives life-saving transplants.
The Question
If people are dying on waitlists, if donation rates can improve, if consent models matter, if allocation is ethical challenge - how should we approach organ donation? When someone dies waiting for a transplant, what system failure occurred? When a family decides to donate in their worst moment, what did that decision mean? When consent models affect donation rates, what policy should we choose? When organs are scarce and many need them, how should we allocate? When living donors give organs to strangers, what motivates such generosity? When we speak of the gift of life, how have we enabled that gift? And when someone needs an organ to survive, what has society done to ensure one is available?