The landmark Human Organ and Tissue Donation Act (HOTDA) came into effect in Nova Scotia on Jan. 18. Under the law, all Nova Scotians will be considered organ and tissue donors unless they opt out. Nova Scotia is the first jurisdiction in North America to pass such a “deemed consent” law. Medical professionals, as well as the 4,000 Canadians in other provinces who need organs or tissues, are also paying close attention.
Canadian Blood Services is also paying close attention to the outcomes. As the organization that provides national support to provinces and territories on all matters related to organ and tissue donation and transplantation (OTDT), we worked closely with Nova Scotia to evaluate the impact of this legislation.
As partners on Health Canada’s Organ Donation and Transplant Collaborative, we are working with Nova Scotia Health, the Nova Scotia Department of Health and Wellness, the Canadian Donation and Transplantation Research Program, and Transplant Québec on evaluating the impact of the new law. The project brings together social scientists, health law experts, ethicists, sociologists, patient partners, and clinicians to examine every aspect of this social and clinical change.
One of our team members who sits on the steering committee and project working groups is David Hartell, our associate director of system development for OTDT.
“The goal of this project is to gather evidence to inform legislative strategies aimed at improving organ donation, and to evaluate the impact of opt-out legislation on organ donation in Nova Scotia,” says David. “It is an important opportunity for the country to observe, measure and understand the impact of this new legislation and social change on the donation and transplant system.”
Each province and territory runs its own intent-to-donate registry and organ donation program. All are looking to Nova Scotia to see if this new system works.
“Our goal is to see what lessons can be shared with other provinces across Canada that are interested in improving their donation systems,” says David. “This falls under our mandate to help improve the OTDT system for all Canadians.”
By studying and examining the new process over the next several months and years, the project leads can identify which aspects of the legislation positively (or negatively) impacted the donation system in Nova Scotia, as well as the impact on the public’s overall trust in the donation system.
So far, the Nova Scotia Health Authority has reason to be hopeful. After the announcement of the HOTDA, but before the new law even came into effect, they saw a huge increase in deceased organ donation. In 2020, there were 33 deceased organ donations, twelve more than the previous year in the province. And ten days after the new law came into effect, only 11,800 people had registered to opt out – just one per cent of the population.
The authority attributes this positive response to an increase in awareness resulting from media coverage, increased education for health care workers, and more people talking about their wishes with their families.
“With all the attention the new legislation has received, and the additional resources allocated to improve the system, Nova Scotia has seen a dramatic rise in organ donations already,” says David. “Our hope is that this increase in donation is sustainable over time and has long-lasting results.”
But working with provinces to help change legislation is just one of the many ways we collaborate to help improve those systems.
“We know from observing other high-performing systems around the world that the introduction of deemed consent legislation is only ever successful if there is broad and comprehensive support of the organ donation system,” says David. “There also needs to be an increase in education and awareness; more donor physicians and donor coordinators; donor audit screening; mandatory donor referral legislation; evidence-informed clinical practice guidelines; and ongoing training and education for healthcare professionals.
“Nova Scotia’s new system is one step in the right direction. It will help save many lives. We are optimistic and eager to see the changes coming to that province, and we will be here to support the rest of Canada if they choose to go that route.”
Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration. Find out more about our research impact.
The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.