Boost in organ donations requires more than opt-out law, says Spanish health official

Alberta is considering doing something Spain did 40 years ago: making every adult a potentialorgan donor by default, unless they explicitly refuse.

Private member's Bill 205would transition the province to an opt-out system fororgan and tissue donation. Currently,Albertans must opt-in to the registry.

Today, Spain has one of the highest organ donation rates globally and is considered a world leader in that arena.

The Calgary Eyeopener sat down with Dr. Beatriz Dominguez-Gil, director general of Spain'sNational Transplant Organization, to find out how much of that success can be attributed to their legislation.

This transcript has been edited for clarity and length.

Q: Spain moved to an opt-out system back in 1979. Why was that?

A: There was a global consensus that our legislation should make clear that the normal thing to do in our country would be to donate, as we live in a country in which everyone will have access to transplantation in case they need it.

But there was also consensus that we wouldn't be applying the opt-out system in a strict way. In fact, closer to an opt-in system than to an opt-out system.

Q: What difference has an opt-out system made for Spain?

A: In reality, we believe that the opt-out system has not made a difference. It has created a good framework of understanding, specifying that in a country as ours, it would be a normal thing to donate.

But it wouldn't be until 10 years later, in 1989, when the donation rates started to increase in Spain. This was due to a set of measures that are mainly of an organizational nature, which imply among others thedesignation of donor co-ordinators working in the hospital with a very specific profile, mainly intensive care physiciansand with the co-ordination and the oversight of the Spanish National Transplant Agency.

That, along with continuous training of our professionals, continuous evaluation of results to identify areas for improvement, have been the keys of what has been named as the Spanish model of organ donation and transplantation. We consider that has been the key for success, and not that much the change in our legislation 40 years ago.

Q: When it comes to general organ donation, aside from opt-out, is there anything else that can be done that can make conditions for donation less restrictive for the average person?

A: Well, we believe that the most important thing to do is education. But the way we have done ithas not beenthrough big promotional campaigns, but through establishing a very specific alliance with the mass media in our country.

The mass media has become true allies in disseminating importance of donation and transplantation with a system thatfunctions in a very transparent manner. And thanks to the support of the mass media, we are able to reach the public.

We have managed somehow to make the Spanish population consider themselves part of the system. We don't forget that transplantation is a collective success. It's not one individual, but it's society, it's professionals, it's all together who make transplantation happen. This is the sort of stories and the sort of information that we transfer to our community.

Q: Spain's donation rate is 50 per million. Alberta's is 19 per million. How does that strike you?

A: Ithink Canada, as a whole, has very much improved over the last few years. The most important thing that Canada has done is to work closely over the last few years with intensive care community. That has made a change in Canada.

In a very short period of time, Canada as a whole has evolved form 15 donors per million population to 20, 22 per million inhabitants.So I think Canada is in the right way, working in organizational issues.

What I'm a little bit worried about, modifying the legislation, is that, depending on how this is shared with the population, people may feel that the state wants to some how take over their organs.

We are much more prone to respect the opinion of the individual, to respect the principle of autonomy. It's important to be transparentas well. Although I know there is room for improvement in Canada as a whole and in Alberta in particular, I think Canada in the last few years has made very important improvements in donation without changing the legislation.

With files from the Calgary Eyeopener.