Big jump in tissue donations, organ referrals after N.S. presumed consent law

One year after Nova Scotia became the first jurisdiction in North America to adopt presumed consent organ and tissue donation, new data indicates a significant increase in tissue donations as well as large increases in the availability of both tissue and organs for transplants.

Under the province's groundbreaking Human Organ and Tissue Donation Act, which took effect on Jan. 18, 2021, people are presumed to agree to donate their organs when they die unless they opt out. There is also an option to proactively register a wish to donate.

Statistics from Nova Scotia Health indicate there were 155 tissue donors in 2021, an increase of 40 per cent over 2020. There were also 28 people who consented to donate their organs, and 23 of them were successful donors.

Dr. Stephen Beed, medical director of the province's organ and tissue donation program, said in an interview Thursday that while encouraging, he would like to see the numbers of annual donations and referrals go up more.

"It's a project that's going to require much more work," said Beed. "This is steps towards a much higher-performing program, but I'm not satisfied that we're anywhere near where we can or should be yet."

In the decade leading up to the new law, Beed said the province typically saw 20 or fewer organ donations per year. He said the one anomaly was 2020, when the number shot up to 34 for reasons that aren't fully understood.

"The 28 number [in 2021] is a substantial increase from where we typically are," he said. "As the system matures, getting into the 30s would be my objective."

Jump in number of tissue and organ referrals

Officials with the provincial transplant program also track referrals, which occur when they are notified of potential donors. Not all referrals lead to successful donations. A total of 1,581 tissue referrals were made in 2021, more than triple the 482 made in 2020, and referrals for organ donations more than doubled, from 95 in 2020 to over 200.

Beed said the substantial increase in tissue donations is significant because of the potential it has to help large numbers of people. A full-tissue donation can produce up to 70 grafts of such things as skin, bones, valves and corneas, he said.

"So if our message around increasing donation in general is getting out, then I certainly would hope, and we did see, that we would have a substantial increase in tissue donation."

Beed said tissue donations are also less complex than organ donations because they can be done in smaller hospitals and the time constraints are not as tight as they are for organ donations.

Don't assume you won't qualify as a donor

Meanwhile, 577,532 Nova Scotians 54 per cent of the eligible population registered their decision to be either an organ or tissue donor, while 57,382 people opted out of deemed consent.

Beed suspects the opt-out number could creep a little higher over time, but he's more concerned about the numbers of people who call his program presuming that they don't medically qualify as donors when that's not the case.

He said it's an indication public education is needed, and he hopes more work can be done in the coming year. Beed said plans are being developed to dramatically increase information on the program's website and to use organ donor co-ordinators as an educational resource.

And while the COVID-19 pandemic has slowed efforts to better educate community nurses and family physicians, he said it's hoped that outreach can also be ramped up this year.

"People are going to have questions that they are going to bounce off their local nurse or physician, and we don't want them to either give the wrong answer or not know the answer," Beed said.

Overall, 112 organ transplants were performed in Nova Scotia in 2021 including 79 kidney, 30 liver and three heart transplants. Transplant doctors in the province draw from a bank of organs available nationally.