From Ontario To Spain And Back: Learning From The Spanish Model
Patient Perspective Ontario has made dramatic progress in organ and tissue donation.
Trillium Gift of Life Network (TGLN), the agency charged with coordinating the donation and transplant system in Ontario, is tracking record numbers of organ and tissue donors and transplants in 2014. The launch of online registration through beadonor.ca in 2011 gave Ontarians a quick and convenient way to register their consent to donation, and now one in four people in the province have registered.
It is not all good news, however. Today, there are more than 1,500 people on the waiting list for a lifesaving transplant. Every three days, one of those people will die waiting. “What’s incredibly frustrating for us is that we know we have the technology, we have the expertise, and we have the infrastructure in place to give every single person a second chance,” says Ronnie Gavsie, President and CEO of Trillium Gift of Life Network. “The only thing we don’t have is enough organs.”
With the highest rate of deceased organ donation in the world, Spain’s model has long been considered the gold standard. In an effort to learn first-hand what elements of the Spanish system might be applied in Ontario, a group of five critical care physicians from the province recently visited the country. “The trip was illuminating,” says Dr. Dhanani, Chief Medical Officer of Donation for TGLN and one of the physicians who travelled to Madrid. “The Spanish feel a true sense of national pride in their donation record and you see that at every level, from first responders to physicians at the bedside. There is a culture of donation in Spain, which is really what makes their enviable rates of consent and donation possible.”
Physician leadership and accountability are key components of the Spanish system. Medical education includes donation as part of the curriculum and continuing physician-to-physician education is routine. Ontario is already working to apply these lessons. “When donation is a possibility, we want to make sure we offer grieving families everything they need to take advantage of the opportunity to let their loved one live on, as part of a respectful approach to end of life care,” says Dr. Dhanani. Doctors in Ontario can now rely on the support of Regional Medical Leads, physicians with an expertise in donation, to provide education and to support the further development of donation programs in hospitals. The Ontario medical model also includes the establishment of a hospital donation physician role in every designated hospital. This program is already begun in the Greater Toronto Area with future expansion to other regions of the province.
Is presumed consent the answer?
An opt-out system for consent to donation — meaning individuals are assumed to have given their consent unless they explicitly state otherwise — has been in place in Spain since 1979 and is often credited for their high rates of donation. Spanish physicians, however, downplay its impact, pointing to the fact that it is not applied in practice; relatives of a potential donor are always approached for consent and still make the final decision. It is recognized by some, however, for helping to normalize donation as part of end-of-life care.
“In essence, the key for the Spanish system is in solidarity, responsibility, and pride,” explains Ms. Gavsie. “We have many reasons to be proud of our donation and transplant system here in Ontario. With the support of public education campaigns and the attention of the media, donation has become part of the national conversation in Spain; we would like to duplicate that experience here.”