On January 18, 2021, the ground-breaking Human Organ and Tissue Donation Act (HOTDA) took effect, and data suggests that the result has been a significant increase in tissue donations as well as large increases in both the availability of both tissue and organs for transplant. One of the key values in organ and tissue donation and transplantation (OTDT) is solidarity, but it’s one that we don’t tend to discuss often.
The Legislative Evaluation: Assessment of Deceased Donation Reform Program (LEADDR) is a national collective of inter-professional researchers who are leading several different projects focused on the monitoring and evaluation of the deemed consent legislation in Nova Scotia. This includes exploring and considering the ways in which different values support, challenge, and are reflected in the legislation and its roll out in health care – including solidarity.
“Solidarity is a value that has received more attention during the pandemic, as part of acknowledging the ways in which we are ’all in this together’,” said Dr. Christy Simpson, Head and Associate Professor, Department of Bioethics, Dalhousie University. “However, this doesn’t mean that we are all being affected or impacted by the pandemic in the same ways; in fact, the evidence shows that some communities and groups are being affected much more than others and in a variety of ways by the pandemic.”
“It is also the case, sometimes, that solidarity can turn into a strong group ’us’ versus ’them’ mentality that can be problematic and exacerbate the divisions between groups rather than a focus on the ways in which we can share with and support each other, as part of lifting us all up,” added Simpson.
Solidarity can also encourage us to consider how some policies and processes may enable access to health and health care, while others create barriers and make it more difficult to access care.
“In other words, the discussions about solidarity in the context of the pandemic are helpful for demonstrating the importance of thinking about what solidarity means and what it calls on us to ‘do’ or ‘reconsider’ or ‘reevaluate’ – particularly from a health care and health system perspective,” said Simpson.
So, what does solidarity mean from an organ and tissue donation and transplantation perspective – especially in relation to deemed consent? According to Simpson, it has been identified as one of the values, among others, that should guide the organ and tissue donation and transplantation system in Canada. She believes that it is, arguably, a sense of solidarity that motivates many persons to donate their organs and tissues.
And, while not specifically stated in terms of solidarity, the noted high rate of support by Nova Scotians for organ and tissue donation may have contributed to developing and implementing this legislation.
However, if what we have learned about solidarity during the pandemic is translated into the organ and tissue donation and transplantation deemed consent context, it means that how we follow through on this legislation needs to be taken seriously.
“This includes things such as revisiting/changing care, policies, social supports and so on in relation to the allocation and distribution of organs and tissues in order to address structural and systemic issues,” said Simpson. “It also means ensuring that there is continued work in relation to letting all Nova Scotians know about this change in legislation, what this means, and what their options are. It is through these types of policy and process changes and work that trust in the OTDT system can be maintained.”
The LEADDR program is supported by Nova Scotia Health’s Innovation Hub. The Innovation Hub leads research, innovation and discovery within Nova Scotia’s healthcare system to deliver high-impact solutions for patients and providers. Through strategic partnerships, Nova Scotia Health’s Innovation Hub is transforming health care through leading-edge research, the best available evidence, and innovative solutions.
