Ontario shifts to opt-out organ donation

Summary#

• This bill would change Ontario’s organ and tissue donation system to “opt-out” for people 16 and older. That means donation after death would be allowed unless the person objected while alive.
• Parents or guardians must give consent for children under 16. If they do not consent, no tissue can be taken.
• Ontario Health would run a list (registry) of people who have objected, and of parental consents for children.
• Hospitals and other designated health facilities would have new duties to notify Ontario Health when a patient dies or is near death and, when told to do so, to check for any objection or consent.

Key changes:

• Default donation for adults: Tissue (including organs) can be taken after death unless the person objected.
• Clear ways to object: Adults can object in writing, by an oral statement with two witnesses, or by email/recorded message, and must tell a doctor or Ontario Health.
• Family role: If the person did not object and cannot speak for themselves near death, close family (spouse/partner, children, parents, siblings, next of kin) may object. They should not object if they believe the person would not have objected.
• Children under 16: Parents/guardians must give consent before any tissue can be taken after the child’s death.
• Ontario Health’s role: Plan and support donation activities and keep a registry of objections and parental consents. Facilities must follow Ontario Health’s process for contacting patients or families.
• Takes effect on Royal Assent (when it becomes law).

What it means for you#

• Adults 16 and older

  • If you do nothing, you are treated as a donor after death.
  • If you do not want to donate, you must record an objection and share it with your doctor or Ontario Health. You can object to all tissue or only some parts.
  • You can make your objection in writing, with a witnessed oral statement, or by email or recorded message.

• Parents or guardians of children under 16

  • Your consent is required before any tissue can be taken from your child after death.
  • You can send this consent to Ontario Health, and it will be listed in the registry.
  • If you do not consent, no tissue will be removed.

• Family members

  • If your loved one did not record an objection and cannot speak for themselves near death, you may object on their behalf.
  • You should not object if you have reason to believe your loved one would not have objected.
  • A trained person may contact you to ask if there is an objection or, for a child, a consent.

• Patients and visitors at hospitals or other health facilities

  • Staff must tell Ontario Health when a patient dies or is near death.
  • You or your family may be contacted to confirm whether there is an objection (or a consent for a child).

• Donors, patients on waitlists, researchers, and trainees

  • More organs and tissue could become available for transplants, medical education, and research, because the default is now donation.

Expenses#

No publicly available information.

Proponents' View#

• An opt-out system will likely increase donation, helping more people get transplants and saving lives.
• It still respects choice, because anyone 16+ can easily opt out at any time.
• Parents keep control over decisions for children under 16.
• A single registry and clear hospital duties make the system more consistent and reduce missed donation opportunities.
• Limiting family objections when they conflict with a person’s likely wishes protects individual autonomy.

Opponents' View#

• Presumed consent may feel like the government is taking organs without clear permission, which some see as a loss of personal autonomy.
• Families could face stress during a crisis if they must object quickly or navigate new rules.
• People who are unaware of the change could be treated as donors against their wishes if they do not know to opt out.
• The registry and hospital processes may add costs and administrative work, and raise privacy questions about sensitive health information.
• Some worry about how well staff will handle conversations at end of life and whether training and oversight will be sufficient.