Interview with Dr Bob Bell

Program Transscript: Dr Bob Bell from Toronto General Hospital spoke with Australian Story about some of the issues relating to live organ donation.

ABC, Australia/June 4, 2007

Canadian law and our policy at the hospital restrict me from discussing any particular patient’s situation. But we are open and transparent about the processes used to evaluate people who are potentially going to undergo living organ donations. We are very proud of our multi-organ transplant program and the fact that they are really trying to push the envelope, trying to increase the number of organs available for patients who desperately need them here in Ontario. We’ve done a number of things in terms of introducing new processes. We’ve been one of the leaders in living related donations of organs for transplant patients, and we’ve also broken new ground in terms of anonymous organ donation, and donations between groups of people – individuals who may not have the appropriate tissue typing to donate to their friends and relatives, but are willing to donate to another person who can find a friend or relative willing to donate to the initial donor’s friend or relative. So we try to be as innovative as possible in terms of creating new ways for organs to become available through living donations, but also through deceased donations. We are one of the leaders in Ontario in donation after cardiac death, for example. So our multi-organ donation program is really one of the international leaders in terms of trying to increase the number of organs available for donation.

Does the question of a potential kidney donor possibly being coerced or pressured create a difficult issue for the hospital to consider?

I think it’s important to talk about the process whereby we evaluate individual’s potential for living donation. Everybody has the right to be considered for organ donation but of course not everybody but we don’t consider that there is a right to donate. There is a very careful process followed to ensure that individuals wishing to donate are capable of doing so based on informed consent, based on their medical history, psychiatric history, based on social supports that can support them during that process of donation. The process we follow is that the specific organ donation team assess the patient individually. When there is a question, especially in new areas such as anonymous donation, if there is a question about the potential donor’s appropriateness for donation, the question is referred to the executive team of our multi organ transplant program, assisted by experts from the joint Centre for Bioethics, from our psychiatry program and other medical experts as necessary, in order to come to that process of decision, and to come to some sort of decision as to appropriateness of donation. That’s our policy that we thought through very carefully in terms of the steps in deciding appropriateness for donation at individual program level and what happens where there be some controversy as to whether a donor is appropriate.

What is a reasonable amount of time for the hospital to decide such matters?

The most important thing for us is to make the right decision. If we’re going to be leaders in the field of organ donation, we are going to be encountering new situations all the time. The most important thing is trying to protect the integrity of the donation assessment process. Living organ donation can have a fatal outcome. It hasn’t happened here, we’re delighted to say, but certainly the process of living organ donation carries the potential for considerable morbidity and mortality. It’s critical to us that we follow through all the processes necessary to assess appropriateness for donation, before making a decision, especially in a situation where there is no urgent necessity. A patient who wishes to donate to someone for example who is needing a kidney transplant where there are other methods of maintaining life, it is critical to us to make an appropriate decision, and we don’t put a time limit on the team. We want to make sure that the whole process is carefully followed, rather than trying to rush to any kind of conclusion based on time constraints. The integrity of our assessment process is extremely important to our underlying goal of achieving as many organs for as many patients in need as possible.

Is it unusual to have a case where the donor and the recipient have found each other on the internet, and basically want your hospital to carry out the operation?

Well I can’t comment on any individual situation nor would it be appropriate for me to consider hypothetical situations. We assess each case on its merits, and we always follow a very carefully established process and policy around what are sometimes very difficult decisions.