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Publications & Resources > The Standard > September 2005

   Last modified: Aug. 25, 2005

New legislation for organ and tissue donation

Starting early next year, Ontario’s Trillium Gift of Life Act will make it mandatory for hospitals to approach family members to request organ and tissue donations. It is expected that health care professionals, including nurses, will take the lead roles.

The Act created the Trillium Gift of Life Network in 2000. The Network plans, promotes, coordinates and supports organ and tissue donation in the province. To potentially increase donations by ensuring that every medically eligible Ontarian is given the option of donation, the Network is implementing Part II.I of the Act, Routine Notification and Request (RNR). It is anticipated that Part II.I will be proclaimed in late fall and take effect in 12 major neuro-trauma/surgical centres in early January 2006 and in 72 other facilities on January 1, 2007.

Currently, most donations occur only if a client or client’s family broaches the topic with a health care professional at a facility. The new RNR legislation will require designated facilities to notify the Network when a physician thinks that death is imminent or as soon as possible after a client has died. The client will then be screened for donation eligibility and, if appropriate, the option of donation will be presented to the client or client’s family.

The College has been following the issue and believes that RNR will not interfere or conflict with a nurse’s professional obligations. “Rather, the new requirements are an additional employment obligation for today’s nurses,” says Heather Campbell, RN, the director of Practice and Policy at the College. The College recommended that the Network educate clients and family members on the organ donation process. “This will help facilitate nurses obtaining informed consent,” says Campbell.

The College’s practice guideline Consent states: “Standards and expectations of common law still require consent for the activities not considered as treatment under the Health Care Consent Act. The principle of informed consent is entrenched in common law and in nursing standards.” To this end, all nurses in Ontario must ensure that the consent obtained for organ and tissue donation is both informed and voluntary.

To prepare nurses for obtaining informed consent, Campbell says that the College welcomes “any education that the Network provides to assist and prepare nurses with routine notification and request.” If an individual considering donation asks for information that is beyond the nurse’s knowledge, the nurse must seek a consultation. The nurse obtaining consent must ensure that the person to provide consent:

  • receives information that a reasonable person in the same circumstances would require to make a decision;
  • receives responses to their requests for additional information about the donation processes and options;
  • understands the information that is relevant to making the decision of donation; and
  • appreciates the reasonable possible consequences of the decision or lack of decision.

The Network acknowledges that RNR will impact hospital staff and it is working closely with health care professionals to provide support in implementing the new requirements. The Network’s Provincial Resource Centre is open 24 hours a day, seven days a week. It helps hospital staff determine medical eligibility of a potential donor and provide guidance on approaching a client or client’s family about donation.

A three-month RNR pilot project began in June at six hospitals: Hôtel- Dieu Grace Hospital in Windsor, The Hospital for Sick Children in Toronto, Kingston General Hospital, Hamilton Health Sciences Centre, The Ottawa Hospital and St. Michael’s Hospital in Toronto. The results will help the Network determine what resource challenges will be created by the new legislation.

“Following evaluation,” says Dr. Cameron Guest, the Network’s chief medical officer, “we will refine our process to incorporate what we have learned works best for hospital staff, clients and families.”

 

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