Organ Donor Policy in Canada: Valuing Inclusion
Abstract
Organ Donor Policy in Canada: Valuing Inclusion Organ, cell, and tissue transplantation has become a common worldwide procedure as knowledge, technology, and skills have developed in this area. Policies relating to all aspects of organ, tissue, and cell donation have emerged in countries aroimd the world in response. An issue that has generated debate is how to ensure sufficient supply of organs to meet the growing demand while ensuring that risks to patients are minimized and quality of care is maximized. In attempting to incorporate these conditions into its proposed new standards, Canada has produced a policy that contains exclusionary criteria directed at men who have sex with men (MSM). The position taken in this paper is that the criteria of minimizing risk and ~naximizingq uality can be achieved without this exclusionary impact. Health Canada's standards in Safety of Human Cells, Tssues and Organs jor Transplantation (2009) are reviewed using a risk theory framework that comprises components of the "risk society" with a "cultural/symbolic" theoretical lens. The risk framework provides insight into reasoning behind the donor exclusionary criteria in an attempt to maximize safety. This facilitates a critical investigation into the underlying forces and meanings inherent within the document. This framework is also used to illustrate why the current Health Canada standards are redundant and discriminatory. Subsequently, alternatives are proposed to the existing cell, tissue, and organ do~~a t ioponl icy statements that address minim~zation of risk but reduce the exclusio~~ariryn pact on MSM by taking into account existing technology. This paper critically focuses on the policy position taken by Health Canada. The reason for this is twofold. Firstly, reflexivity related to Canadian transplant policy assists in filling a gap in the literature. Reflexivity encourages awareness to the personal, social, cultural and political processes that influence and shape policy. In their overview of Ulrich Beck's conception of the risk society, Lash & Wynne (1992) describe, following Beck that "in order for societies really to evolve inodernization must become reflexive." Secondly, reflexivity is often "excluded from the social and political interactions between experts and social groups over modem risks, because of the systematic assuil~ptiono f realism in science" (4). This paper strives to engage in and encourage reflexivity in the area of Canadian transplant policy. As Cal~adiavia~l ues and legal principles deter discrimination based on group membership; in this case MSM, alternative approaches to maximizing safety in organ transplantation without the promotion of discrirnination need to be considered. (Les politiques visant les dons d'organes au Canada : valoriser l'inclusion) Les crit2res d'exclusion qui ciblent les hornmes ayant des rapports sexuels avec des hornrnes 21 l'e'gard des dons d'organes continuent h Etre renforcQ duns les politiques visant les dons d'organes et les transplantations au Canada. Ayant pour cadre la the'orie des risques, les politiques en vigueur au palier fe'de'ral pour les dons d'organes et les transplantations sont analyse'es en visant particulierement la cornposante d'exclusion. Les politiques fe'dirales en vigueur peuvent faire l'objet de re'visions qui minimisent les risques et garantissent la quulite' des soins, tout en pe'conisant l'inclusion sociale. Pour que les politiques canadiennes visant les dons d'organes et les transplantations soient h la hauteur des connaissances et de la technologie actuelle, l'exclusion collective h l'e'gard des hornmes qui ont des rapports sexuels avec &S hommes pour ce qui est du don d'organes ne'cessite une re'vision
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