Public solicitation for organ donors: a time for direction in Canada.

The disparity between supply and demand for transplantable solid organs has resulted in strategies to drive increased organ donation, including public solicitations for living donors. Public organ solicitation occurs when a recipient or their representative solicits an organ for transplantation by public broadcast (e.g., social media or a public notice). The intended donor and recipient may not have a prior relationship. Lack of regulation of public solicitations for organ donation in Canada is a cause for concern. We call for careful screening of altruistic donors within a well-organized system that links willing donors with a maximum number of beneficiaries. Public solicitation for organs offers an opportunity to find a living donor for potential recipients who do not have one within their social or familial network. Thus, solicitations are a way to redress a somewhat natural injustice, whereby some people have more friends or family members who are willing to donate than others. Accepting these donations does not discriminate1 nor does it disadvantage those on the waiting list.2 Solicitation leads to access to an organ that would not otherwise have been available for donation.3 In addition to being a benefit to the direct recipient, every transplant reduces the demand on the waiting list.2 Solicitation can also increase the awareness of organ shortages and may elicit more donors for other recipients.3 However, there are concerns. Organ solicitations have been criticized as unfair, because they enable donation to identified recipients rather than to a recipient on a waiting list. Celebrity status and access to resources clearly provide increased opportunities to find a donor. A person with a high profile or more appealing story may be perceived as getting ahead in the transplant system, which could influence the public against organ donation.4 Recipients who are computer literate, social media savvy or English-speaking have enhanced access to potential donors beyond their local community and are more likely to find a donor than those without these characteristics.2 Publicity surrounding personal stories involving organ solicitation can be misleading and encourage offers to the solicitor, without considering donations to those with greatest need.5 However, all living donation is inequitable in that the donor chooses to whom to donate — generally someone they know — without any requirement to donate to the wait-list recipient with the greatest need. One concern with public solicitations for organs is the potential for exposure of the recipient to harms from a donor who is unknown to them, which may in turn damage the reputation of transplant programs.3 Canadian law requires a minimum donor age for living donors, voluntary consent and no exchange of goods for an organ.6 Public solicitation may increase the potential for exchange of valuable considerations for an organ, because the donor is unknown to the recipient. Two recent, well-publicized Canadian cases focused attention on these issues. The owner of the Ottawa Senators hockey team, who needed a new liver, used his public profile to solicit an anonymous donor.7 In the other case, the family of a young girl who needed a liver transplant made a public appeal through a Facebook page.8 The solicitation was fuelled by media attention surrounding this touching story, whereby the child’s twin had received liver tissue donated by their father, who could only donate once. The solicitation received more than 500 responses from people willing to donate.8 These two public solicitations for organs received markedly different public responses: one faced criticism9 and the other garnered sympathy. The difference in public Public solicitation for organ donors: a time for direction in Canada