ODTC Project Snapshot: Legislative Strategies to Improve Deceased Donation in Canada: A Special Focus on Evaluating the Impact of Opt-Out Legislation in Nova Scotia

Legislative Strategies to Improve Deceased Donation in Canada: A Special Focus on Evaluating the Impact of Opt-Out Legislation in Nova Scotia

What is this project about?

Project background

In April 2019, Nova Scotia became the first jurisdiction in North America to introduce legislation in which an adult will be considered as a potential candidate for organ and tissue donation unless they actively opt-out. Families will continue to be consulted to confirm a person’s wishes. Other provinces currently use an opt-in model where a person must sign up to become an organ donor. While the majority of Canadians say they are willing to donate organs, a much smaller percentage have registered to do so. In countries that have adopted an opt-out model, organ donation rates are higher, however this may be only one of the factors influencing rates. Other potential factors include health care spending, infrastructure, public attitudes, and donor availability. This landmark legislation has created a unique ‘natural experiment’ in which to understand the implications of opt-out models, and apply this understanding to other Canadian jurisdictions.


This project will gather evidence to inform legislative strategies aimed at improving organ donation and to evaluate the impact of opt-out legislation on organ donation in Nova Scotia.

Overview of activities

  • Examine the international experience of opt-out legislation to help guide the implementation of the legislative change in Nova Scotia.
  • Understand public and health care professional opinions on donation and opt-out, and the role of the media.
  • Evaluate the impact of the opt-out legislative change in Nova Scotia on key donation system metrics.

How will the project improve the organ donation and transplantation system in Canada?

The project will contribute to:

  • Implementing more effective outreach strategies that could increase donation rates and acceptance of opt-out legislation through analysis of public opinion polls and engagement with leaders from specific populations, e.g. linguistic, religious and ethnic minorities, and patients with disabilities.
  • Informing future policy and legislation decisions in other provinces across Canada and potentially changing the culture of organ donation to overcome the chronic shortage of organs.
  • Providing health professionals with knowledge on how an opt-out system takes into consideration family decisions, wishes and experiences.

The project leads

This project involves collaboration of five partner organizations: Nova Scotia Health, Nova Scotia Department of Health and Wellness, Canadian Donation and Transplantation Research Program, Transplant Québec, and Canadian Blood Services.

Dr. Stephen Beed Medical Director Legacy of Life and Critical Care Organ Donation, Nova Scotia Health Authority

Dr. Matthew Weiss Medical Director of Organ Donation, Transplant Québec

“Nova Scotia’s donation system is undergoing a transformative change with the passage of the Human Organ and Tissue Donation Act by moving towards an opt-out consent model. The Legislative Evaluation: Assessment of Deceased Donation Reform Program will study the implementation of this change - with the expectation that health care will improve for patients in Nova Scotia, and lessons learned can influence decision making in other parts of Canada to increase organ donations for those who need it most.”




The Organ Donation and Transplantation Collaborative is an initiative led by Health Canada with provinces and territories (except Québec), Canadian Blood Services, patients, families, clinicians and researchers. Funded by Health Canada and other partners, the project Legislative Strategies to Improve Deceased Donation in Canada: A Special Focus on Evaluating the Impact of OptOut Legislation in Nova Scotia contributes to the Collaborative’s vision to achieve organ donation and transplantation system improvements that result in better patient outcomes and an increase in the number and quality of successful transplantations. For more information, please consult the Organ Donation and Transplantation Collaborative (the Collaborative) website: https://tinyurl.com/ODTCollaborative.