Angela Welz lost her daughter Zoe to an overdose in 2016.Amber Bracken/The Globe and Mail
People who died from a drug overdose accounted for more than one-third of deceased organ donors in Alberta in 2022 – a significant jump from four years ago as the province confronts record high opioid deaths.
The increase is an inadvertent consequence of the raging drug poisoning crisis that has killed thousands across Canada and shows no signs of abating. Nearly 1,700 Albertans died last year from unintentional drug overdoses, an average of five deaths daily compared with the prepandemic average of two a day.
Organ donations come at the crossroad of life and death, where families and caregivers can face the difficult decision whether to donate their loves ones’ organs to provide life-saving or life-altering transplants to others in need. Some see the process as a way of “taking grief and turning it outwards into hope for others” said Cheryl Mack, a former chair of the Canadian Anesthesiologists’ Society Ethics Committee. But the choice can be even more fraught when the death is preventable, as is the case with drug overdoses.
In 2022, a record 491 transplants were performed in Alberta from living and non-living organ donors. The year also marked the highest ever deceased donation rate, with 21 donors per one million people. The overall increase is a result of improvements in the identification and referral of potential organ and tissue donors, Alberta Health Services said in a statement.
But about 35 per cent of the deceased donors – 34 of 97 – died from drug poisonings, according to data provided by the AHS. In 2020 and 2021, that number was similar, at 33 per cent. In 2019, just 13 per cent of donors – nine of 69 – had died from a drug overdose.
Jim Kutsogiannis, a professor of critical care medicine at the University of Alberta, said that while the donor pool needs to be expanded, doing so from drug overdose victims is not desirable and “nothing to be proud of.” He said it demonstrates inadequate action to address the epidemic.
“There’s pressures from the organ donation groups, Canada Blood Services, governments, but we have to make sure it’s done responsibly within the greater context of our health care system,” said Dr. Kutsogiannis, who served as the medical director of Alberta’s Human Organ Procurement Exchange (HOPE) program for more than 20 years until 2018.
Angela Welz remembers getting a call from a hospital in Edmonton and being told her 18-year-old daughter, Zoe, had been admitted. It wasn’t until she arrived that she learned Zoe was put on life support after overdosing from fentanyl. Doctors told her there was no brain activity.
Before Ms. Welz was able to process that her child was essentially gone, she said conversations about potential organ donation took over after representatives from HOPE, which co-ordinates the deceased organ donation process, told the family that Zoe was a “good candidate.” Ms. Welz said there was a sense of urgency to make a decision. The family spent an agonizing two days considering it.
“It was probably the hardest decision I’m ever going to have to make in my life,” she said. “If we hadn’t done the organ donation, it probably would have haunted us, but we did it and it sort of haunts us still, in my case especially because we didn’t know what her wishes would have been.”
On a November morning in 2016, the Welz family watched Zoe, with life support machines still beeping, get wheeled down a hospital hallway to an operating room. Zoe saved four lives with the donation of her heart, lungs, liver, kidneys and pancreas.
“You go through the shock, the trauma and then you’re not even able to grieve her as a whole person because she’s going to get ripped apart and everything’s going to be gone, taken out of her. It’s just a horrific picture in your mind,” Ms. Welz said. “I didn’t give birth to this kid to be an organ donor.”
A lack of compassion for people using drugs complicates donation for the loved ones of those who died from overdoses, Dr. Mack said. She added that the government is also taking insufficient action to meaningfully address the crisis.
This April, the province hit a grim milestone with 179 opioid deaths, the highest monthly toll since the province began tracking drug-related fatalities in 2016.
“Families that are donating organs to others are showing compassion and love that they aren’t receiving back,” said Dr. Mack, who, as an anesthesiologist and pediatric palliative care doctor, has spent countless days at the bedside of families considering organ donation. “When you look at organ donation, it’s really part of this social contract that we take care of each other … where’s the reciprocity here?”
Ms. Welz, who is now an advocate for drug policy reform with Moms Stop The Harm, said that what plays over and over in her mind is how her daughter’s life didn’t have to end that way. She deserved proper support during her drug use but never received it.
Alberta’s United Conservative government is focused on recovery-oriented supports for people using drugs, such as increasing access to residential treatment facilities and opioid use disorder treatments. It has limited access to supervised consumption sites and discontinued funding for other harm-reduction programs.
Consent from immediate family or next of kin is required for non-living organ donation in the province, and only people who no longer have brain function and have been put on a ventilator are eligible. Tests, such as blood and urine analysis, are conducted to check for infections and the health of different organs.