Nova Scotia Becomes First in North America to Pass Opt-Out Organ Donation

When I first learned that Nova Scotia became the first jurisdiction in North America to pass opt-out organ donation, I remember thinking: finally, someone on this side of the Atlantic gets it. On January 18, 2021, the Human Organ and Tissue Donation Act took effect — passed unanimously in the provincial legislature back in April 2019. Unanimously. That's the part that gives me hope for what we're doing in New York.

A Historic First

While opt-out systems have been adopted across much of Europe — including Spain, France, Wales, England, and the Netherlands — no jurisdiction in North America had taken this step before Nova Scotia. The province, home to roughly one million people, became a testing ground for whether presumed consent could work within the North American cultural and legal framework. And it did.

"Nova Scotia is leading the way in North America. This legislation will save lives and give hope to the hundreds of Nova Scotians waiting for a transplant." — Dr. Stephen Beed, Medical Director of the Nova Scotia Organ and Tissue Donation Program

Key Provisions

The law applies to Nova Scotia residents aged 19 and older who have lived in the province for at least 12 months. Several groups are excluded: those under 19, people who lack decision-making capacity, and recent arrivals to the province. Anyone can opt out at any time through an online registry, by contacting the program directly, or by informing family members. Families continue to be consulted as part of the donation process.

Early Results

In its first year, Nova Scotia saw an increase in organ donation referrals and a decrease in family refusal rates. The province also reported that more people had conversations with their families about their donation wishes — a key secondary benefit of opt-out legislation that I think gets overlooked far too often. Changing the default saves lives, but it also changes conversations, and those conversations matter just as much.

"The most important outcome isn't just the law itself — it's that families are now talking about organ donation before tragedy strikes." — Nova Scotia Health

A Blueprint for New York

This is the example I bring up in every conversation with legislators in Albany. If a Canadian province of one million people can implement opt-out legislation within North America's legal and cultural context, there is no reason New York — one of the most progressive states in the country — cannot do the same. Nova Scotia proved that presumed consent isn't just a European concept. It works right here on our continent. We at YCOD point to this success story every time we advocate for Bill A07954, and I won't stop until New York follows their lead.