Max and Keira: Life from Death

Barry Hoffmaster tells the story of Keira Ball and Max Johnson to illustrate the need for better organ donation policies.


Keira Ball was nine years old when she was killed in a car accident.  Max Johnson was also nine when he was in the hospital with heart failure.  The operation that put Keira’s heart in Max was a success.  After hearing that story, the Prime Minister of the UK was prompted to introduce in Parliament presumed consent for organ donation in England so that it could become law.  In Great Britain, an opt-out system for organ donation is already in place or will be soon. Wales had already introduced presumed consent in December 2015, which means that adults will be presumed consenting to organ donation after their deaths unless they have opted out. As of now, Wales has the highest organ donation consent rates in the United Kingdom at 75%. Northern Ireland likely will have a similar scheme soon. More recently, Scotland adopted a system for organ donation that is an opt-out approach.

England will soon have a new law about organ donation.  The new legislation that the MPs passed will have the name “Max’s Law.” This statute will prescribe that organ donation will assume consent to donate as long as the person has not opted out. Moreover, if the donor is on the organ donation register, the family cannot oppose the donation. More than 400 people died in the UK in the previous year while waiting for an organ transplant.

In Europe, most countries already use presumed consent, and opt-out law is common around the world. Spain, France, Belgium, Poland, Finland, Italy, Israel, and Turkey are only a few examples. What about North America?


Photo credit: Magnus D, Image description: An image of an organ and tissue donation consent form.

In Canada, people who are willing to donate their organs must register (opt-in).  For a long time, Canada has had wait lists for organ transplants. At present, there are 4,333 people who are waiting for organ donations. Each year, 1,600 Canadians are added to the waiting list, and about 260 of them will die. In a survey, more than 81% of Canadians indicated that they would donate their organs, but there is no evidence to confirm their claims that they would donate.   

The Canadian Transplant Society is concerned with three issues: too many people die unnecessarily every year; 90% of Canadians say that they support organ donation; and less than 20% of people have made actual plans to donate. Two proposed solutions are to eradicate the wait list for transplants across the country through increased donation and make lifesaving organ transplant units available to hospitals.           

In the Canadian context, though, two important issues need to be considered. One is that the number of organ donations from deceased donors must increase from the less than 20% where it currently stands. The other is that provinces have conflicting views. Nova Scotia will become the first jurisdiction in North America that will have presumed consent for organ donation once their bill passes. New Brunswick is considering doing this as well.  On the other side, though, a similar bill in Manitoba was rejected.

Presumed consent is the core of strong, expansive organ donation. Making decisions about a system that helps people who are dying is difficult because that requires judgment. Using presumed consent is an efficient and effective approach to removing organs and then implanting them – thus sustaining ever-precious life.

Although death is unavoidable, it can be delayed.  Living is important, challenging, and rewarding. Life needs preservation. Life is momentous, and momentous is worthy. All of that is especially true for people who are seriously ill, weak, or debilitated. They need support and help. Among everything, sick people need attention and care. With that, they can live better and longer.


Barry Hoffmaster is Professor Emeritus in the Department of Philosophy, Western University.

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