Job-protected leave for organ donations possible

Ontario looking at changing employment standards

Maternity leave. Parental leave. Compassionate care leave. All three are job-protected leaves in most parts of the country. Now, Ontario is considering adding a new leave to the mix to protect the jobs of workers who want to take time off work to donate organs.

The province is looking at more education and financial support measures to encourage living organ donation, including consulting with employer and labour groups on providing legislated job protection for living donors.

Specifically, this means exploring amendments to the Employment Standards Act (ESA) so living donors receive job-protected leave, said David Jensen, a spokesperson for the Ontario government.

“Currently the ESA provides for 10 days of unpaid emergency leave in a workplace with 50 employees or more, and for family medical leave in all workplaces in cases of terminal illness,” said Jensen. The current medical leave provisions in the ESA do not specifically protect living donors, he said.

The province also intends to establish a fund (administered through the government-run Trillium Gift of Life Network) to cover pre-approved living organ donation expenses such as travel, accommodation and meals. In 2006, the province convened the Citizens Panel on Increasing Organ Donations and the current plan of attack came out of public consultations held between November 2006 and February 2007.

There were 473 living organ donations in 2004 in Canada, according to the Canadian Institute for Health Information. Across the country, there are more than 4,000 people waiting for a life-saving transplant, including 1,743 in Ontario. Living donations are possible for the kidney, liver and parts of the lung.

Loss of income plus medical-related expenses are potential deterrents for living organ donations, said Tracy Brand, managing director of the not-for-profit Canadian Counsel for Donation and Transplantation in Edmonton.

“Currently there is no set of regulations or programs to encourage employers to cover the cost or loss of income for living donors,” said Brand. Many organ donation organizations would like to see a national strategy for reimbursing living donors, which could include a guarantee of job security and possibly paid leave.

Fred Quinton, a senior consultant at Cowan Benefits Consulting in Cambridge, Ont., said most employer group insurers would treat these cases as they would any illness for standard health plans.

“This means that if the expense is covered under the group policy — such as semi-private hospital or ambulance — they would cover the expense, even though the procedure is elective and not medically necessary (for the donor),” he said.

They will not usually pay for any expenses that are not part of their plans, such as travel, hotel accommodation and food. There may also be tax issues to consider if an employer pays certain expenses the Canada Revenue Agency does not consider part of private health services plans.

“This may keep employers from authorizing some expenses,” he said.

Quinton added that while short- and long-term disability plans have exclusions for self-inflicted injuries and elective surgeries, the two major carriers he consulted said they would administratively waive this restriction in special situations.

“I must emphasize that an insurance company will not pay for something that is not a covered expense (such as travel or hotel) even in special situations,” he said. “Covered expenses are specifically outlined in the contract. If an expense is not mentioned, even though it may be medically necessary, there is no coverage. They will, however, waive some restrictions or limitations.”

A March 2006 CMAJ (Canadian Medical Association Journal) commentary by three doctors pointed out there are financial disincentives in Canada for living donors. They cited research that shows financial hardships were incurred by 23 per cent of people who donated a kidney.

“In other examples, 53 per cent to 99 per cent of donors experienced costs due to travel and accommodation in two North American studies, and 14 per cent to 30 per cent lost income,” read the commentary. The income loss was as much as $4,400.

“Although the magnitude of these costs may not seem dramatic to some, the context in which they occur deserves consideration,” said the doctors. “In a single-centre study involving 133 potential donors to a family member, 24 per cent did not donate because of the anticipated financial hardship.”

Current federal living donor initiatives include employment insurance and short-term disability as well as a tax credit for medical expenses, according to the authors. Provincial initiatives include coverage for medical services, limited travel coverage in some provinces (Newfoundland and Labrador, New Brunswick, Prince Edward Island and northern Ontario) and paid-leave programs (Saskatchewan).

“However, the requirements necessary to receive employment insurance and benefits delivered through tax credits may work to the disadvantage of people who work in alternative arrangements or have a lower income, and all existing programs are limited in scope and availability,” stated the authors.

Ken Donahue, manager of communications at the British Columbia Transplant Society in Vancouver, said that because recovery from a living donation can take anywhere from two to eight weeks, the financial burden can be huge. He heard of one employer who granted a living donor fully paid leave for the surgery but said other employers forced living organ donor employees to dip into their sick leave and vacation banks.

The changes in Ontario were proposed by the current Liberal government. Ontario is holding an election on Oct. 10 and it’s not clear what will happen to the initiative if another party assumes power.

Lesley Young is a Toronto-based freelance writer.

Organ donation

Results from the B.C. experiment

Last year, the British Columbia Transplant Society and the B.C. branch of the Kidney Foundation of Canada teamed up to launch a three-year pilot program to reduce barriers to donation by reimbursing living donors for expenses related to recovery time, travel and accommodation.

Living donors in B.C. are eligible to apply for coverage of expenses and loss of income. In the first year, 101 donors accessed the program at a total cost of $80,000, said Ken Donahue, manager of communications at the British Columbia Transplant Society in Vancouver.

The program is funded 50-50 by the Provincial Health Services Authority (PHSA) of B.C. and pharmaceutical companies. Donahue also said the PHSA recently implemented a policy stating it would cover loss of income for any employee donating an organ.

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