House of Commons Hansard #60 of the 41st Parliament, 1st Session. (The original version is on Parliament's site.) The word of the day was organs.

Topics

Organ Donations
Government Orders

8:25 p.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

Madam Chair, I would like to thank my colleague opposite for his heartfelt speech.

There are a lot of problems in terms of delays obtaining organ donations and transplantations, and very little research is carried out when it comes to recipient lists. While people wait, would the member opposite agree with the federal government investing money so that more research can be conducted in the area of recipient lists? Just as there is a need for donor lists, there is also a need for recipient lists, so that—

Organ Donations
Government Orders

8:30 p.m.

NDP

The Chair Denise Savoie

Order, please. The hon. Minister of Intergovernmental Affairs has the floor.

Organ Donations
Government Orders

8:30 p.m.

Conservative

Peter Penashue Labrador, NL

Madam Chair, I apologize. I missed most of the translation of that question. However, I will say there was an important transplantation workshop organized by CIHR in Montreal and certain positions came out of that.

Every year, thousands of Canadians receive transplants of solid organs, stem cells and pancreatic islet cells. End stage renal, liver, lung, heart, pancreatic and small intestine failures are now treated by organ replacement. For cancer, stem cell transplantation can be a cure. However, there are currently more than 4,000 Canadians on waiting lists for organ transplants, far more than accommodated by our current rate of organ donation. Achieving long-term survival accompanied by a good quality of life remains a challenge. The health and economic burden in Canadian society is steadily rising and the aging demographic creates increasing demand for donor organs.

In addition to these challenges, CIHR transplant workshop participants identified the need for improving both quality and quantity of living and deceased donor organs; improving our understanding of the immunological mechanisms and pathways mediating transplantation-related infection, inflammation and immunosuppresssion in humans; overcoming rejection and establishing the long-term tolerance to grafts; developing improved therapeutics to sustain graft survival with fewer adverse side effects, and expediting their uptake into clinical practice; establishing tailored transplantation policies and programs for children and other vulnerable populations; and developing national standards of clinical care and mechanisms for long-term follow-up of Canadian transplant recipients.

In order to address these challenges, CIHR transplantation workshop participants recommended that teams and networks would foster collaborations across the field of research; partner with public and private sector for the purpose of forging the necessary linkages among the transplant communities; support a common platforms, infrastructure, databases and operating procedures; and encourage training.

Organ Donations
Government Orders

8:30 p.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

Madam Chair, I am very pleased to be able to speak today on the crucial importance of organ donation.

Donating one’s organs or tissues means giving the gift of life to someone who truly needs it. Obviously, consenting to donate one’s organs is not an easy decision and a number of factors may also influence that choice. In any event, more and more people are dying while still waiting for an organ to be offered by a generous person. The gap between the number of organs available and the number of patients waiting continues to grow. The number of people desperately waiting for the telephone call that will change their life is also growing steadily. It is therefore important for us to discuss this, to think about it and to develop strategies that will improve the situation.

In spite of recent efforts to increase the number of organ donations, the number of organs available in Canada has stagnated. The two reports published in 1999, one produced by the House of Commons Standing Committee on Health and the other by the National Coordinating Committee for Donation, led to only meagre progress and did not result in the adoption of a long-term, Canada-wide strategy orchestrated by the provinces and the federal government.

Canada is still far behind other countries such as Spain, France and the United States in terms of the number of post mortem organ donations. In fact, Spain’s rate of post mortem donors is twice as high as Canada’s. Of course, that figure depends on a number of other factors, including the traffic accident rate, for example.

According to statistics from Transplant Québec, a provincial organ donation agency, the number of organ donors fell from 151 to 119 between 2008 and 2010, while the number of people needing transplants rose from 1,159 to 1,241 in the same period. The trend is therefore very similar in Canada. We need to redouble our efforts if we want to be able to close that gap.

There are solutions to consider, however. On average, each donor contributed to nearly four lives, and a single donor can save as many as eight lives. Saving lives is therefore within the reach of all of us. So what can we do to increase the number of patients who receive an organ donation?

Because health is under provincial jurisdiction, the federal government can play a coordinating role in raising awareness and in initiating a dialogue with the provinces to establish a national organ donor registry and possibly adopt measures that have been successful elsewhere. We should also consider creating a more effective registry of recipients and way of searching for matches between the two registries. Establishing a national registry would therefore facilitate the process of identifying people who need a donation or people who are prepared to donate. The registry could be associated with income tax returns or the census form. Then everyone who worked on their finances at some point during the year would have to think about the importance of organ donation.

There is not always a lot of leeway in terms of time when an organ transplant is needed. The less time people have to wait, the greater the chances of success. Information is needed before a transplant is done, such as blood group, tissue type, the size of the organ, the urgency of the procedure, and so on. A national registry that was managed effectively could mean a higher success rate.

Let us talk about awareness building. There have been no further campaigns since the 2001 and 2002 national campaigns, which followed the recommendations from the two 1999 reports. The focus should instead be on a long-term awareness-building strategy in order to ensure, among other things, that health care professionals can discuss these matters with their patients and that families discuss organ donation more. Moreover, according to the doctors I consulted, families can sometimes be an obstacle to organ donation following the death of a loved one.

We know that doctors do not necessarily have the resources or the time required to make requests of the families of the deceased. More money should therefore be invested to give doctors the tools they need and to help health care professionals obtain family consent in order to proceed with the removal of organs from a deceased person.

This certainly is not the best topic of conversation around the dinner table at holiday time, but it is an important subject to discuss with our loved ones. If, upon reflection, you consent to donate your organs and tissue upon your death, it is crucial that you share your decision with your loved ones, which may also have a positive effect in terms of how others think.

Building awareness is important as it helps to debunk myths and address public fear. For example, many people are afraid that if they give prior consent, less effort will be put into saving their lives. In fact, this fear may explain the discrepancy between the number of people who are in favour of donation and the number who actually sign their donor card. In fact, this discrepancy may also be due to simple logistics, but if doctors were able to discuss this myth, people would be reassured and might be more likely to sign their donor card and discuss what they have done more openly.

Moreover, we could also encourage our provincial counterparts to explore the question of presumed consent. Canada currently uses a system based on explicit consent. In other words, consent cannot be presumed given unless the individual in question has signed an official statement indicating his or her consent.

In some countries, such as Spain, where the post-mortem donation rate is very high, consent is presumed, which means that it is assumed that the individual automatically agrees to donate his or her organs upon death, unless the person, while alive, has expressly refused organ donation. Those in favour of presumed consent argue that, according to polls, the majority of Canadians are in favour of organ donation, but very few of them complete their donor card. In short, although I am not explicitly suggesting that we should adopt this kind of approach, it is nevertheless worth serious and in-depth consideration.

Finally, the Health Canada standards for potential donors could be revised. Currently, these standards exclude homosexual men, because men who have had sexual relations with other men in the last five years are excluded. This is an outdated standard because we now have the tools required to screen for blood and organ diseases. There is a lack of dialogue in the medical and research community concerning Health Canada's standards.

In light of the growing gap between the number of available organs and the number of people in need of an organ, we must act very quickly. We will have to be creative and work closely together with the provinces and territories. There are enough examples elsewhere for Canada to find practical and achievable solutions. Canada must develop a public awareness campaign to facilitate and encourage organ donation, explain how the organ donation process works, and do more to create a national registry of donors and recipients.

Organ Donations
Government Orders

8:40 p.m.

Conservative

Joy Smith Kildonan—St. Paul, MB

Madam Chair, I would agree that it is not only government, but it is also personal awareness of the need to sign the card to donate an organ because it is a gift of life to many people.

The Government of Canada contributes to the prevention of kidney disease as well, and that is done through the Canadian Diabetes Society, the aboriginal diabetes initiative and the integrated strategy on healthy living and chronic disease. That is one piece of it.

Tonight when we are talking about the actual national strategy for donation, I would like to draw attention to the living donor exchange, which is a national registry. Even though the availability of deceased donors has gone down somewhat, the living donor exchange, which involves a person who actually chooses to donate a kidney to another while still alive, is of paramount importance.

I would agree with the member opposite that it is an awareness thing. That is why earlier tonight I asked in the House, as the member for Vancouver East so eloquently pointed out too, what does each one of us as a Canadian have to do?

So it is a combination of both.

I would ask the member opposite to elaborate a bit more clearly on some more things individual Canadians could do, coupled with the partnership with government, to make this awareness more available. We do not talk about it over the Christmas dinner table, but maybe that is something we should do, because it is a matter of time when people need organ donations. Perhaps the member could expand on that thought a bit more for the House.

Organ Donations
Government Orders

8:40 p.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

Madam Chair, I thank the member opposite, who spoke about a number of topics.

Indeed, there are many people waiting for kidney transplants. Seventy-five per cent of patients on waiting lists are in need of kidney transplants. It is a problem. Even when there are lists of living donors, there are challenges when it comes to compatibility. What we could propose, for example, is to have a list of paired living donors. Someone who wanted to sign up to donate a kidney could be paired with someone who was in need of an organ. This way, two people would be put on the registry: a donor and a recipient. Every time, there would be two people put on a list.

We can work on promoting awareness at the individual level. We can encourage people to talk more about organ donation. Obviously, when we are healthy, we do not usually think about getting sick or having an accident and dying unexpectedly in some stupid way. People do not necessarily take the time to sign their donor cards. For the time being, this is one of the ways we have available to give a precious gift to someone who needs a vital organ. We absolutely must talk about it.

The hon. member mentioned the holiday season, when family and friends often get together. This is a topic that must be talked about. There are no miracle solutions. We could work on the best ways to manage the registries and all the tools we have available. We could work with the provinces and territories to ensure that health care professionals are able to talk to families and that they have better resources to manage the information they are able to collect from patients and their families.

Organ Donations
Government Orders

8:45 p.m.

NDP

Libby Davies Vancouver East, BC

Madam Chair, I thank my colleague for informing us about what is taking place in Quebec.

There has been a lot of discussion tonight about the need to talk to our families and friends at the dinner table. I do think that is really important. However, it is similar to the chicken and the egg situation. If people are going to talk about it, it is because they are aware. It is one thing if there are 10,000 individuals who are aware and have conversations. However, we need to have a massive public awareness campaign in order to have those conversations.

There is awareness about drunk driving because year after year there have been messages about it. For example, in B.C., the Insurance Corporation of British Columbia has a massive campaign. We have campaigns by groups in the non-profit sector, such as Mothers Against Drunk Driving. We have police campaigns. There is a massive awareness and slowly, a shift begins to take place.

Of course, people have to have discussions before making a decision about whether to sign a donor card online, in person or at the auto insurance bureau. However, unless we have huge public awareness campaigns to deal with some of the myths about organ donation, I do not think we are going to make a lot of progress.

I wonder if the member would just comment on the need for some kind of huge public awareness campaign across the country.

Organ Donations
Government Orders

8:45 p.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

Madam Chair, I would like to thank my NDP colleague for her important comments. Clearly, the federal government must promote a Canada-wide awareness campaign. The more publicity this issue gets, the more people will see the symbols of organ donation all over. This will start discussions, get reactions and generate debate. That is exactly what we want. However, the government must manage this campaign so that the debate is based on factual information and not on fear.

I mentioned myths. Many people think that if they sign an organ donor card and they become ill, they will not be given the same level of care because doctors will want to harvest their organs to give to others. That is not at all true. Health professionals treat all patients ethically and professionally in order to help them regain their health. Once these myths are debunked, people will feel safer and will know what will happen to their organs and how health professionals go about doing transplants. They will understand the odds of a donor being compatible with a recipient and the odds of success for transplant operations.

The more informed people are, the more confidence they will have in these procedures or operations. When people see the positive effects that organ donation has and how it helps others, they will have a stronger desire to get involved and to contribute. That is why it is important that the government get involved and demonstrate leadership in raising awareness of the issue of organ donation and the positive effects it has on the health of Canadians from all walks of life.

Organ Donations
Government Orders

8:50 p.m.

Conservative

Joy Smith Kildonan—St. Paul, MB

Madam Chair, it is heart-wrenching to see a friend, family member or colleague suffer from organ failure. The impact is significant on both the individual and the family.

Patients must spend hours hooked up to a dialysis machine instead of spending time with their loved ones. Parents know that their child must take a cocktail of drugs every day and spend time in the hospital rather than being out in the playground with friends. It is very worrisome. Organ failure also threatens individuals' autonomy and their ability to support themselves and their loved ones.

It is uplifting to hear and read the stories of people who get a second chance at life following a successful organ transplant. It is inspirational to know how it is made possible through the generosity and altruism of organ donors.

I would like to take this opportunity to underline the generous spirit of people who have already donated an organ or who have made the decision to do so, whether to someone they know or to a stranger.

A significant milestone was recently achieved in Canada on organ donation and transplantation. Just last week it was announced that the 100th successful kidney transplant was completed through the Living Donor Paired Exchange Registry.

This registry, which is the first Canada-wide organ donation registry, was launched two years ago by Canadian Blood Services in partnership with transplant programs across the country to help address the shortage of organs in need. This registry, with support of all the provinces, illustrates what can be achieved through cross-country collaboration.

Approximately 4,000 Canadians are waiting for an organ transplant. In 2009, there were approximately 1,000 organ donors in Canada and more than 2,000 transplants of solid organs were performed.

However, many patients remain on waiting lists. Roughly 200 Canadians die each year while waiting for an organ transplant. Three-quarters of the 4,000 patients on the organ waiting list need a kidney transplant.

Unfortunately, there are not enough deceased kidney donations to help everyone who needs such a transplant. That is where the Living Donor Paired Exchange Registry comes in. This registry allows someone whose kidney is not compatible with a friend or relative in need of a transplant to donate to a stranger instead. The friend or family member in turn is matched with another person's incompatible donor. Basically it allows for what we call kidney swapping.

Although deceased donation is the type of organ donation most people are familiar with, it is also possible for a healthy living person to donate a kidney. This involves surgery to remove a kidney from the living donor and to transplant it into a patient who needs a kidney. A person can live a healthy life with only one kidney.

Kidney donation is the most frequent type of living organ donation. There are many advantages to live kidney donations. For example, a kidney from a living donor is usually healthier; it may function better and may last longer than a kidney from a deceased donor.

A living kidney transplant is the most successful of all transplant procedures. Not only do these transplants improve and save lives, estimates suggest the savings of a transplant over dialysis to the health care system are significant.

The 100th successful exchange transplant milestone reached by the Living Donor Paired Exchange Registry was just announced on November 29, 2011, exactly one year after it officially became Canada's first national organ donation registry with the last province joining in.

This achievement was made possible through the generosity and compassion of individuals who donated anonymously to anyone in need.

As of the end of October, the registry had 247 donor-recipient pairs registered in the system, as well as 25 non-directed anonymous donors. One of these donors is Ms. Erin Taylor, a 30-year-old emergency room nurse in Edmonton who was recently featured in The Globe and Mail. Ms. Taylor donated her kidney to a stranger in Vancouver. Her generosity triggered a chain of events that resulted in two additional transplants.

It is stories like those that reflect the generous spirit of Canadians and that inspire motivation to do something to help a fellow citizen, whether a friend, relative, colleague or a perfect stranger. In fact, Canada has been doing well compared to other countries in terms of recruiting live donors. We are among the top performing countries in this regard.

In the last 10 years, living donors accounted for more than two-thirds of the increase in the number of organ donors in our country. While this progress is encouraging, we could be doing better, especially for deceased donor rates. This is where Canada lags behind other countries. At about 14 donors per million Canadians, our rate is less than half that of the best performing countries. As I said, that is in the deceased donor part of it.

It is not that Canadians are not compassionate and altruistic. Ms. Taylor's story and that of countless other Canadians prove otherwise. Furthermore, a public opinion poll released last year showed overwhelming support for organ and tissue donation. However, only about half of respondents had actually made the decision to donate their organs at the time of death. Taking the next step to actually register one's intention to donate is crucial to keeping pace with demand.

It is predicted that the need for organs will more than double over the next two decades. Further, at age 20, a person is approximately five times more likely to need an organ transplant in his or her lifetime than to become a deceased donor. With an aging population, with rising diabetes rates and ensuing risk of kidney failure, and with advancing medical technology that makes transplants more possible, it is important to keep up with demand. Just the fact that the number of Canadians living with kidney failure tripled over the past 20 years should be a wake-up call to us all.

We have seen the impact of one of our own parliamentary colleagues in need of an organ transplant in the prime of his years. The time to donate is now.

I understand that two new national organ registries are expected to be launched early next year, one for hard to match kidney patients and one for all non-kidney patients across Canada suffering end stage organ failure. This is extremely important and shows our government's leadership.

These upcoming registries, along with a living donor paired exchange registry, are good news for patients waiting for an organ transplant, However, without donors, too many patients will continue to suffer needlessly.

This government recognizes the need to continue to improve organ donation. There is no doubt about it. That is why our government, along with our provincial and territorial partners, asked Canadian Blood Services to develop a plan for an integrated organ and tissue donation and transplantation system.

Provincial and territorial governments are currently reviewing Canadian Blood Services call to action, which includes its proposals to improve the performance of the donation and transplantation system in Canada. That is how our government is showing massive leadership in this area. We expect these proposals to be made public in the spring of 2012. Again, our government acknowledges that we can and will continue to improve organ donation in Canada.

I invite all members to join me in encouraging our fellow citizens to sign the donor card and discuss their intention to donate with their loved ones. By taking this next step, we can contribute to the inspirational stories of patients getting a second chance at life. I must say that it is so critical because in my own family my husband had to have a stem cell donor. I cannot say how heart-rendering it is to wait and wait for a donor.

I am very proud that our government has taken a giant step forward in collaboration with the provinces and territories to improve the donor registries that we need so badly and are developing so quickly in this country.

Organ Donations
Government Orders

9 p.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

Madam Chair, does the Conservative member believe that the federal government can play a key role in awareness campaigns on television, in the print media, such as newspapers, or on posters that could be placed in hospitals and other public places?

This will get people thinking about organ donation. One strategy could involve having a place on federal forms where people could register as organ donors. If there were a Canada-wide awareness campaign, people would have to think about it. They could discuss it and would be more aware of organ donation.

Organ Donations
Government Orders

9 p.m.

Conservative

Joy Smith Kildonan—St. Paul, MB

Madam Chair, as my colleague knows and what has been mentioned earlier, the actual delivery of health care is under provincial jurisdiction. The safety of the actual organs is in the federal jurisdiction. However, as I outlined in my speech earlier, the collaboration in all fields needs to be between federal, provincial and territorial jurisdictions. Not only that, it needs to be with each Canadian citizen. That is why earlier I asked my colleagues what they can do. We need to have the big picture through the federal, provincial and territorial collaboration that is happening now.

It is happening now when we hear about the national living donor registry that is in place right now. I heard one of my colleagues say that nothing has happened in the last five years. Lots have happened in the last five years. More has happened in the last five years than ever before. This is collaboration between the federal, provincial and individual Canadians. We are all responsible to ensure that everybody knows that kidneys and other organs are needed to save lives.

Organ Donations
Government Orders

9 p.m.

Liberal

Hedy Fry Vancouver Centre, BC

Madam Chair, the thing about organ donation is that there is organ donation when we are living and there is post-mortem organ donation.

One of the problems we find with organ donations from living donors is that people tend to do this for family members who are in dire straits. It is a difficult thing for people to give up one of two organs because they are always afraid. They wonder what will happen to them in 20 years' time if they suddenly find they have a problem with the remaining organ and they do not have another one to kick in.

Everyone has been talking about different ways of dealing with this issue. One of the ways would be for public education and public awareness. However, does the member see any incentives for encouraging people to want to donate organs? I know some countries have incentive plans. What does the member think?

Organ Donations
Government Orders

9 p.m.

Conservative

Joy Smith Kildonan—St. Paul, MB

Mr. Chair, I know my colleague, being a medical doctor, is very well aware of the challenges that people have in this area. It takes every Canadian to be aware of the need for these organ donations and to put the fear factor away where so many people are afraid to donate.

I was quite surprised to find, when I came to Parliament Hill and out there in the community, how little I knew, how little the public as a whole knew and how little parliamentarians knew and know about organ donation or stem cell donation. As the member so eloquently put, often it is a family member, or something that happens within a family, that causes almost a forced awareness. In our busy lives there are so many things to do, with jobs and everyday life, that we often are not confronted with that.

This is a dialogue that needs to be here in Parliament on an ongoing basis. It needs to be between the provinces, the territories and the federal government, and, as we are doing this evening, we need to put the spotlight on the urgency of organ donation for our country.

Organ Donations
Government Orders

9:05 p.m.

Blackstrap
Saskatchewan

Conservative

Lynne Yelich Minister of State (Western Economic Diversification)

Mr. Chair, understanding that researchers met in Montreal awhile ago to discuss research in transplantation, what were the key challenges that were identified and what were some of the recommendations, if the member could enlighten us, on the CIHR transplantation workshop and how to best address the challenges through research?

Organ Donations
Government Orders

9:05 p.m.

Conservative

Joy Smith Kildonan—St. Paul, MB

Mr. Chair, I would be very pleased to do that.

Every year, thousands of Canadians receive transplants of solid organs, stem cells and pancreatic islet cells. End stage renal, liver, lung, heart, pancreatic and small intestinal failures are now treated by organ replacement. For cancer, stem cell transplantation can be a cure. However, there are currently more than 4,000 Canadians on wait lists for organ transplants and far more than can be accommodated by the current rate of organ donation. Achieving a good quality of life for these patients remains a challenge.

The CIHR transplant workshop participants identified the need to improve both the quality and quantity of living and deceased donor organs, and improve our understanding of the mechanisms and pathways mediating transplantation related infection inflammation. These kinds of challenges have happened after an organ transplant. Even some of the drugs that are used toward ensuring there is no rejection is a challenge as well.

Overcoming the rejection and establishing long-term tolerance to grafts are an important aspect to this. Tacrolimus is a drug that my husband had some challenges with when he had his transplant. Further recommendations are developing improved therapeutics to sustain graft survival with few adverse side effects and expediting their uptake into clinical practice, establishing tailored transplantation polices and programs for children and other vulnerable populations, and developing national standards of clinical care and mechanisms for the long-term follow up of Canadian transplant recipients. This was a very important workshop in Montreal.