Foreign Affairs Committee on Nov. 16th, 2022

[The Chair, Liberal, Ali Ehsassi]

Professor Cohen, could I ask you to wrap it up? You're a minute and half over your five minutes, so perhaps you could wrap it up in the next 10 to 15 seconds. We will then have the opportunity to ask you questions, and you can incorporate what you were about to say in your responses.

Thank you.

[Dr. Miriam Cohen]

Thank you.

The rest of my intervention today was to address specific points on the need to tackle organ trafficking specifically, in addition to the provisions that already exist in the Criminal Code concerning the trafficking in persons for the purpose of organ removal. I would be glad to answer questions from members of the committee.

Thank you very much for your consideration.

[The Chair, Liberal, Ali Ehsassi]

Thank you very much, Dr. Cohen.

We now go to Dr. McKay.

You similarly have five minutes. The floor is yours.

[Dr. Lindsey McKay, Assistant Teaching Professor, Faculty of Arts, Thompson Rivers University , As an Individual]

Thank you, Mr. Chair, and thank you to members of the committee for inviting me to appear.

I am a sociologist. In brief, I support this bill. I think it's an important piece of potential law that we could pass in Canada to tackle this problem.

I'm going to focus my remarks on my 2016 publication called “Generating Ambivalence: Media Representations of Canadian Transplant Tourism”. This is in an open-access journal called Studies in Social Justice. There's a link to it on page 6 of your legislative summary.

In this research project, I sought to understand why there was not more public pressure to stop Canadian participation in the organ trade despite a robust anti-transplant-abuse movement.

What I did was analyze mainstream Canadian media. I found that the media generate ambivalence towards the issue of transplant tourism, first by absolving Canadians of responsibility and second by consistently orienting public attention away from knowing and thinking about health outcomes and human rights, especially for organ providers. The anti-transplant-abuse movement has had to overcome that kind of mainstream public messaging that we find in the mainstream media.

In my study, I included print and online newspaper, films, TV documentaries and books. The earliest mention I found was in 1988 and sources went to 2015.

This is secondary research. The premise of the study is that the mainstream media shape public attitudes and thus public policy. I used a post-colonial theoretical lens to analyze the data.

My findings were from 233 articles over this 27-year period, most from 2004 to 2009. The articles tended to be sensationalist.

Then I did a deeper qualitative analysis of 74 articles, they included those on six Canadian transplant tourists, with mention of two brokers operating out of Canada. The pattern in the dataset, based on mainstream media, was one of gross imbalance.

Organ transplant providers are invisible in these stories. The public learns very little to nothing about live organ sellers or potentially coerced deceased donors. We are not invited to stand in their shoes and think about their journey. When health outcomes and human rights were mentioned, it tended to be in an isolated passage within a sentence with an overall narrative of sensationalism, one that was oriented around the buyer.

Transplant tourists are centre stage in the narratives of what Canadians learn about this practice. We hear about them and read about them as heroes in a survival story narrative of a dangerous journey, which is presented with empathy. Their actions are cast as morally wrong but understandable, difficult, relatable and even rational and necessary. Buyers are compelled to take radical action.

The public are invited to stand in those shoes and to gain that knowledge about what it's like to be that potential recipient with the challenges they face. Transplant tourists are presented in the mainstream media as innocent victims, compelled to travel and take risks, innocent because they are ignorant and “don’t know” why or how the organ provider is able to give that organ. They are also sometimes presented with this narrative of reciprocity and how it's a fair exchange, as if an organ and money are commensurable objects.

Buying an organ is also presented as being understandable because of the narrative of organ scarcity, so transport tourism is presented in mainstream media as a symptom of another problem for which Canada is to blame and is also the solution. We must solve the larger national organ scarcity problem, and then that would solve the transplant tourism problem. This is another way of constructing transport tourists as victims of long wait-lists.

I argue, having studied this topic for 20 years, that there's no evidence that the shortage will ever end and that this is a deflection from the concerns around human rights and health outcomes, especially for organ providers. The mainstream media eclipse public discussion of whether and how to stop Canadians from buying organs in other countries. Imbalanced narratives generate one-sided knowledge and empathy and absolve responsibility for health outcomes and human rights.

That is the messaging the transplant abuse movement has had to overcome.

One notable exception from that movement that does this very well is Rama Rau's 2010 independent film called The Market. It's unlike every other mainstream media piece. In this story, a B.C. woman on dialysis travelled to India.

What's unique is that she actually met the kidney seller. She saw the radically unequal standard of living between them, and the life chances, and after getting to know the seller said no. She did not proceed with the transplant. She returned home to dialysis. The only challenge, though, is that the public does not have access generally to that film.

Thank you.

[The Chair, Liberal, Ali Ehsassi]

Thank you very much, Dr. McKay.

We will now go to Dr. Gill.

Dr. Gill, you have five minutes.

[Dr. Jagbir Gill, Vice-President, Canadian Society of Transplantation]

Thank you very much, Mr. Chair and members of the committee, for the opportunity to speak with you today on this very important issue.

As a point of clarification and disclosure, I am a transplant physician who works at St. Paul's Hospital in Vancouver. I have nearly 15 years' experience dealing with the ramifications of transplant tourism. I also sit as the Canadian representative and councillor with the Declaration of Istanbul Custodian Group, which was mentioned earlier. This is an international organization whose mandate is to end organ trafficking.

Today I'm speaking in my capacity as a representative of the Canadian Society of Transplantation. I have also been asked to speak on behalf of the Canadian Society of Nephrology. These organizations represent health care professionals in Canada in the field of organ transplantation as well as kidney disease.

In the interest of time, I'll limit my comments today to a few key areas pertaining to the proposed bill. I'll make myself available for any further questions even after this session, if that's the will of the committee members.

First, I would like to highlight the status of this issue in Canada from a frontline perspective. The side of the practice I'll focus on is what we encounter as transplant professionals in Canada, which is really the patients who return after having engaged in the presumed purchase of an organ. It goes without saying that the issues from the donor side that we've heard already today are abhorrent. The transplant community feels strongly that these issues need to be addressed.

There are some key details that I think are worth sharing in terms of what happens and what we see. Typically, patients who are engaging in this practice have indeed been waiting for a transplant for many years. The median wait time in Canada is about five years for a kidney transplant. This is anecdotal, but typically what we see is that at some point, someone within their social network will give them advice and say, “Why don't you look outside of Canada for options?” That then leads to this act. I think a key issue that needs to be acknowledged is that there is almost always a broker involved. The act of travelling overseas to purchase an organ is being coordinated by a third party. Someone is profiting financially from this.

It's also notable, and I think important, to reflect on the fact that when we look at the demographics of who the individuals are who have engaged in this practice—I've done a number of research studies on this issue myself—we do see that it's often individuals from populations in whom there is documented reduced access to transplantation in Canada. In terms of access to transplant, that does appear to be a driving factor in some of these cases.

In terms of what happens when people come back to Canada, many require urgent or emergency care for infectious complications. To make matters more complicated for clinicians, we have very little, if any, documentation provided to us. We've had to guess whether the organ was purchased, what the donor situation was and what the matching was. That really does compromise our ability to care for these individuals when they return. We are relying solely on the knowledge, and hopefully the forthrightness, of these individuals who have come back so that we can provide care for them and do our jobs.

Importantly, in the long run these people do worse. Outcomes are much poorer for people who engage in transplant tourism compared with those who got a transplant locally. Some research I've done recently has shown that when we've looked at factors to try to deter individuals from engaging in this practice, we see that education seems to be the key issue. In particular, educating people around the dangers to them is potentially more effective than punitive measures. That is an important issue.

In terms of the current status, we do not have accurate numbers in Canada, but it does appear that, compared with 10 years ago anyway, the practice has reduced a bit, presumably on the basis of global efforts and in terms of education that we've done on the clinical side warning people of the risks.

In terms of the legislation, first of all, I'd like to express our support for legislation that aims to curb this practice, although there are a few issues that are important in terms of the details of this bill that we'd like to address.

First, our overriding priority is to advocate for our patients and their care [Technical difficulty—Editor] is within the transplantation and medical community, some [Technical difficulty—Editor] in a bad way and have resorted to this terrible act, particularly when, at least in part, this is driven by a reduced access to transplantation in our country.

This is accentuated in terms of the bill by the magnitude of the sentence and the fact that the culpability appears to be equally shared between patients and those who are coordinating the practice. The feeling generally is that it should be weighed heavier on those who are third parties who are coordinating it, versus the patients who are partaking in it.

We'd also like to distinguish between the notion of transplant commercialism and organ trafficking. They are both issues that currently are illegal within the Canadian context, but there are discussions in other countries, including the United States, that have been going on for many years about a regulated system that would be legislated to allow for transplant commercialism. Thinking about the future state of that and how this legislation would impact something like that is also worth considering.

Finally, there are some practical considerations that we're concerned about.

The proposed legislation may deter patients, if they're concerned about being penalized legally, from sharing some of the details that we rely on to know that this has occurred and to be able to care for them. Last, I would like to humbly advocate an increased investment on education on this issue, in addition to this legislation.

Thank you very much. I'll stop there.

[The Chair, Liberal, Ali Ehsassi]

Is there no translation...?

Is it okay?

Are you almost done, Dr. Gill? You are over five minutes.

[Dr. Jagbir Gill]

Yes. I'm okay. I can wrap up now. Thank you.

[The Chair, Liberal, Ali Ehsassi]

Thank you very much, Dr. Gill.

[Stéphane Bergeron, Bloc, Montarville, QC]

Mr. Chair, can you ask the witness to repeat the last words he said, so that we can have the interpretation?

[The Chair, Liberal, Ali Ehsassi]

I'm sorry, Dr. Gill. We had problems with translation.

Could you kindly repeat the last concluding sentences you used in your presentation? We'd be grateful to have the full benefit of understanding.

[Dr. Jagbir Gill]

Yes, certainly.

I had requested that the importance of education go along with the legislation, as that does appear to be the most effective piece in making sure that people are aware of the legislation. That does appear to be the most effective piece: making sure that people are aware of the legislation. Having a mechanism towards that would be critical.

I also raised concerns that legislation may make it more challenging for us to ascertain that these cases have occurred, as patients may not be as forthright about the details.

[The Chair, Liberal, Ali Ehsassi]

Thank you very much, Dr. Gill. We're very grateful for that.

We will now go into questions by the members. The first person is MP Genuis. You have four minutes, Mr. Genuis.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Thank you, Mr. Chair.

I want to thank the witnesses for their excellent testimony and underline the fact that although witnesses certainly had excellent suggestions about more that can be done besides passing this bill, none of the witnesses raised any problems with the bill as written or suggested that its passage should be delayed. My view, our view, has been that we should expedite consideration of this bill and try to move it forward quickly.

I support not doing clause-by-clause consideration so that the bill can be automatically reported to the House and proceed more quickly and directly to third reading. We've been working on this for 15 years. It's been too long. I think that's what we owe to the victims of this horrific practice.

In that light, I want to share a notice of motion: “That the Chair be instructed to schedule an in public committee business meeting on Wednesday, November 23, and that the first order of business during that meeting be the resumption of debate on the motion of Garnett Genuis moved on Monday, November 14.”

Now that the notice of motion is out of the way, I want to say on a personal note, Dr. Gill, that my brother practises at the same hospital that you do, so maybe you recognize the name, or maybe not, but thank you for your service on the front lines on many important issues.

There were a number of witnesses who ran out of time in their opening remarks. I would like to invite any witnesses who had additional points that they weren't able to make in their opening remarks to feel free to add those to the record now.

[Dr. Jagbir Gill]

Yes, if I may, very briefly, I do have a point of clarification.

I wanted to reiterate that the one area of the legislation where there was some trepidation was around the fact that it appears that culpability is equally shared between the patients and those who are coordinating the practice. The suggestion—certainly from the professional organizations—is that it be shifted such that the primary culpability would go towards those who are coordinating the practice and secondarily towards the patient population.

Thank you.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Thank you for that.

My one reflection on that is that in many cases the coordination is done by people who would be, to a greater extent, beyond the reach of Canadian law, whereas this law is aimed primarily at those who are from Canada going abroad to receive the organ. It would seem less likely, although not impossible, that someone in Canada would be coordinating the process of organ harvesting.

I'm sorry, but I don't have the names in front of me. Our first witness had some comments in her opening statement—it's Dr. Cohen, yes.

Do you want to finish your opening statement? I think maybe you ran out of time.

[Dr. Miriam Cohen]

Mr. Chair, I would add then to my initial comments the need to tackle organ trafficking specifically, and the criminalization of trafficking an organ. That is a different crime from the trafficking of a person for the purpose of harvesting or removing their organs, which is already criminalized in the Criminal Code. This proposed legislation disconnects organ trafficking from human trafficking, making it a separate offence. It also focuses on consent and informed consent, which addresses the situation of children who are victims of forcible organ removal.

Also, the text of Bill S-223 seems to apply solely to organs, exclusive of tissues and cells.

These are the main points that I did not address in my opening remarks.

Thank you very much.

[The Chair, Liberal, Ali Ehsassi]

Thank you.

We will now go to Ms. Bendayan.

You have four minutes.

[Rachel Bendayan, Liberal, Outremont, QC]

Thank you very much, Mr. Chair.

Let me begin by saying how proud I always am when we welcome experts from the Université de Montréal, an institution located in Outremont, which I represent with great humility and pride. It is still a source of pride for me today to welcome a witness from this university.

I would also like to say that I once had the pleasure of being Professor Cohen's co‑worker. I hope there is no objection to my asking her questions.

[Stéphane Bergeron, Bloc, Montarville, QC]

There is a conflict of interest, ha, ha!

[Rachel Bendayan, Liberal, Outremont, QC]

That's precisely why I mention it. Do you have any objection to that, Mr. Bergeron?

[Stéphane Bergeron, Bloc, Montarville, QC]

Not at all.

[Rachel Bendayan, Liberal, Outremont, QC]

Thank you.

Dr. Cohen, thank you again for being here. You touched on a number of issues, including international conventions, in your introduction, but I also understand from the senator's presentation just a few moments ago that other countries have strengthened domestic legislation in order to combat organ trafficking.

I'm wondering if you can enlighten us on best practices that you have seen around the world and how the bill before us perhaps compares to what our allies are doing.

[Dr. Miriam Cohen]

Mr. Chair, I would like to start by saying I did not conduct a thorough, exhaustive study of all countries, but there is a tendency, especially with the convention that I mentioned—the Council of Europe Convention against Trafficking in Human Organs—to dissociate human trafficking for the removal of organs from the actual trafficking of human organs, and some countries—

[Rachel Bendayan, Liberal, Outremont, QC]

I'm sorry, but to be more specific, I understand the international convention framework, and it's fine if you don't have that on the tip of your tongue, but in terms of domestic legislation, is there anything you would like to point the committee to in terms of what other countries are doing domestically?