Health Committee on May 7th, 2018

[John Oliver, Liberal, Oakville, ON]

Thank you very much for your testimony.

I do want to thank our colleague Mr. Webber for bringing this topic to our attention and making sure we made time for it in our meetings. Thank you for that, Len.

I have the recommendations—I'm just trying to capture them—that you've made in terms of what we could be addressing: develop and implement a sustained multimedia campaign to promote donors, develop a strategy to administrate and manage interprovincial organ sharing, and increase the opportunities for donor recognition, particularly in federal documents, tax forms, or Service Canada.

I am a bit fuzzy about supporting a system across Canada that prioritizes these initiatives. I wasn't quite sure what that was about. Could you just elaborate on that one again, Ms. Gavsie?

[Ronnie Gavsie]

Yes, certainly. I'll do so using an example, if I may. It's already been acknowledged this afternoon that British Columbia's living kidney donation program is recognized across Canada as being best in class. The recommendation is that all the details surrounding that program be packaged and moved across the country.

[John Oliver, Liberal, Oakville, ON]

Okay, so it's an adoption of best practices as they emerge, rather than reinventing it.

[Ronnie Gavsie]

Rather than creating something new I think if you went to various different provinces you'd find they are centres of excellence.

[John Oliver, Liberal, Oakville, ON]

It's recognizing and adopting best practices as they emerge.

[Ronnie Gavsie]

Correct.

[John Oliver, Liberal, Oakville, ON]

There's a bit of a darker side to the shortage of organs, which is the buying, selling, or trading of human organs. As I understand it right now, the Criminal Code in Canada doesn't prohibit that activity, and I was just reading that Canada's in the top 10 of global importers. Most of it's done through transplant tourism whereby people leave, go to another country, receive an organ, and come back with it, so they're importing it already transplanted.

I'm worried about the consequence of that in some countries where the socio-economic realities might lead people to...with wealthier countries adopting or taking organs from other people based on an economic transaction.

Do you think more needs to be done there? Is that an area of concern to any of you? Do you think there should be something stronger in our Criminal Code to deal with the buying, selling, or trading of human organs?

[Amber Appleby]

Obviously, while I can't comment on legislation and what should or shouldn't be in place, what I can comment on is that within Canada I think we do a really good job of making it clear that we do not support those practices.

[John Oliver, Liberal, Oakville, ON]

Okay.

[Amber Appleby]

We are faced with the reality that, from time to time, people will leave the country and they will receive organs outside of the country and they will come back. That's something that we are forced to reconcile when they do return, in terms of ensuring that they receive the optimal post-transplant care.

[John Oliver, Liberal, Oakville, ON]

Would any of you recommend that this committee make a recommendation around that, that at the national level we recommend restrictions on that kind of trade?

[Dr. Isra Levy]

We haven't done a legal analysis of the implications, but from an ethical point of view we clearly abhor that behaviour and would support in principle strongly conveying that piece.

[John Oliver, Liberal, Oakville, ON]

Thanks very much.

On the strategies to advance interprovincial organ sharing, I noticed in our analysis from our librarian that Saskatchewan, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, the Yukon, Northwest Territories, and Nunavut do not at this point maintain registries. They have vehicles so people can identify themselves as donors, but there is no registry of them so it's harder to track and harder to find them.

If we look at interprovincial sharing agreements, does there need to be at least a national agreement among the provinces and territories around the maintenance of a registry? You would think that would be a minimum start.

[Amber Appleby]

I want to make a point of clarification. I think the registries you're speaking of are very different. The intent-to-donate registries are operated provincially. You're correct. Some of them have more paper-based systems. Each province needs to look at that and decide what they need to do about that situation.

The interprovincial organ-sharing programs that are operated nationally by CBS have interprovincial sharing agreements already in place. When we say expanding them, what we mean by expanding those registries is not to be confused with the other registry. We're looking at expanding them to other organ groups.

We talked about highly sensitized patients. Right now we're exchanging kidneys routinely across Canada to improve Canadians' likelihood of receiving a kidney transplant. We need to do that for other organs. If a patient is sensitized, we need to start to put in place heart-sharing agreements, for example.

Those are some of the things we continue to work on.

[John Oliver, Liberal, Oakville, ON]

That's not necessarily the donor. It's the organ itself, and who would benefit from it best.

[Amber Appleby]

That's right.

[John Oliver, Liberal, Oakville, ON]

Prioritize that nationally. Thank you for that.

I noticed by law all deaths in designated facilities such as hospitals must be reported to the Trillium Gift of Life Network. I think that came in recently. I used to be a hospital CEO. I remember implementing those changes.

You mentioned running the on-the-ground teams. That was a phenomenal add. It was very difficult for the doctors and nurses in the ER or the ICU to have that type of conversation. Now with the reported death, they would simply pass on the family contact information to your agency who would then initiate the call, have the conversation with the family, and if they were willing, the harvesting team—they don't call it that any longer—would go through the procedure and support the family. It was a real value-add to the local facilities.

Is the duty to report just Ontario, or is that Canada-wide? Is there any work on replicating those on-the-ground teams across Canada?

[Amber Appleby]

You're right in that the legislation differs provincially. I will have to double-check, but I believe right now five provinces have mandatory referral written into their current legislation. It's also important to note that even the mandatory referral legislation differs provincially. For example, in B.C. there is a requirement to report all deaths of those younger than 75.

The way the legislation is currently written is quite different, and a few provinces still do not have mandatory referral legislation. A couple are in the process of getting it, that don't yet have it in place. It would be very helpful to ensure that was in place in every jurisdiction.

[The Chair, Liberal, Bill Casey]

Your time is up.

Now we go to Mr. Webber for a five-minute round.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you.

I thank my colleagues for allowing me to continue with my questioning. I will share a bit later on.

Dr. Levy, in your presentation you suggested that the federal government could perhaps be involved in developing strategies for organ sharing among the jurisdictions here in Canada. Of course, there are technologies out there. Cryopreservation and ex vivo technologies allow organs to survive outside a body for three to five days. I have seen these machines where you can see a heart pumping away, or lungs expanding and contracting. It's amazing.

What is occurring right now throughout Canada with regard to the sharing of organs? Is it strictly B.C. and Alberta that share within themselves, or is there sharing throughout the country?

[Amber Appleby]

The first priority is usually provincial allocation when it comes to organs. There is a big focus on provincial self-sustainability there. The reasons we usually share organs outside of a province are a few different cases. One is when you have a medically urgent patient somewhere else in the country and you need to prioritize them, typically somebody on a ventilator in an ICU and they will die without the organ. We prioritize those. We also prioritize hard-to-match patients. That's what I referred to in terms of highly sensitized patients. There are a number of other cases, not just highly sensitized, where patients are hard to match.

Those are the types of programs that we're trying to advance in terms of sharing the organs. Typically, it's within jurisdiction first. Then also to maximize utilization of organs that are donated, if a jurisdiction can't use that organ because it's not the right size, not the right match, or not the right patient, we will take those non-utilized organs and we will share those across the country.

[Len Webber, Conservative, Calgary Confederation, AB]

Is there co-operation amongst the provinces and territories with regard to allowing to give if it's more required over here? Are there any instances of “No, we're keeping it; we need it here”?

[Amber Appleby]

We have established agreements nationally whereby we have agreed when we're going to share organs. For example, with our HSP program, which is currently highly sensitized for kidneys, we have an interprovincial balancing threshold that's within our IT system that says you are required to give one of the kidneys to the national list first and then this one can be allocated provincially. Those are the types of agreements. We work really hard with our clinical community to come up with what makes sense and also to make sure it's not inequitable when we actually are sharing organs.

[Len Webber, Conservative, Calgary Confederation, AB]

Ms. Gavsie, you mentioned the need for increased opportunities on the federal level with respect to channels to registration. I would be remiss if I did not mention my private member's bill that is coming forward here very soon, Bill C-316, which if it is passed, would allow Canadians to indicate their desire on their income tax forms of whether they would be organ donors. I have many official seconders from all parties, including numerous individuals in this room.

Thank you for that.

There are 25 million Canadians who file taxes annually. Can you comment on this proposal, all our witnesses, and what impact you think this would have? Do you see it as a positive thing? Do you see any concerns with this bill?

[Ronnie Gavsie]

I think it's a very positive thing. Registration has been proven to be transaction-based, and that's a transaction where you have millions of Canadians. What would simplify the process is, rather than having them register on their tax returns, a requirement for them to go through CRA to the home province's mechanism for registering, thereby not needing to move personal information through a different channel.

I certainly do, and we do at Trillium, support that concept and believe it would go a long way to increasing the consent rate.