Health Committee on May 9th, 2018

[Dr. Norman Kneteman]

It would be a huge help. As I mentioned, and as Dr. West mentioned as well, we have many of the pieces in place to do these jobs well, but at the present time, for example, in Canadian Blood Services, the section charged with this goes back every three years to write another request to the federal-provincial-territorial ministers conference for funding. How much is going to come, and whether any is going to come, is never known for sure, and that's a very difficult way for a national organization with such an important job to be operating. It seems that you just get the last tranche of money and, within a year, your focus is on looking at how to get funding next time rather than how to do the job that we're basically required to do.

[Ben Lobb, Conservative, Huron—Bruce, ON]

I'm sure ALS Canada would be happy to provide what that meant to them, but my time is up.

[Dr. Norman Kneteman]

I'm sure Dr. West feels that it's exactly the same situation as well.

[Dr. Lori West]

You've provided a strategy in your documents that proposes exactly that pathway forward. Your support on that would be very helpful.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we go to Mr. Ayoub, so it will probably be in French.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Yes, it's going to be in French.

Thank you.

First of all, thank you very much for being here today. This is an extremely interesting issue.

Ms. Blackstock, your testimony was truly captivating, and it is more than welcome. I was very touched by it.

We have begun our study of the issue of organ donations and transplants. I do not want to be negative, but I have one remark.

I would like to know what keeps you up at night. You are professionals with many years of experience in your field. I realize that working in isolation is problematic. The provinces and the organizations are working separately. I understand from your presentations that there are many organizations. However, I've noticed a lack of efficiency in the results.

Personally, I'm all about results. If managers look at these results over a long period of time, they would ask themselves if any major progress has been made. The percentages are important because there are few donors. In Quebec, we have 173 donors. One is always better than none, but, if some were to be added to the list, then the percentage would soar.

Canadian Blood Services is responsible for providing leadership in Canada. I've already met some people from this organization, and I look forward to meeting them again. Does this leadership translate into public awareness? Canadian Blood Services has not been involved in any public awareness activities for a long time. Yet this is part of their responsibilities.

How do you see this? What is the trigger?

I've already taken two minutes to ask you this very broad question, and I only have five minutes. Any of the witnesses can answer.

[Dr. Norman Kneteman]

I'd first like to apologize. It took me a few minutes to get to the English translation, so, unfortunately, I missed the question.

[David Hartell]

I can answer.

Seeing all of these organizations here working together gives me hope. This is recent. When the Canadian national transplant research program was created, it was the first time that we brought researchers working on organ donations together with those working on transplants. Normally, these are two separate fields, but we realized that we achieve progress by working together.

The document we gave you lists all the partners we have brought together, because transplantation affects many fields. It affects the Kidney Foundation of Canada and the Canadian Liver Foundation. It's really by working together that we can improve the situation. Canadian Blood Services is one of our most critical partners. It's by working together that we can give—

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

It's well known that we achieve more by working together.

You're here, we're together, and we're talking. But where is the leadership, and where are the results? Apart from getting together and writing reports, that is. According to Mr. Kneteman's presentation, many reports have been written over the years. These reports aside, what measures have been taken?

You say that you need ongoing funding, but how can we get to 200, 800 or 1,000 organ donations? How can we increase the number of organs donated and the number of lives saved? How can we shorten the waiting lists and lower the number of people who die every year waiting for organ donations? Where are these results?

[David Hartell]

We would be glad to share our results as well as all the progress we've made in the last five years. We also need to consider the new technology that is changing the way transplants are done in Canada today, not tomorrow.

Our goal is to eliminate, 10 years from now, the wait time for new transplants. It really has transformed.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

I would like to hear from Mr. Kneteman on this issue.

[Dr. Norman Kneteman]

I did show slides that illustrate the fact that, over the last decade, we have gone from that very discouraging flat line stuck at 15 donors per million to an increase in Canada by 50% over the last 10 years. I think we also recognize that although that's a very important accomplishment, there is much more that can still be done.

That work has been done by federally and provincially and by all the different agencies that had a role in that. In fact, there is ongoing work and co-operation. For example, Ronnie Gavsie, who is the head of Trillium Gift of Life from Ontario, sits on our organ donation and transplantation expert advisory committee for Canadian Blood Services and provides input from her expertise in her province in terms of what's working, what's effective, and what we should do.

There are ongoing supports between the different systems, and we would like to see those strengthened and basically carried forward, because that national interaction is critical. With the system of health care and government that we have in Canada, it's not going to be just one national system that runs everything. Basically, this is a provincial responsibility, but there are many jobs that just aren't going to be done by a provincial agency because they involve sharing organs across the country, which happens not infrequently, and putting these sorts of strategies in place in all of our provinces rather than just some.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

What's troubling—

[The Chair, Liberal, Bill Casey]

Your time is over.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

My time is up?

[The Chair, Liberal, Bill Casey]

Your time is up—by quite a bit.

We will transplant over to Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. West, you had a reference in your opening remarks to the issue of organ trafficking and tourism. Can you give us an idea, broadly speaking, of the scope of this?

[Dr. Lori West]

Do you want to take that, Dave?

[David Hartell]

The scope of organ trafficking is one that I think, on the positive side, has decreased lately. It is still a problem. There are many countries in the world where they do illegal organ trafficking. It is still a problem that we need to address, but at least it's decreasing. One of the reasons it's decreasing is that we're seeing advances in our own deceased-donation programs and living-donation programs here. The kidney paired-exchange program in Canada is having a big impact on that.

In terms of what we need to do, I'm happy to share this with the committee. We commissioned a study with international researchers, legal experts, and transplant experts to look at what we could do to help fight the organ trafficking and medical tourism problem in Canada. One of the main recommendations that came out of the study is that we should be tasking physicians with doing mandatory reporting on their patients who have received transplants from another country.

[Don Davies, NDP, Vancouver Kingsway, BC]

Can I interrupt for second? I'm trying to get a handle on what the extent of the scope is in Canada. Do you have any idea how many Canadians may be engaging in this?

[David Hartell]

That's the problem. By implementing reporting, we would get a proper sense of the problem. Right now it's hard to understand how many patients are going out. Because of doctor-patient confidentiality, we're not capturing this information.

[Don Davies, NDP, Vancouver Kingsway, BC]

I don't mean to be cheeky, but how do we know that it's decreasing then?

[David Hartell]

What I've been told by my colleagues in the field is that they are seeing—

[Don Davies, NDP, Vancouver Kingsway, BC]

Is that the general sense?

[David Hartell]

Yes. The general sense is that there is less of this. I don't want to diminish the problem, but it is something on which I think there is a role for the federal government to play. I'm happy to share the recommendations with this committee.