At a recent meeting of the Kidney Foundation of Canada, Phil Halloran made a brief yet spine-tingling presentation on the state of organ transplantation in this country.
Unfortunately for him, Canada's ministers of health were not in the room. Had our political leaders been there, they would have been shocked, perhaps sickened and, hopefully, feeling ashamed.
Dr. Halloran is the editor of the American Journal of Transplantation and one of Canada's foremost transplant surgeons.
What he said, quite bluntly, is that almost 1,200 Canadians a year who needed life-saving organs didn't get them because of the failings of our transplant system.
"This is a scandal," he said.
He's right: It is a scandal -- one almost on a par with Canada's infamous tainted-blood tragedy.
The tainted-blood tragedy -- in which about 2,000 hemophiliacs and transfusion patients contracted HIV-AIDS and 20,000 more recipients of blood and blood products contracted hepatitis C -- had its roots in bureaucratic inefficiency, turf protection, jingoism, secrecy and paternalism.
Sadly, the same issues are front and centre in transplantation.
Yes, we have some wonderful transplant organizations in Canada, and what follows is not an indictment of their work. But, over all, the organ transplant system is inefficient and scattered: Truth be told, it's not a system at all.
In fact, Canada is the only developed country without a national transplant organization.
In Dr. Halloran's expert opinion, that is costing lives, a lot of lives.
He would like Canada to follow the lead of the United States, which has two key national agencies, the Organ Procurement and Transplantation Network and the United Network for Organ Sharing.
These non-profit organizations, created in 1984, have a simple yet essential task -- to increase the effectiveness, efficiency and equity of organ sharing. They have been very successful.
Consider that the United States transplanted 28,108 organs in 2005. Canada should transplant 11 per cent of that number, or 3,091 organs.
But Canada transplanted only 1,905 organs - a shortfall of 1,186.
Put another way, the cadaver kidney donation rate in the United States increased to 29.8 per million population in 2003 from 29.0 in 1994. In that same time period, the cadaver kidney donation rate in Canada fell to 20.7 per million from 24.3 per million.
The change in live kidney donation rates is even more striking. In the United States, it rose to 22.3 per million from 11.4 per million in a decade. In Canada, the increase was to 12.6 per million from 7.3 per million.
All kinds of explanations are given for these numbers. The United States, it is said, has more guns and hence more brain deaths; it also has, in some jurisdictions, more motor vehicle crashes and more brain-damaged victims.
Dr. Halloran dismisses those arguments as nonsense. "You can arabesque around this all you want, but the bottom line is that it's an organizational issue," he says.
"In Canada, donation and transplantation rates are falling and in the U.S. they are increasing."
Why?
Because Canada has a handful of provincial/regional transplant agencies doing their own thing while the United States has a centrally co-ordinated network. There is, in this country, a Canadian Council on Donation and Transplantation, but it has no power, no national mandate and no budget to speak of, so it barely merits mention.
UNOS and OPTN aggressively advocate and promote organ donation. They set national standards for the collection of organs (Canada has no such standards), they collect up-to-date national data (in Canada, data sharing is voluntary) and they distribute organs based on need, irrespective of state boundaries (in Canada, interprovincial exchanges are rare).
Lori West, an internationally renowned pediatric cardiac surgeon and president of the Canadian Society of Transplantation, shares Dr. Halloran's concerns. She was aware of the problem generally but says his statistical analysis places the issue in stark terms.
"Our system is terribly outdated and inefficient," Dr. West says. "Having a national agency would resolve a lot of problems."
For her, the tragedy of the current setup is that a lot of organs are going to waste; they are simply not being harvested from willing donors, strictly for bureaucratic reasons.
"We all have patients who die on the waiting list," Dr. West says. "It's not fiction or melodrama. A lot of people are dying for lack of organs. There's no question we can do a lot better."
So what are we waiting for?
In the tainted-blood situation, even after the problems became evident, there was little, if any action. An absence of leadership compounded the initial tragedy.
It is hoped that this time history will not repeat itself.
About 1,200 people a year in Canada are risking death because the transplant system is second-rate.
We don't need another committee, commission of inquiry, study or other half-measure. We need action.
Who will step forward and show leadership now that Dr. Halloran has thrown down the gauntlet?