Nearly 200 Canadians die each year for lack of an available organ that, if transplanted, could have saved their lives.

Medicine has made breathtaking breakthroughs in transplantation, including drugs that prevent rejection. But Canada cannot take full advantage of those breakthroughs because not enough organs are available. Keith Martin, a physician and Canadian Alliance MP with a special interest in organ-transplantation policy, calls the situation "a silent crisis that's only going to get worse." And he's right.

Austria, to take one example, comes closer to getting policy right. Its organ- donation rate is almost double that of Canada's -- 24 per million compared to 14. Spain's rate is the world's best, at 32.5 per million. What's the difference?

In Austria, the law allows medical authorities in a public hospital to take organs from those who have died unless the patient or family has refused consent prior to death. In Canada, the practice is the other way around: Organs cannot be taken unless permission has been formally given.

The Austrian policy is what marketers would call "negative billing": You get something unless you specifically indicate you don't want it. In the organ-transplant world, this is called "presumed consent."

Presumed consent drives up the availability of organs. It is now the policy in Austria, Spain, Belgium, Finland, Portugal, Hungary and Sweden. Three of those countries -- Austria, Spain and Belgium -- lead the world in donor rates. Spain tops the list, partly because of presumed consent and partly because of an aggressive government-funded education campaign of doctors, patients and the public.

Education campaigns and national or provincial registries of available organs are the preferred approach in Canada and other countries. Sadly, they don't work to increase donation rates.

In 1999, a House of Commons committee conducted an exhaustive study of organ donation and opted for the education and registry approach. Provinces had already adopted some of these policies, and the federal committee urged still more education and a national registry.

The results are clear: little progress. In 2001, for example, there were 1,020 kidney transplants compared to 1,105 in 2000, 1,011 in 1999, 993 in 1998 and 1,218 in 1997. There were roughly as many heart transplants done in 2001 as in 1993. Liver transplants have risen only slightly. Donation rates, in other words, are flat despite whatever efforts have been made by hospitals, governments and organizations raising money to fight diseases.

The number of people waiting for organs, meanwhile, has risen, to 4,000 in 2001 from 2,700 in 1997. In that same period, the number of transplants rose by only 180.

The numbers tell the story: Only presumed consent significantly pushes up donation rates. Strangely, the Commons committee devoted only one paragraph to presumed consent, saying "Canadians would resist such a system" without explaining why. The committee then said, in defiance of the evidence, that "there was no evidence where this method has been enacted to show a substantial increase in organ donor numbers."

This putative opposition is untested. Dr. Martin, who remains wary of presumed consent, said four religious leaders signed donor cards, indicating that their religions do not oppose organ donations. So the opposition is apparently not religiously based. Maybe some people believe doctors would kill patients to get at their organs.

Canada should be in the forefront of organ-donation rates, if for no other reason than to further the research breakthroughs made by Canadian doctors. The Edmonton Protocol for pancreatic islet transplantation to reverse diabetes was pioneered by University of Alberta researchers under the world-renowned James Shapiro. Other Canadians have made progress in developing anti-rejection drugs.

There's obviously more that could be done through education to increase donor rates. But the evidence here and abroad suggests that Canada could achieve the results of countries that have adopted presumed consent.

Canada can draw on the practical experiences of other countries in working through the thicket of questions around presumed consent. Maybe a Charter challenge would be launched against it, but such challenges are a dime a dozen.

The evidence is in: Presumed consent works. Canada should go for it.
jsimpson@globeandmail.ca