Health committee  There are a couple of questions there. One would be, what happens when you move to another province? The way it works right now, yes, you would have to re-register your intent to donate wherever you move to. To try to make that easier we've created a national microsite, where you can go to one spot.

Health committee  In terms of IT infrastructure, so that I'm being really clear, within each provincial jurisdiction, you're right, some do have IT systems for intent-to-donate registries. Those are strictly provincial systems that are intent-to-donate only. They're not the same as listing a patient for a transplant.

Health committee  I think what's been said a couple of times is just in knowing and understanding the complexity of the system. Public education and awareness is really important, but equally if not more important is professional education and awareness. I think this is one of the learnings as well from Spain, and how they have professionals at every level within their health care system who truly know and understand the intricacies of what's required to facilitate donation.

Health committee  In terms of some of the very specific things we're doing to improve collaboration and help each other as a system, we have a group that meets regularly and that shares practices from one jurisdiction to another. We do that actively. Every year we get together and come up with our biggest national priorities that we want to work on together to improve performance, recognizing that some provinces may be focused on other things as well.

Health committee  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.

Health committee  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.

Health committee  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.

Health committee  That's right.

Health committee  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.

Health committee  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.

Health committee  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.

Health committee  Just to clarify, is that also in regard to the same question?

Health committee  I think Ronnie is correct in that we do really need to look at creating a culture of donation. Really, we don't want donation to be an afterthought. I think all of the opportunities that make it most convenient for people to have many interactions with that opportunity would definitely facilitate an increase in people registering their decisions.

Health committee  There are shortages of organs across the board in every single—

Health committee  I wouldn't say it's one more than another. Wait-lists per province differ substantially depending on the type of organ that's needed and also depending upon a number of other factors, including how highly sensitized a patient might be, for example. That's why we have looked at what the opportunities are—when we know we have such a scarce resource—to share that resource across Canada, to look for the best match.