HEAL Committee Meeting

STANDING COMMITTEE ON HEALTH

COMITÉ PERMANENT DE LA SANTÉ

EVIDENCE

[Recorded by Electronic Apparatus]

Tuesday, November 24, 1998

• 0910

[English]

The Chairman (Mr. Joseph Volpe (Eglinton—Lawrence, Lib.)): Our committee is now in session.

We are here today to address the issue of motion M-222, presented by Mr. Keith Martin, in another life known as Dr. Keith Martin, on organ transplantation. The motion was presented in the House last spring. It came before this committee very briefly and the committee determined that it would proceed with this motion today.

I think all of you have this blue binder. It was delivered to your office. It represents the department's initial response to a request by the committee so that we could listen to Keith's presentation and motion in a context that was more or less informed.

I have a couple of department officials here with us this morning. They'll go through the package with us and answer all of our questions, if we have any.

I have another development, pursuant to some of the discussions we had here last week, that is immediately relevant to the undertakings of today. The minister was advised of some of the considerations this committee deliberated upon last week. You'll recall that we went through I think five items that you thought we might like to have as a focus for committee study once we finished off some of the business of this particular session. One of those deals with Keith Martin's motion.

• 0915

At any rate, it's a letter from the minister. I hope you'll all receive it in the same positive vein that I received it in. It's addressed to the chair and it says:

Today the Standing Committee on Health will be examining the issue of organ donation, as proposed by Dr. Keith Martin, MP, in M-222.

Dr. Martin is to be commended

—talk about partisanship—

for his foresight in proposing this motion. Organ donation is a very serious issue and I believe worthy of more in-depth examination by the Standing Committee on Health.

That's what happens when you have spies.

I would like to ask the Standing Committee on Health's advice on the appropriate role of the federal government to improve Canada's organ donation situation and save lives. To this end, I would suggest the following terms of reference:

That the Standing Committee on Health consult, analyze and make recommendations regarding the state of organ and tissue donation in Canada;

That the Standing Committee consult broadly with stakeholders, including, but not limited to, provinces, transplant centers, medical personnel, patients, families, organ and tissue retrieval organizations and international experts;

That the Standing Committee consider the appropriate role for the federal government in the development of national safety, outcome and process standards for organ and tissue donations, as well as in promoting public and professional awareness and knowledge regarding organ and tissue donation, procurement and tranplantation;

That the Standing Committee consider the legislative and regulatory regimes governing organ and tissue donations in other countries;

That the Committee submit its report no later than April 30, 1999, provided that, if the House of Commons is not sitting, the report will be deemed submitted on the day such report is deposited with the Clerk of the House of Commons.

Thank you for considering this request. I look forward to the Committee's advice on this issue and other health care matters during the course of the government's mandate.

Yours very truly,

Allan Rock, PC, MP, Minister of Health.

The official copy, as I said, is on the way. I'll give everybody a copy of that as soon as it comes in. I thought you might wish to have that at least read to you before we begin hearing Keith Martin.

Keith, I'm sure the minister didn't intend in any way to steal any of your thunder, and I didn't mean by reading out his request to take the rug from under your feet or in fact from under the feet of the department officials who are here specifically to address this package. I hope you receive that as good news.

Mr. Keith Martin (Esquimalt—Juan de Fuca, Ref.): Mr. Volpe, I couldn't have wished for better news.

The Chairman: I hope the rest of the committee feels the same.

If you'll forgive me for a moment longer, Keith, what I will do is I will turn my attention to committee members and underscore for them the word “consider”, which is what the minister asked us all to do. I don't think we have to make a decision today on whether we will take up this consideration. But certainly if we are going to consider his request then I think whatever submissions you may forward today, plus whatever information the committee members gain from their questions to the department, ought to be incorporated in whatever we decide to do with your motion.

Specifically, my procedural options are as follows: one, we'll take your motion, decide on it today and report to the House; or two, take your input and your motion today, plus the information we garner together with our consideration of whether we will conduct the study, and fold your motion into that study. In this case, I, on behalf of the committee, would not report to the House until such time as we have completed our study.

I say this now because you may have some views on it even though you are not part of the committee and the committee is going to have to make the decision. I feel it's important for everybody to appreciate that if we're going to talk about your motion, we either report and have the House decide to do what it wants with it, or decide not to report and incorporate it as part of the further study. You can decide that later; we can do it towards the end of the meeting.

Ovid.

Mr. Ovid L. Jackson (Bruce—Grey, Lib.): This is a motion and not a bill. Is that how it's dealt with?

The Chairman: Yes.

• 0920

All right. I've already explained to Keith the usual procedures that we follow in the committee. I also gave him an indication that we might be a little more flexible with him in terms of time. I certainly want to give him the opportunity to make the presentation as fully as he can. We'll try to be as diligent as possible in observing the question-and-answer period.

Go ahead, Keith.

[Translation]

Mr. Keith Martin: Thank you very much, Mr. Chairman.

[English]

I hope everybody's had an opportunity to receive one of the blue packages. They're in French and English. Please get one of them, because you'll find that much of what I have to say is in fact in that document.

Mr. Chairman, I couldn't have hoped for better news from the minister. I certainly hope that members of the committee will indeed take his words to heart and deal with this issue, which is, in my view, one of the more pressing health care issues, one that in fact has been pushed under the rug for many years at the expense of the lives of a great many people and their families. If you have a family member who is in need of an organ, you will see that it is an issue that not only affects the patient himself but also has a dramatic effect on the entire family and completely disrupts the family life. The fact that a person can receive an organ can dramatically change that person's life in ways that we on this committee can hardly imagine.

The situation in our country is one that is very unfortunate, but it is rectifiable. Over the last few years, we see a widening discrepancy taking place. Although the number of organ transplants has increased between 1991 and 1995 in the order of 16%, we see that the number of people who actually require organs has jumped 40%.

That number and that widening will actually increase as time passes, for a number of reasons. One, we have fewer resources. Two, we have more people who are suffering from chronic diseases, and from diabetes in particular, which is going to have and does have a dramatic effect on the need for dialysis, because a lot of those people suffer from end-stage renal disease; in other words, the kidneys just pack it in, and their only option is dialysis. That situation is worsening as time passes.

If we look at the experience of other countries of the world, we see something very interesting. We see that in those countries that have implemented a few points that are in motion M-222—which passed, as Mr. Volpe mentioned, unanimously in the House—they see quite a jump in the number of transplants that do take place. This has a twofold effect, not only on the person himself and the obvious benefit to that particular individual, but also, in cold hard dollars and cents, to the taxpayer.

If you look at kidneys, for example, the cost of doing a transplant, with all the moneys involved in that over a five-year period, is about $50,000. The cost of dialysis is about $250,000 over that same period of time. So for every patient we manage to transplant, we save the taxpayer $200,000 right off the bat. That doesn't take into consideration the obvious gain from having that person go back into the system as a taxpayer and as a worker, or of course the obvious benefits to the family, which are incalculable.

The motion I put forth has four parts to it. I think it needs to be looked at in context with the fine work that was done by the federal-provincial strategy when the feds and the provinces got together and said we have a problem, so let's deal with the problem. They came together and have already established 13 points that can be implemented, which would dramatically improve our organ system and which makes the work of the committee easier if you choose to adopt this, because we didn't have this a year ago. These 13 points, along with the four points of the motion, I think can be married up, because there certainly is a lot of overlap.

The point of the matter is a lot of these points are in fact doable today. My hope is that if the committee chooses to look at this you won't take very much time to see it, because a lot of this stuff has already been debated and looked at and studied for many years, and what we need is action, not more study.

Having said that, if you look at the situation in Canada, our organ donor rate is around 12 per million. Compare that with countries such as Spain, which has a rate of 21.7, or Austria, with 25.2.

• 0925

Looking at the Spanish experience is interesting, because when Spain adopted a national database and a couple of other things, the organ donor rate essentially doubled, in a dramatic increase. It's sad that our country, which has had such a profound experience and been a leader in organ transplant science for so many years, has in fact lagged behind in making that kind of science available to Canadian people.

The first point I had suggested was a real-time database that links health care facilities. Essentially what you'd have on this database, which is very easy to do—one central location—is donors and recipients. For example, if someone is killed on the road out here, you could take their social insurance number, for example, pump it into the database, and know whether that person is an organ donor or not. It would be very quick. That would obviate a lot of the situations now where organ transplant teams, which are provincial, have to spend a lot of time tracking down available people as recipients.

Having the central database would be a dramatic improvement, which, as I said, could be done tomorrow. When they implemented that in Spain, there was an 89% increase virtually overnight.

The second point is a mandated choice strategy, which can be done on the federal income tax return. One of the problems we have had for so long is that although most of the Canadian public recognizes the need for and would like to be organ donors, people tend to forget about ticking off that box, for whatever reason, and that includes health care professionals, where there's a relatively low rate, in the order of 65% to 67% of people who are willing to donate their organs or at least tick off the box. But a much greater percentage would like to. If we put this on the income tax return, we would hit more people on an ongoing basis and would also be able to collate that information in a central location.

The third point is the removal of financial disincentives. This is a very doable thing. Right now, hospitals that take it upon themselves to harvest organs do not get that money replaced. That does act as a disincentive, believe it or not. Where there has been a situation where money has gone back to the hospital... Quebec is an example of this; that is, the Province of Quebec has in fact taken a leadership role in doing this, and as a result has managed to improve their organ donor rates by doing that one simple act. So just replace the money to the hospitals engaged in organ procurement and you will see a jump right there.

With respect to the rights of those who consent, I'll say that this is a very important part. It's also somewhat contentious, but if you look at the experience of various studies, if you look at what religious leaders have done in this country, if you look at the Canadian public at large, a significant chunk of the Canadian public—81% in a recent poll—said that the family should not be able to override the wishes of a donor. Unfortunately, that happens these days, when, in the trauma of losing a loved one, understandably, blockages are put up by family members. They do not want one of their loved ones to donate their organs. And yet, if you ask them at a moment outside of that critical situation, 81% of Canadians say that the family should not be able to override that wish.

Legal respect for the consent of an individual to donate organs is, I think, very important in trying to enable more organ donations to take place.

Lastly, my colleagues, I will just draw to your attention the blue book. The department has done an excellent job of putting this together. It's very comprehensive. It has a lot of good points in it, particularly on issues such as education and establishing standards within our country across federal-provincial boundaries. I hope you will take a look at that and marry that up with M-222.

Lastly, I will just say this: If we had a situation in our country where 140 people were dying every year, and if there were a plane crash or a railway catastrophe, there would be a commission, there would be studies, and there would be the implementation of effective solutions to address this problem. That has never happened in this case.

And unfortunately, although this seems to be somewhat of a motherhood issue and Canadians have said for years that we need something done about it, this particular issue tends to go only so far. We do the studies, and the good solutions are there, and then all of a sudden it just falls off the edge of our plate. It winds up in a legislative purgatory, if I may say so.

• 0930

And while 140 Canadians are dying every year, that situation is going to get worse. For their sake, for the sake of the economy, for the sake of our health care system, and particularly for the sake of the family, I hope you will take a look at this issue, take a look at the essence of what the federal-provincial strategy is, look at the motion and bring them together.

Lastly, I'd like to also thank Philip Murphy, who did an outstanding job of helping me put this information together.

I'd be happy to entertain your questions.

The Chairman: Thank you, Mr. Martin.

Mr. Hill.

Mr. Grant Hill (Macleod, Ref.): Thank you.

Keith, there seems to be one inconsistency in your report. That is, Australia has the national database, yet Australia is the lowest of the countries in terms of numbers of donations per million. Is there some other factor going on in Australia?

Mr. Keith Martin: I can't answer that. I don't know. It's a good question. All I've seen is that where national databases have been implemented—and I draw your attention to Spain—it did increase quite dramatically. In fact, if you look at the countries of the United States and all of western Europe, and if you look at most western countries, they all have national databases. We're one of the very few countries that do not. But specifically with respect to Australia, I don't know the answer to that. It's a good question. Maybe the committee would be able to find out if you choose to deliberate it.

Mr. Grant Hill: Second, the suggestion here is that the federal government compensate the hospitals who are doing the removal of the organs. Is there any problem with that in terms of jurisdiction, do you think?

Mr. Keith Martin: The feds could do it in a number of ways. They could allocate it through their CHST and increase the amount of funds relative to that, thereby giving the provinces a larger sum of money to use within their health care budgets, and then the provinces could allocate that money to the hospitals themselves, or in fact it could come as direct funding from the feds.

That would be something for discussion between the feds and the provinces. I see a lot of goodwill and a lot of willingness to cooperate with respect to what I saw in the national-provincial strategy. I hope that would not be seen as a barrier. In fact I hope it would be seen as a gesture of effective goodwill on the part of the federal government to deal with the situation in a very substantive and effective way by giving the moneys directly to the hospitals themselves when they do procure organs.

Mr. Grant Hill: Thank you.

The Chairman: Mr. Myers.

Mr. Lynn Myers (Waterloo—Wellington, Lib.): Thank you, Mr. Chairman.

I have two questions. First of all, in your conclusion, I note that you say 138 Canadians died in 1994. I wonder if you have more up-to-date information, for 1997, perhaps, or 1996.

Mr. Keith Martin: Mr. Myers, I can give you 1998. Between April 1 and June 30, 1998, in a three-month period, 35 people died. If you extrapolate that for the period of a year, you're dealing with 140 people. And 18 of those were adults waiting for kidneys, while four were adults waiting for livers. In fact, if you look at the number of people waiting for organs, about 82% are people who need kidneys; next are people waiting for livers, and then you get down to heart, heart-lung, and pancreas. That's sort of the order of organ transplants.

And I might draw this fact to the attention of the committee: in terms of those savings that I spoke about, they're really for kidneys. It's more difficult to quantitate savings for liver, pancreas, heart, and heart-lung, because there is no option. There is no such thing as dialysis. There's no other option but transplantation for the other ones. There is only an option for kidney. That may change for heart, because we're moving very far along in terms of the development of an artificial heart, particularly here in Ottawa, but that's really not a doable clinical option at this point in time.

Mr. Lynn Myers: Second, when I was speaking to the Kidney Foundation people in the spring, I was struck by the lack of education and awareness and those kinds of issues surrounding people knowing exactly what is happening or should happen in this area. In the countries you looked at—and clearly others have better track records than we do—was there any one program that stood out in terms of awareness for people and in terms of educating people about the importance of doing these kinds of things?

• 0935

Mr. Keith Martin: That's a good question. Spain did a very interesting thing. They developed organ donor coordinators, who actually added a significant educational component to what they were doing. That certainly helped.

The situation here in Canada, I would suggest, is not one of ignorance. Studies clearly show that when you ask people whether they want to be an organ donor and whether they think organ donation is a good thing, the majority have an overwhelmingly positive response. It's more than 80% or 85%.

It runs across religious lines, too. In fact, here in Ottawa, we have leaders of at least four major religions: Jews, Roman Catholics, Muslims, and... I believe there's a fourth, but I don't remember it now. At a press conference, they signed their organ donor cards in an effort to try to show that religion was not a barrier to organ donation.

People need to be jogged. It's sort in the back of their minds, not in the forefront of their minds.

Certainly, in the federal-provincial strategy, they addressed that very clearly. They have some very good suggestions on addressing the issue of education. But I think of lot of people would agree, if you asked them, that they would want to be organ donors.

Mr. Lynn Myers: I have just a quick supplementary, Mr. Chair, if I might.

In the income tax scenario you outlined—that's having a quick check mark or whatever—would you anticipate additional inserts or information to potential people to outline the pros and cons, or would it simply be a form in the income tax package where you would respond yes or no?

Mr. Keith Martin: The way I envisioned this, it would be a form in the income tax package, such as what you would receive now for your driver's licence. In fact, there's a move now to provide that in some provinces on your health care card. It would be stamped on your health care card that you were an organ donor.

The beauty of the income tax form that I see is that it's a work in progress. Say, for example, you weren't sure about this in one year, so you said you didn't know. Then, if you got more information during the course of that year, you could tick off the form to say that you want to be an organ donor in the next year.

This is as opposed to your driver's licence, which is renewed every five years. It tends to be a more static document.

You could, however, in conjunction with your income tax form, have a document on organ donation that would make it very simple to marry those two together every year. I think that would be an excellent and probably very cost-effective way of getting that information out to a lot of people.

Mr. Lynn Myers: Thank you.

The Chairman: Mr. Jackson.

Mr. Ovid Jackson: I don't know if you can answer this, Keith. There's a very interesting case going on out west now with regard to when a person is legally dead when you don't resuscitate them. I imagine, because of hospital urgency, that this is important in terms of getting the organ, whether it's from someone who died in a motorcycle accident or from some brain dysfunction or damage to the brain.

Are you following that case? Do physicians throughout the country have one specification with regard to when a person is legally dead if the brain is dead?

Mr. Keith Martin: There are basic criteria for brain death. It's not a legal thing, it's a medical definition. When somebody comes in who has been in an accident, the establishment of brain death is well documented. It's very complicated and does take time. It involves doing an EEG on the brain to show brain death, among other things. That's essential. You cannot label somebody as being dead or brain dead until those criteria are met.

So there are criteria for brain death neurologically that have to be followed before you can actually say that, and in fact, this has to be documented. So there are tests that have to be done, and documentation that has to take place. It takes time. The person is kept on life support until that can be established.

Mr. Ovid Jackson: Thank you.

[Translation]

The Chairman: Mr. Bigras.

Mr. Bernard Bigras (Rosemont, BQ): Before coming to the meeting, I tried to look at the figures we had available, particularly for 1995 in Quebec.

• 0940

I noted that in 1995, 375 people had benefited from organ donations and 117 people had consented to donate an organ to these 375 patients. I also noted—you probably have more up-to-date figures—that 500 people were still awaiting a transplant.

I also reread a few notes from an old report of Quebec Transplant. The report states that the fundamental problem is that of all the people who die, only a tiny proportion meet the criteria for donation. In other words, despite all the deaths that occur, very few organs can be transplanted to people who need them. I don't want to draw any hasty conclusions, but the solution to this problem would be to increase the supply, if I'm not mistaken.

I quickly read your document. Don't you think it would be important to strongly emphasize an increase in public awareness programs for organ donation in order to increase the supply, since only a very tiny fraction of organs can be harvested at death? I'd like to have your comments on the importance of increasing the supply through various public awareness campaigns, given the situation I just described.

[English]

Mr. Keith Martin: You're correct, Mr. Bigras, that the supply has to be increased, and the essence of the motion is to do that. In fact, the essence of the federal-provincial strategy is in part to do that too. It has to be done in context with certain standards to ensure the organs are being transplanted in a good way, the health care considerations are taking place, and we do not have a situation such as what we faced with the blood crisis, the Red Cross crisis.

But the suggestions within the motion address that and involve a number of tools, as I mentioned before. On one of those, the Province of Quebec was a leader in taking and ensuring moneys were being given to the hospitals that were involved in procurement. As a result of that, their organ donation rates increased.

Now there are various ways in which we can increase that pool of available organs. One, which was mentioned by Mr. Myers, is to increase the education amongst the hospital staff to ensure they are more attuned to doing this, which is a problem. There's an obvious reluctance in a situation of those traumas to actually approach a family in grieving over the loss of their loved one. It's a very difficult thing to do.

There are other factors, such as dealing with the national base and the mandated choice strategy, giving the moneys to the hospitals that procure, and a consent strategy to respect the wishes of those who are deceased. They would all help increase of supply of organs that are available.

The Chairman: Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Thank you, Mr. Chairperson.

I'd like to thank Keith for his work on this issue in bringing the motion before the House and then to committee. He's clearly done a lot of work. It's also apparent from the binder today that under the auspices of Health Canada a considerable amount of study and work has gone into this issue.

My question for Keith is what is your opinion of the document dated September 1996 entitled Organ/Tissue Donation and Distribution in Canada? It suggests a 13-point strategy and a plan of action. Have you an opinion on that direction?

Mr. Keith Martin: Thank you very much, Judy. I read the document very carefully and had an opportunity to look at the essence of it a few months ago. I think there are many good points in there.

My concern is that a lot of time will be spent dotting the i's and crossing the t's. Some of those 13 points will require a little more time to implement, but there are things we can do today that can be implemented today that will save people's lives.

• 1945

I think we need to separate those two groups of suggestions: the ones we can do today and the ones that will have to wait because it's just going to take time to make sure they are workable solutions. An example is the standards. They are very important and will take time to establish, but there's a good working relationship between the feds and the provinces to make this happen.

There was a point in here that said there was no desire to have a single national organization because it would introduce another level of hierarchy. I would submit we could have one central location to deal with on a lot of these issues, and then the provincial jurisdictions and organizations would actually be folded up into this one central database.

I don't think we need all these provincial organizations doing what they are doing. It just adds a lot of overlap and a lot more fingers in the pie than are necessary. In organ donation, as Mr. Jackson mentioned, time is of the essence, so in order to make sure the organs that are available are going to be transplanted in the time required, you have to save time. A national strategy, a national database, a national central location where you can marry up the donors to potential recipients is essential.

If the committee chooses to take a look at this issue, I hope they will look at it with a view to streamlining a lot of these things. I know members from Health Canada will have a lot to say on this. I'll be interested to hear what they have to say, but I think a lot can be done to centralize this into one location and get on with it now, particularly the central database. I think that is really essential. Please look at the experience of other countries and what they have done.

The Chairman: Do you have another one?

Ms. Judy Wasylycia-Leis: I have lots more. How much more time do I have?

The Chairman: Five seconds.

Ms. Judy Wasylycia-Leis: I'll put myself on the list again.

The Chairman: Judy, you're too much. Go ahead, ask another question.

Ms. Judy Wasylycia-Leis: My question is a follow-up to Keith's response. Using his own words, time is of the essence. I'm wondering how much time we need to actually study this issue further. Do we have the basis, through the work you've done and the work that's been done at the federal-provincial level, to start looking at a plan of action and focus on implementation, as opposed to engaging in a lengthy process in this committee that, as recommended by the minister, could take us to the end of next April? Would we not have the ability now to...? I'm wondering how many meetings we need, how many witnesses we need to hear from in order to advance this issue quickly and put a recommendation before the minister in terms of a specific plan of action.

Mr. Keith Martin: This issue has been studied so many times. If I may paraphrase Rosemarie Kuptana, who came to this health care committee once dealing with a different issue, she said, on her dealings with aboriginal health, that we don't need more studies; we need action. If I can apply that to this, I think we need action, not more studies.

There's been so much good work done by both the department and other individuals that the most effective thing the committee could do is suggest a plan of action. More studies are not required, but the drive to get this thing implemented into action is clearly needed. If the committee were to do that we would break a glass ceiling that has been in existence for so many years. So many Canadians out there are begging for this issue to be resolved. You sort of get up to the ceiling, maybe tap on it a bit and then go down again. We don't smash it, get through it and get it done.

The Chairman: Okay?

Ms. Judy Wasylycia-Leis: Yes.

The Chairman: Ms. Caplan.

Ms. Elinor Caplan (Thornhill, Lib.): As I said at the last meeting, this is something I personally feel is a very important issue for Canadians, but it's also a terrific opportunity for this committee to actually act as a catalyst so we see some action.

One of the things I found very disturbing as I looked into this issue is this is something that has been talked about in Canada, and different initiatives in different provinces have been tried.

• 0950

I point everyone to page 1 of the 1996 document, which is the one I'm going to be referring to, which says that Organ Sharing Canada was disbanded in 1995. Then it says on page 5 that Canada is an anomaly in not having a formalized national mandate or system. Then on page 9—and this is the part that I think is worthy of reading into the record—it says, on the lack of public voice and accountability:

The absence of accountability mechanisms and a strong public voice in the determination of a fair allocation mechanism was raised by a number of individuals consulted. The preferences of Canadians regarding the desirability of a national versus provincial/regional distribution system are unknown. Several survey respondents indicated they suspected that the general public incorrectly assumes that a national distribution system is in place whereby organs are allocated objectively on the basis of individual “need”.

As you go through this document and come to the principles, my reaction was to ask why this hasn't succeeded. Why haven't we moved forward on this? I then looked and saw the list of some of the different things that are happening in the provinces across the country, and I'm familiar with some of the problems. I think this committee could play a very important role in exposing what the problems have been, what the barriers are to moving this forward, by looking at what each province is doing and asking them what the problem has been. What's the problem here? Whose role and responsibility is this? How can we get and encourage working together in the national interest?

That's where this federal government can play an appropriate role in raising the public consciousness, improving public education, not only with citizens across this country but with organizations that have an interest in doing this and provincial leadership, and be a facilitator to the kind of action we all want to see happen.

I look at the fact there is a committee in place and am concerned that this has been around for a long time. I'm aware of initiatives that took place in the province of Ontario over ten years ago, for example, that were not successful in achieving the objectives that were originally intended.

So I think this committee can play an extremely important role by asking what works in other countries and why it is working. Is there a need for legislation? Maybe there is, maybe there isn't. Are there some areas where we can, by raising public consciousness and letting people know what doesn't exist, encourage the kind of action I think everyone around this table would like to see?

By the way, I also consider this to be a non-partisan issue. If you look across the country, governments of different stripes are all coping and dealing with this issue. I would hope the work of this committee would focus on finding out what the barriers are and what kind of action plan would lead to something that will save the lives of Canadians in a way that meets with our Canadian values and defines the appropriate role for the federal government.

Mr. Keith Martin: Mrs. Caplan, as you correctly mentioned there have been a lot of studies on this. I remember in medical school in the 1980s this was a problem and you had a lot of people pointing fingers at each other saying “Well what are you going to do?” It's like waiting for Godot. We're all wishing something will happen but nothing is happening.

If the committee were to translate these ideas into action, as Judy mentioned, they would accomplish something that no one has accomplished yet to date. It would be an enormous benefit to Canadians.

• 0955

There were 3,340 people with end-stage adrenal disease in the country as of the end of 1996, and there had been an increase of 28% over the 15 years before that. Those numbers are increasing, increasing, increasing, increasing, so we really have to do something about that. A tragedy would be that after all this good work has been done across the country, it again just falls back into this—

Ms. Elinor Caplan: Could I ask one more question?

The Chairman: You might want to ask that when we go back to the others.

Ms. Elinor Caplan: Okay.

The Chairman: Keith is getting close to being an advocate for another position, and maybe he can do that as well when he sits over on this side after his presentation. Do you mind?

We'll now turn to Lynn Myers for one last question.

Mr. Lynn Myers: It's not so much a question as a comment. Perhaps I should take it later, then.

The Chairman: I would prefer that, if you don't mind. If it's along the same vein, maybe we can do that when we have the departmental officials before us. I notice that we're now getting into this document, so some of our observations or questions might be better directed there. There's a little bit of an interruption, but it'll be continuous there. You can have first crack at the departmental officials.

Keith, I gather you're coming over here, so you can join us in asking questions. We'll take just a moment or two as Keith is moving himself over to this side.

Mr. Keith Martin: Thank you for your consideration.

The Chairman: Thank you for making the presentation, Keith.

From Health Canada we have Mr. André LaPrairie, who is the acting project manager, Blood, Tissue, Organ and Xenotransplantation (BTOX); and Dennis Brodie, acting manager, policy division, Bureau of Policy and Coordination. Gentlemen, I welcome you both. I think you've already been introduced to the members around the table.

Our normal procedure is to give you about five minutes if you want to make a statement. You don't have to. You may wish just to take questions. You've been here for the last hour, so you see how this thing functions, and members may go right at it.

André, what do you want to do?

Mr. André LaPrairie (Acting Project Manager, Blood, Tissue, Organ and Xenotransplantation (BTOX), Health Canada): I'll take just five minutes to say what's in the document.

The Chairman: Sure, go ahead.

Mr. André LaPrairie: First of all, I'd like to say thank you for all the kind comments Health Canada and its various branches received about this binder. We don't hear that a lot, so it was certainly nice.

The purpose of us being here this morning is to provide you with some information on Health Canada's activities addressing transplantation, both our role in this national coordinating committee and in developing standards for the safety of organs and tissues and a standards-based risk management framework.

As Dr. Martin pointed out, medical therapies involving the transplantation of organs and tissues have not only significantly reduced morbidity and mortality associated with many tissue and organ end-stage failures but also, in combination with the health system, which is quite exemplary, it has created a shortage of organs and tissues in Canada. This shortage has engendered heightened interest in strategies both to improve organ and tissue donation rates and to develop more equitable and effective distribution of organ tissues in Canada and even the interest in using animal organs and tissues for transplantation to address the shortcoming.

This rapid pace of scientific discovery has also accelerated the role of the regulator in biotechnology, such as transplantation, and relevant issues, including HIV, mad cow disease, and other new technologies, have further increased the public demand for more regulatory involvement in this area.

Clearly, the shortage of organs and tissues is a critical and ongoing issue, as we've heard this morning, and Canada's organ donation rates remain constant at around twelve to fourteen per million population. So while the donation rates have maintained the same levels for many years, the demands have gone up, the opportunities for transplants have improved, and even the availability of donors has changed, with other therapies, including even seat belt legislation, reducing the availability of donors that are brain dead.

• 1000

In September 1996 the Advisory Committee on Health Services issued a document, which is number 3 in your package, recommending a federal-provincial-territorial strategy for addressing the key policy objectives related to donation rates. This included a survey of many health professionals and people involved in transplantation, which looked at some of the shortfalls in the Canadian system. Then in December 1996 federal, provincial, and territorial deputy ministers of health reconfirmed their commitment to the strategy and developed the implementation plan, which is item 2 in the binder, along with an estimated budget of $350,000 over three years to support specific implementation activities, as well as $150,000 over three years for support to this national coordinating committee. The committee members are described in item 1 of the binder.

The national coordinating committee actually had a preliminary meeting in May of this year to clarify issues, to establish the mandate for the committee, and also to recommend that the non-government co-chair be chosen. That was Dr. Phil Belitsky, who is a transplant physician in Halifax and who previously was the medical director of their organ program there.

Before the committee could start, it was important, especially for the non-governmental participants, to deal with the verification of indemnity for the co-chair, Dr. Belitsky—post-Krever, this has become an important issue—and as well, to make sure that physicians were compensated for their extensive efforts. Up until now, the work, whether it was with the organ share in Canada project or on many of the committees, such as the Kidney Foundation committee, has all been on a pro bono basis. Every time they miss a day to attend a meeting, they still have to pay for their office staff, and they have to re-arrange their clinics.

So these have been important activities that we see as not limited just to transplantation but that will come up again and again. That was an important issue to be resolved, and it has been.

Now, Dr. Belitsky and his co-chair, Elizabeth Barker, have written a letter to the committee concerning moving on to the next steps. I think that has been circulated here this morning. They're certainly showing that they have this renewed effort, a two-month period of time to establish some contracts with the various stakeholders in transplantation to submit proposals for the elements described in section 2.

Actually, the letter notes that—and also as Dr. Martin pointed out—there are 13 strategy elements. That's a lot to deal with in a short period of time. They saw that element two, donor identification and hospital procurement standards; element three, organ-specific sharing algorithms; element four, the improved performance of hospitals in identifying donors; and element eight, the national tracking system, would be the priorities for this committee. Those are the four they're looking at right away.

Related to this activity, Health Canada sponsored a national consensus conference in 1995 to look at the safety of organs and tissues in transplantation. Following this meeting a working group of experts was established that included many Order of Canada members, physicians, ethicists, etc., who were to work on a Canadian general standard for the safety of organs and tissues, along with specific subsets for solid organs, ocular tissues, bone marrow transplants, reproductive tissues, and now xenotransplants. The document under item 4 of your binder is a proposed descriptive risk management framework, which will use these standards to improve transplantation in Canada. This was strategy element number one for the national coordinating committee, recognizing that all programs had to be screening their donors in the same way, keeping appropriate records etc., if there were to be sharing and improved donation rates across the country.

I didn't want to take more than five minutes.

Certainly Health Canada is seen as breaking new ground in the development of national standards for the safety of organs and tissues. This initiative is viewed nationally and internationally as an effective regulatory approach to transplants, and the use of standards can be expanded to cover more than just the safety of organs and tissues. It can look at issues such as the identification of donors, the practice in hospitals, many things that normally you can't write into the Food and Drugs Act that don't fit nicely into that regulatory tool, an example of which would be informed consent. And again, the comprehensive policy framework works well with this national coordinating committee and the strategy to improve organ and tissue donation in Canada.

• 1005

That was my five-minute spiel.

The Chairman: Okay, good. Thank you very much.

Mr. Brodie, did Mr. LaPrairie speak for you, or did you want to add something?

Mr. Dennis Brodie (Acting Manager, Policy Division, Bureau of Policy and Coordination, Department of Health): He brought me along to answer the hard questions.

The Chairman: Hey, I'm always happy to see a Butch Cassidy and the Sundance Kid combo here.

My first question here, if you don't mind, will pick up from where we were. It's in the same vein.

Madam Caplan, did you want to finish off that question, or is that okay?

Ms. Elinor Caplan: The question that I'd like to ask is whether or not there been an analysis of what's gone wrong, what's not working in some of the organizations across Canada. Conversely, has there been an examination of, for example, why Manitoba's rates are almost double many of the other provinces in Canada? Has anyone looked at what's happening out there?

Mr. André LaPrairie: I think some of that is in this document dated September 1996, on organ and tissue donation and distribution. When they did this, they did actually survey hospitals and people in the field, looking for their opinions as to what has or hasn't gone well. It may be a snapshot, although it's not a very detailed one. I think they interviewed 26 different organizations to see where things could be improved, so that may be the best indicator of some of the issues.

Now, you note that some provinces do all of a sudden have an anomaly of a rate that's much higher than in other years. Even the provinces go back to ask what they did well and what they can continue to do. An example is Quebec introducing compensation to donor hospitals, providing them with some funds to cover the ICU costs, etc. They get a small blip where they see an increase, and the question is whether it was the financial incentive or just the attention that was paid that caused that increase. I think it's never clear.

Ms. Elinor Caplan: As I say, we haven't had an opportunity to read this from cover to cover. There's a recommendation in here, though, that says the information of consent for donors should be on the health cards, for example. It doesn't say what exists today in each of the provinces in regard to consent. For example, I'm aware that in my province we used to do it on the driver's licence. I don't think we do it on the driver's licence any more, so I'm curious as to what is happening in each of the provinces. What was the result of those changes? I'm wondering if that information has been done.

Mr. André LaPrairie: The reason for putting it on the driver's licences in the first place was that the focus was on donors in accidents. Clearly, the shift has now gone away from that. Most of the solid organ donors, for instance, are not necessarily in car accidents. As you find out, many people aren't carrying their licence at the time they're injured, so the question then concerns the value of it. What's the value of signing any card unless you tell your family about it? They're ultimately the ones who are being approached to ask for consent. I think different provinces have now chosen other means, including health cards, for that reason.

The issue always comes up about how you have access to that information. No initiative, whether it's health cards, national registries or provincial registries, can exist without the infrastructure behind it to provide some education to people so that they understand how the system works. They have to have confidence in using it, and have to be sure the information is still kept private and only used at appropriate times. Patients don't want to fear that they'll show up at a hospital and that there'll be this red flag saying they're an organ donor before they're even treated. So there are many sides to it.

Ms. Elinor Caplan: Do I have time for another question? I'm happy to pass and then come back if anybody else has anything.

The Chairman: Go ahead.

• 1010

Ms. Elinor Caplan: I guess that's part of what I see as the possible work of this committee: to actually ask some of those questions. I notice that you refer to some of the ethical questions. The recommendation here is that there would be an ethicist on the internal committee. I'm wondering whether there are experts in this area that the committee could call on to ask for advice as to what the rules would be.

In other words, as I understand it, there would be two types of databases. One is the database of donors. There is also a database for when an organ becomes available, one of potential recipients. There is a need for ensuring there are the algorithms—I think that's the word—or the standards to make sure there's an appropriate allocation on the basis of who's going to get the available organ. I think there are a lot of issues relating to this. Are those the only two parts of the system, or is there something else?

Mr. André LaPrairie: If there was an easy solution, I suppose we would have done it by now. Many times, we hear the example of what Spain did to change its donation rates. I don't think it's a matter of going to Spain and asking the Spanish which element they chose that turned their donor rates around. It was the process that got them there, their final solution. They had to study their health system, their own population's perception of donation rates, and the professional perception of participating in transplantation, and they developed a comprehensive approach that worked well for Spain. That's what we're looking to do here in Canada.

The issue of allocating organs nationally is not as simple as it may sound at first. Many organs have a very short shelf life once they're removed. For a heart, it may be a maximum of six hours, so to allocate organs on a national basis is not feasible because of transport times. Of course the longer the cold ischemic time of the organ, the less likely it will survive a longer half-life in the patient.

These aren't easy things to answer. If there is a good role or a parallel role to play as this national committee works towards proposing some solutions, it's to give people participating in these activities the hope that they will be implemented. That's been the frustration for many of the surgeons and the health care professionals. They can do the studies, they can work towards solutions, be they donor registries, improving allocation rates, or educating in hospitals, but unless they're implemented, unless somebody will support that work, I think they also lose faith.

Ms. Elinor Caplan: And there have been huge barriers to implementation in Canada, obviously, if we're an anomaly in the western world.

Mr. André LaPrairie: We're an anomaly because we deliver on a provincial basis. Every province has its own system, so we're an anomaly in maybe two ways. We have a national health system; every Canadian has health coverage. We all have equal access to treatment, so that's probably a good anomaly. But that same positive is the negative, which means it's harder to share organs between provinces, and it's harder to develop national strategies because every province has its own way of doing things.

The Chairman: Is there a European Union initiative to centralize some of the registry for both donors and recipients? Are you aware of any such thing?

Mr. André LaPrairie: I haven't talked to the European Union recently. It's always confusing to know whether it's the Council of Europe you should see, or the European Union or some subcategory. I think many of the countries in Europe have a coordinated donor allocation system, and a parallel one for tissues, actually. That is reasonable to look at, and it should actually be in this document—I think they might have referenced some of that work—but I don't know whether the European Union this year has any further desires.

The Chairman: Thank you. Mr. Myers.

Mr. Lynn Myers: Again, Mr. Chair, I'm going to ask you if it's appropriate to ask questions or make comments relative to where we're going. Perhaps my discussion would be better...

The Chairman: I would prefer that you kept that until the end.

Mr. Lynn Myers: Okay, thank you.

The Chairman: If it's on the same line, we'll come back to it later.

Mr. Jackson.

• 1015

Mr. Ovid Jackson: In keeping with what Madam Caplan said, one of my experiences—and everybody is looking for results—has to do with the databases. It seems to me that every province or organization has a kazillion different ones. I want to know if you've come up with an appropriate accountability regime.

You know, we talk about a lot of things, like the EI, for instance. If a person crosses the border, you should be able to check it out and all that. One of the biggest barriers is that these computers do not talk to each other. That's a very difficult thing in any program we have as a government. How do you get the groups not to use a kazillion different programs and a kazillion different techniques?

Do you have any kind of models or regimes the other people are using that might be appropriate to deliver this service?

Mr. André LaPrairie: Well, that's a good observation. For instance, in some provinces the listing of patients is essentially in a shoebox. On the other hand, other provinces will have very sophisticated computer systems that track their patients and their health status. They use that for their allocation of organs and tissues.

Maybe each one has its merits. I'm not saying the shoebox one hasn't been working well for the program it's in.

One area that hasn't been addressed very well is the listing of patients on a national list, except for liver transplants where there's been some cooperative effort among programs. They at least generated a printed list that went out by fax every week. But even that's not an ideal situation.

It also doesn't help address the fact that all hospitals, all cities, don't have transplant programs for pediatric patients, for instance. And how do you identify a pediatric donor in a centre that doesn't do transplants?

They need to know where those organs would go, if there are any patients in need of them in another city or province. So that's certainly been an area that has been lacking...for a long time.

Mr. Ovid Jackson: Is that something the committee should do in order to make sure...? Everybody is asking about action, and to me that's one of the biggest barriers to making sure...

Things have to be done very quickly. In some cases you may have an organ in one province that another province needs. They don't need it in that province, and so timeliness is very important.

Mr. André LaPrairie: That kind of work could assist this national coordinating committee as they deliberate on information systems and what Canadians want, as opposed to what hospitals are looking to establish. So I think that would be helpful.

The Chairman: Keith.

Mr. Keith Martin: Thank you very much, Mr. LaPrairie and Mr. Brodie, for the work your department has done on this; it's outstanding.

I have a couple of questions. The document stated very emphatically that there should not be any national database or coordinating group. I wanted to know why you felt that would not be a good idea, particularly in view of the comments you just made to Mr. Jackson.

You articulated very clearly the problems we have on provincial coordination, and the differences between provinces, their ability to ascertain the recipients, and marrying the recipients with the donors.

So do you not think that a national database and a national location where you have both the recipients and the donors would make eminent sense? Through the mandate choice strategy I had suggested in my motion you would also be able to have the option on your income tax forms, and all that information would come to one central location. It could be dealt with there. So if, for example, somebody had passed away in Vancouver and the best match was in Calgary, all that information could be known at that one central database, as opposed to the situation we have now.

As a second question, which of the 13 suggestions you recommend here in your document could be implemented today without any difficulty?

Mr. André LaPrairie: For your first question, I think the main reason they were not looking for another level dealing with transplantation in Canada was that most people look to the experience in the U.S.A. That is where they established United Network Organ Sharing as an additional level of allocating organs and tissues across their country. They found it to be a very burdensome agency that didn't deliver on the promises it initially made.

• 1020

Most people in the transplant field feel that they already have the resources within the provinces, but what's needed is to somehow link them. So why create another registry? There are already registries in each province. Why not get them to agree to standards for how they put in that information, and to agree to make it available to each province?

Rather than create another level, make a redundancy, the desire is to use what's there, but use it better.

Mr. Keith Martin: My suggestion really is to get rid of the provincial ones and just have one national one.

Mr. André LaPrairie: Well, I think there may be some problems, obviously, at least with the provincial programs that are already doing that work, saying, well, maybe they wouldn't be comfortable with it. It would be hard to do, I guess. Maybe that's—

The Chairman: You don't have to answer the question—

Mr. André LaPrairie: Oh, oh.

The Chairman: —any further.

Mr. André LaPrairie: Okay, thank you. And actually that—

The Chairman: I wanted to just see how long it would take you.

Ms. Elinor Caplan: You could achieve Mr. Martin's objectives by getting agreement to link what's happening amongst the provinces, and by the establishment of national standards and outcome accountability.

Mr. André LaPrairie: I'll stretch a little further and say, perhaps they'd be more willing to cooperate if they knew the other solution was to eliminate them and have a national system, I don't know.

Maybe the reason they didn't include the proposal to use your tax return form in this document is that I guess they normally don't think of a tax return as a link to donation rates. Maybe life insurance would be a better choice. I don't know.

The second question was which of the implementation strategies could be done tomorrow?

Mr. Keith Martin: Today. Of the 13 recommendations you have in the book here, which ones could be implemented today, and which ones require further study?

Mr. André LaPrairie: I don't know whether any of them could be implemented on the spot, or whether by themselves they will achieve the result you want. Most people in the field seem to believe that there hasn't been enough attention paid to professional education and support.

As you pointed out, Canadians are more than willing to donate organs. There are many surveys showing that we get almost 100% support. We have religious leaders and everyone else saying, yes, organ donation is a good thing.

So why is our batting average so low? Well, it's because when you do the surveys people aren't facing the death of their next of kin, and who is approaching them at that time? Who has the support, education and experience to go up to a family and say “We're sorry that someone in your family has died. Are you willing to consider donations?” So that has always been an area that required extra support, and it has been lacking until now.

The Chairman: Thank you.

Monsieur Bigras.

[Translation]

Mr. Bernard Bigras: I would like to make a comment similar to those of Mr. Martin and Mr. Jackson. I was rereading the federal- provincial document. Essentially, the 13 strategic orientations, if summarized, can be divided into three areas: standardization, organization and management, and the whole issue of education. Organization and management includes collection, organ distribution, public education, awareness and information.

You more or less broached the question that I wanted to ask. In terms of efficiency, would more provincially oriented management and organization increase our effectiveness in so far as we could succeed in increasing the supply, as I was saying earlier? I'm no expert on this issue and I didn't examine the matter the way Keith did, but if we have trouble meeting the demand right now and if there are waiting lists, it's because we are not able to increase the supply. If we could have a more effective strategy, could we then satisfy to the demand?

From a technological standpoint, is there a problem in meeting the demand? As Mr. Jackson said earlier, the problem of time is basic to these issues we're examining today. Allow me to ask this question without really being familiar with the whole issue: Is there a problem of distance? For instance, if there was an organ available in British Columbia and a demand in Prince Edward Island, would today's technology enable us to respond to that demand? I ask this question without knowing the answer. I ask it very humbly.

• 1025

[English]

The Chairman: I guess, Dennis, this is maybe one of those difficult questions André brought you along for.

Some hon. members: Oh, oh!

Mr. Dennis Brodie: That's an easy question.

Some hon. members: Oh, oh!

The Chairman: You're out of luck, André, it's yours again.

Mr. André LaPrairie: I know, I know.

I think I heard two questions. The first one was about the strategies of provinces, and actually it's a very good point. Maybe the reason is that a national body would have a hard time influencing the practice in a hospital.

Most of these practices are occurring in hospitals: the identification of donors; the procurement of organs and tissues; even the allocation and transplant. They are hospital-based activities, and in many ways, a national body would have very little direct powers to influence that hospital practice.

The second question was one of distance. This is also an important consideration. For some solid organ transplants, where the time between procurement and transplantation is very short, distance is important. So for lung transplants and heart transplants, the distance you can cover creates a logistical problem.

For other transplants, such as kidneys, where cold ischemic times can go beyond 24 hours—where livers, I think, are 14 hours—it's still an issue, but not as critical.

For tissue transplants, such as human heart valves for congenital heart problems, for bone graphs, for reconstructing hip-replacement surgeries, these are tissues that are preserved indefinitely in some cases, so time is not a factor. Bone marrow transplants are another example.

But for those tissues, not every province actually has a bone bank or a heart valve program. So the need to coordinate among areas where there's a demand and where there's supply is critical. Every organ and tissue has its own unique set of logistics that has to be worked out.

The Chairman: Madam Minna.

Ms. Maria Minna (Beaches—East York, Lib.): Thank you.

In what little I've read of the report so far, obviously there are the strategies you talk about. Somewhere I think I also read the fact that there have been meetings of deputy ministers. I presume these are federal-provincial, across the country.

What kinds of discussions or negotiations are going on in terms of establishing potential national standards? This would be with a national-provincial body being established, which could connect—certainly connect electronically, or connect what's available across the country—as well as find systems to assist, to create bone banks or what have you.

As you said, this would be in provinces where they do not exist. Also, this would be to somehow also assist in any way with respect to protocol in hospitals, although that's a provincial issue. Still, whatever assistance can be given to establish an infrastructure in place so that there's communication... Is that kind of discussion taking place now with provinces as the deputies meet and try to look at establishing some sort of infrastructure and standards that would allow for it?

So when there is communication, and people say that's a good idea, you have a system in place that can actually take advantage of it, because otherwise it falls through a gap. The next thing you know, five years have gone by, and we're back to square one. Is that kind of discussion going on now?

Mr. André LaPrairie: I think the provinces are waiting for this national coordinating committee to make recommendations that look at many of the things you're mentioning. So I don't—

Ms. Maria Minna: I guess I thought that from what I've read on this so far, the information that's here, it's more a matter of... I thought the deputies were having the discussion already. At least the knowledge seems to be here. It's more a matter of how you get past what we know is the problem to establish something. I just wondered whether there was any discussion going on beyond...

Mr. André LaPrairie: I guess they've had the discussions. The purpose of this committee is not to do more surveys, but it's to actually ask, how would you implement what you desire?

These 13 elements are desirables—

Ms. Maria Minna: How do you put them into practice?

Mr. André LaPrairie: —and as we've seen, there are logistical things that don't make it very simple to do. So what are the solutions to get you to those points?

The Chairman: Thank you. Madam Wasylycia-Leis.

• 1030

Ms. Judy Wasylycia-Leis: Thank you, Mr. Chair.

I'd like to ask a few questions based on the proposed risk management framework that's in the binder before us. I think this has a very significant impact on the future direction of any coordinated federal-provincial strategy around availability of organs and tissues, because in fact if we deal with that end of the problem and try to find a way to ensure that there is a higher donor level in this country but we don't take the necessary steps around safety we could be back to square one.

This paper recommends in fact a risk management strategy, or a standards-based regulatory model, and clearly rejects a highly regulated model. Taking the words directly from the document, it says:

A highly regulated model was also rejected by TPP. This model included the licensing and inspection of all transplant programs by the TPP.

It would seem to me that in the area of tissues and organs, more than any other area, we would want to have the highest possible safety standards. This paper rejects that approach and recommends a risk management approach, which implies a paper process and implies standards being set and then adhered to through paper verification, as opposed to a proactive licensing, regulatory and inspection approach. I'm wondering why this is being recommended in such a vital area as tissues and organs.

Your paper mentions Justice Krever and suggests that Krever in fact clearly said the challenge when it comes to the blood supply is to make that blood supply as safe as possible. I think he was suggesting a highly regulatory approach not a risk management approach. And I think he would feel the same way about tissues and organs. Why would this even be on the table for discussion?

Mr. Dennis Brodie: We agree that in terms of the safety standards they should be as high as we can make them. What you're referring to is how do you ensure that those standards are being followed? We can send teams of federal inspectors out across the country and inspect every organ transplant program to ensure that the standards are being followed, or we can rely on systems already in place—accreditation programs are in place—without imposing a whole lot of cost and infrastructure on the system.

I think the important part is the safety standards. That's the critical element, and how you ensure conformity to those standards is the area you're wondering about. As I said, there are various ways of doing that. Our view is that we're not convinced it's effective to have a team of inspectors going across the country when a lot of that work is already being done. We see our role as ensuring that there are proper standards in place.

The Chairman: Ms. Judy Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: But aren't we dealing with an issue similar to some of the controversy around the blood supply, where in fact it's been acknowledged that you cannot guarantee a safe blood supply without some mechanism for, if not regular inspection, certainly spot checks in terms of these organizations? In fact, without that you run a risk, especially given the fact we're talking about products that are now seen as a lucrative area in some cases. The question of people donating blood for money is a very real part of our lives today, and the question of giving organs or tissue for money is a very real possibility. It may in fact be with us today. So isn't it in that context important for government to ensure the safest possible product?

• 1035

I acknowledge that we are talking about risk. Everyone knows that when you have an organ transplant there is always an element of risk. But I don't think the Canadian public thinks that risk enters into the area of the actual quality of the donor, where it came from, and whether or not it is safe beyond a reasonable doubt. So I think that's the question I'm raising. How can we, in an area like this, start to even look at a more passive risk management approach in such a life-threatening situation?

Mr. Dennis Brodie: I don't think you can say it's passive. We would retain the authority to do whatever is necessary to shut down a transplant program if that's required, if the standards aren't being followed. What we're suggesting is that the way you go about ensuring the various transplant programs conform to the standards can be done by organizations that are already there without the federal government hiring a bunch of extra people to do it. Our view is that this is not an effective way of ensuring conformity to the standards.

The Chairman: Last question, Judy, a very short one.

Ms. Judy Wasylycia-Leis: We had a similar discussion over the past year around natural health products, and when we raised questions about the quality of the product, such as a natural herb coming from China and whether or not that was a genuine, authentic product, it was suggested to us that by having inspectors in those plants in China we were able to ensure the quality and then didn't have to worry at our end. So I'm wondering why we would have anything less than that when it comes to blood and organs and tissues. Would we not want to ensure a system that is as regulated as possible, where there's active inspection of the facilities and a very meaningful licensing scheme so that there is the least amount of risk possible involved when someone goes through a tissue or an organ transplant?

Mr. Dennis Brodie: I don't think the idea was to have an inspector in China from Health Canada inspecting the quality of those products. You're basing your reliance on conformity to a certain standard that's the standard for Canada on another party—i.e., the inspector in China, if that's the case. So this is an example of using resources already in place to ensure that the standards are being followed, and it's not dissimilar to what we're suggesting here.

The Chairman: Madam Caplan, do you want to go another round on this?

Ms. Elinor Caplan: Yes, I would like to make some comments.

The whole issue of accountability to Canadians is something the government feels very strongly about, and in order to do that first you have to have the standards in place against which you measure results and outcomes. So I think the work that's been done here is a very important first step in recognizing that while transplantations usually take place in teaching hospitals—I don't think there's a situation across the country in any province where they're doing transplants in community hospitals, not that I know of anyway, and I'd be interested in it if they were—and each hospital establishes their own standards, one of the things we've learned is that if you share information, establish national standards, monitor those outcomes, you raise the quality, whether you're talking about transplantation or any other kind of surgical procedure.

We just saw this weekend a very interesting article on the result of a report card on what's happening in B.C. cancer care compared to Ontario cancer care. It raised for me a lot of very important questions that I think need to be answered. I hope we will use the accountability, the report card the government is so committed to, to in fact make Canadians aware of the need for monitoring outcomes and results. And I don't see anything in the proposal here that is contrary to this view. Once you set the national standard, then you can monitor this.

• 1040

Then the question becomes, how do you do the monitoring? We know there are a number of organizations, whether these are accreditation groups that go in or provincial ministries that are interested in that. The important factor from my view is the sharing of that information on the national scene so that all Canadians can be aware of the results.

We pay lip service. We also pay a lot of dollars. So anything we're going to recommend would fit, I hope, within the deep desire of the federal government at this time to ensure that we have the appropriate accountability mechanisms in place across this country that will give all Canadians confidence and would also identify problem areas.

I could probably take all of the committee's time this morning asking some questions that flow from these reports, such as why is this? I think that's part of the work this committee could and should be doing.

So whether it's risk management or a national standard, we can have that debate. It has to do with the role of the federal government. My own view is that the risk assessment approach is appropriate only if you have the accountability mechanisms.

The Chairman: Madam Caplan, could you come up for air for a second?

Ms. Elinor Caplan: I'm sorry. It's something I feel strongly about.

The Chairman: It's clear that you do. But those aren't questions directed at our witnesses. They fall more into the area of some of the discussion that I wanted to reserve for later. Mr. Myers has been waiting to intervene in this.

Are there are no other questions for our witnesses?

I thank both André LaPrairie and Dennis Brodie for taking their time and going through their knowledge of the report with us. Thank you very much, gentlemen.

We'll just take a moment. We'll just catch our breath. Then we'll continue with the consideration of what I indicated we would do at the very beginning. If you think you want to get a drink, go ahead, but do it within the next minute.

• 1042

• 1046

The Chairman: Ladies and gentlemen, I asked the researcher to hand out the letter to me from the minister. I don't have it in French. I hope the members around the table who know that we should have it in French will be content to receive the French copy later on. Otherwise, we wouldn't have anything to deal with. We would just have to go on the basis of my—

[Translation]

Mr. Bernard Bigras: I understand, Mr. Chairman, but in future, I would hope that if it's possible, before you distribute a document in English, you wait to have the document in French. I think that is the rule that has been established in all committees.

In this instance, I will accept it, but next time, I would like to have the documents in French. I'm sure Ms. Picard has raised this matter before. However, I will not prevent the letter from being distributed today.

[English]

The Chairman: Thank you. Your point's received, and it will be acted on. Thanks for taking it into consideration as it was given.

We can proceed on this on the basis of what I suggested. As the minister is asking us to consider this, I thought we might want to consider the request formally here in view of the fact that in the last session this area was one of the ones the committee suggested ought to be part of the work plan for the committee itself. While we didn't set priorities in the last meeting and we didn't make decisions, there were four basic items that came out. There were actually five if you want to divide one of the four up.

This is one of them. It does not need to monopolize the committee's time. The timeline the minister was looking at for a report—I give you this as context for whatever consideration the committee wants to make—was to have it by April 30.

I had a quick consultation with the clerk and the researchers. We would have to complete our work, given the parliamentary timetable, by no later than the end of March in order to prepare a report, go through the draft, and then present it to the House. So we're looking at, if the current calendar holds, a couple of weeks in February, and then three to four weeks in March for our study. That's assuming it occupies our time exclusively.

Keep in mind that we will get other material coming before the committee that we will address. Then we can either add time on—we don't have to stick to a Tuesday and Thursday schedule—or we can establish a subcommittee to handle things.

What I'm trying to get at is that we can do whatever we want if we want to be flexible on this. But if the committee should decide in the next few minutes that this is the area it would like to give its attention to, then keeping those logistical considerations in mind may help you come to a decision.

What we need from the very beginning, in order to get this discussion under way formally, is a motion for our committee to undertake the study.

Do I have such a motion? Mr. Myers.

Mr. Lynn Myers: I would so move, Mr. Chair.

• 1050

The Chairman: I obviously have a seconder. Yes?

I don't need one? Okay. My wrists are slapped again.

Now, I have a speaker to that. Mr. Myers, I gave you an indication that I would let you speak first because you have pressing stuff.

Mr. Lynn Myers: Thank you, Mr. Chairman. I want to say at the outset that I think the more you hear about this very important issue, the more it becomes apparent that it's important for this committee to do the kind of work that's being suggested.

I was struck by two of Mr. LaPrairie's points. The first was the need for hope. I think he made that comment about the need for hope not only for people working in this area, but obviously for people who would be beneficiaries and recipients. It seems to me that if as a committee we can somehow move the agenda on this, we should be doing so and be proud to be part of that process.

The second point he made was in reference to Spain. He said we may discuss Spain, but they have different values and ways of approaching it. I hope I'm not extrapolating too much on what he was saying. I think his point was that we also have a political, ethical, and social culture here in Canada that should be looked at in a very detailed way that would make sense for us as a committee and for all Canadians.

To that end, I think the Minister of Health is suggesting—this is with respect to taking a look at what exists now, as I understand it—that there should be consulting with stakeholders to see where we should go. We should take a look at other countries in terms of what they have done. Finally, we should look at what the role of the federal government should be in all of this, since it's very important. At least in my view, I think it underscores the significance of the kind of work this committee has cut out for it and where we should go. I see this as a huge issue. It's a huge issue of importance to people. I think we need to move on it in a way that makes sense.

I have to tell you that I'm a little concerned when you mentioned the notion—Nancy obviously twigged you with respect to the end of March—that this really is a short time in which to get a feel for this kind of an issue. I didn't know if you had travel down or if travel was part of this in terms of going across Canada. It seems to me we might want to do that. At least, it should be reviewed to see whether or not that possibility exists.

I happen to be of the view that this issue is of such importance that by going across Canada, you would in fact raise the education and awareness level, which is the public consciousness, if you will, on this issue. It seems to me that this should be at least thought about in terms of what this committee does. I think part of our job in all of this is to raise that public consciousness to try to make sure people understand it. Whether it ends up in some form, or with income tax, or whatever, you still need an education process in place where people understand exactly what our committee is doing. So I think we at least have to note that.

Mr. Chairman, I think at the outset of the meeting you indicated there were two ways of approaching this in light of Mr. Martin's motion. I thought your second option made a great deal of sense, which was to incorporate what Mr. Martin has presented to us this morning in terms of the overall approach that we as a committee would proceed with. That's my recommendation, based on the motion I made. I hope we could proceed accordingly.

Let me reiterate and emphasize that this is a huge and important issue, not only for us sitting around this table, but for all Canadians.

The Chairman: Thank you, Mr. Myers.

Mr. Martin.

Mr. Keith Martin: Mr. Chairman, I think what Mr. Myers mentions about raising public consciousness is very important. The committee could have a huge role in doing that. I think it would be wonderful from a national perspective also, since we all come from various parts of the country.

With respect to the timeline, much of what Minister Rock has requested has actually already been done. So in fact the task may not be as onerous as it appears to be at first blush. Much of the work has been done by the ministry, so if we can pull that stuff together, many of Mr. Rock's questions would be answered, and what has not been asked, such as those mentioned by Ms. Caplan, can be addressed.

At the end of the day, I hope that what can be accomplished by the committee is that we can take all of the recommendations we've had from all of these studies and determine how we can translate them from words into action. If that committee can accomplish that and guide the minister in determining how these very constructive solutions can be translated into action, then we will be breaking that 15-year glass ceiling and saving a lot of people's lives.

• 1055

The Chairman: Ms. Wasylycia-Leis.

Ms. Judy Wasylycia-Leis: Thank you very much.

I think we all agree that this is one important issue among many that are facing us in the health care field. We have to find a way, as a committee, to actually deal with some of the other suggestions raised at the previous committee meeting. Those were some very critical issues. My suggestion would be that we either agree to set up a subcommittee to recommend an implementation strategy for the many studies and recommendations that have been done on organ tissue transplantation issues, or that we confine our work to a one-month period.

I say this not because it's not a serious issue—I think we all acknowledge that it is—but because I also know from previous discussions in this committee that we have touched upon and addressed a number of critical issues facing us, the most important being what the future of medicare is and what the impact of the whole financial situation and the transfer payment question on our provincial health care systems is. In fact, I think we know that if we don't address those issues, there isn't much point in going any further on the organ transplant matter.

We only have to look at the United States and see what the situation there is with respect to people who want and need organ transplants. I vividly recall the situation of a family whose wife and mother needed a liver transplant. They had to pay $150,000 just to get her on the organ transplant list. When the first liver transplant didn't take, they needed to come up with another $60,000 or so just to get on the second list. She eventually died, and the family ended with over half a million dollars in costs that they had to bear themselves.

I think that's a good example of why we have to address the fundamental questions of our health care system, why we have to address the principles of medicare before we go a step further. We've all acknowledged that we're in a critical situation. As a committee, we have to take this on as a number one priority.

Secondly, I think it's—

The Chairman: Just a second, Judy. I'm sorry, I'm trying to follow you as deftly as I can, but what is it that we have to take on as a number one priority?

Ms. Judy Wasylycia-Leis: I was referring to the whole question of the status of our health care system, as we discussed at the last meeting, building on Ovid's suggestions to look at some comparative situations, but also dealing with the threats to medicare here in this country.

I think it's also important for us to say that while we acknowledge that the question of transplants is a major issue and that we had 130 deaths a year in relation to this issue, as a committee we also have to possibly look seriously at the whole issue of tobacco, which causes 40,000 deaths a year. I think there has to be a way to priorize, to do all the work that's required, without ignoring our responsibilities as a committee. I would therefore suggest that we either set up a subcommittee to deal with motion M-222 and the implementation strategy as proposed by the federal-provincial task force, or that we confine our work on this issue to no more than a one-month period.

The Chairman: Before I go to Bernard, I just want to clarify something you mentioned a little earlier on, since you've just repeated something about that one-month period.

When I said we will need that four-week period from April 30, working our way back, that does not mean the committee will not be involved in other things during that month of April. That's the time period that we need for consideration, publication, going into printing, etc. The committee can be doing other things during that period, and I don't want to convey the impression that the whole month of April will be on this one item. In fact, that will be true for every report we make.

That's just as a bit of a clarification on what the logistics mean, Judy. There's no other reason for saying that.

Okay, Bernard.

[Translation]

Mr. Bernard Bigras: You're right, Mr. Chairman, there should be no mistake. However, the reality is that the entire issue that we have examined this morning is an important one. The impact of transfer payments on our health care system is also important, and that must be recognized. It's the entire state of the health care system that we have to look at. If that's not a major issue, Mr. Chairman, I don't see what could be, because it covers a lot of things. At some point, we have to set priorities.

• 1100

I agree with Judy on this. I wouldn't say that we agreed on this issue last week, but it is a matter of the impact of the cuts in transfer payments on our health care system and the way health care is delivered. That is a priority.

Mr. Myers said that we could travel throughout Canada to see what's done elsewhere. I think it is possible to examine this issue as a subcommittee without going on trips. Indeed, we do have an awareness role to play, but I think our committee should take a leadership role.

I'm looking at the 13 strategic orientations grouped under three themes: standardization, management and education. It is unclear that there is an important leadership role here, be it in organization or education, for the federal government. That's my opinion.

I really don't think it would be a good idea for our committee to travel throughout Canada on this issue. I agree with Judy about the fact that we could examine the issue as a subcommittee; that would enable us to study it thoroughly. The fundamental issue of this committee is: how is our health care system doing and what was the impact of the federal transfer payment cutbacks on the health care system?

As a matter of fact, there was an opposition motion in the House of Commons last week on this. All the parties agreed on this issue. Let me remind you that we voted yesterday. At least we could vote on this. Everyone agreed on this issue except, of course, the party in power. It might be a good idea to discuss this in committee.

[English]

The Chairman: Ms. Caplan?

Ms. Elinor Caplan: I'm actually quite surprised at the rhetoric, Mr. Chair, although maybe I shouldn't be. Having served on this committee for over a year now, I know there is a real opportunity here to do important work that's going to have a direct impact on Canadians. Given the fact that the minister has asked the committee to do just that, I find it somewhat distressing that two of the colleagues opposite don't see, as I see it, the value that this committee could bring.

I believe Mr. Martin's motion was an excellent catalyst. It also gives this committee a chance to do something really important and really significant. This is an issue that has been discussed in Canada, but no action has been taken. Frankly, I think there are several important reasons for that, and the work of this committee can make a real difference when it comes to public education, but only if we tell the public. The only way we're going to get the interest in this issue is by actually considering going to some of the provinces and talking to them about what works, what doesn't work, what the barriers are, what the problems are, and what the appropriate role is for the federal government. The issue of why Canada is an anomaly in the western world is something the Canadian public would really like to have answered.

As for what this committee can do in terms of being a catalyst to make something happen, perhaps it's as simple as creating the spotlight, as I would refer to it. If we take the time to shine some light on this area where work has been done at a bureaucratic level, perhaps just the shining of that spotlight will mean this committee has made an enormous difference to the people who are awaiting transplantation in this country and who are dying simply because the rate of transplantation and available donors in this country is abysmally low.

The fact that provinces have responsibilities is clear. No one is suggesting that we interfere with provincial jurisdiction at all. What we're saying is that whether it is through public education, through the establishment of national standards that have been agreed upon by consensus, through the sharing of information, or through the determination of how provinces, in a consistent way through consensus, come to policies that are appropriate, consistent, and will lead to better results...is where this committee can make an enormous contribution.

• 1105

The fact that we are seeing the kind of rhetoric from two of the opposition members does a great disservice to all Canadians. I think the opportunity this committee has been given by both Mr. Martin and the minister is something we should take advantage of.

Ms. Judy Wasylycia-Leis: On a point of order.

The Chairman: One second. Hold on, Madam Caplan.

Ms. Elinor Caplan: No, I'm quite upset about this because—

The Chairman: I have a point of order.

Ms. Judy Wasylycia-Leis: Mr. Chairperson, I think Ms. Caplan has taken comments of Bernard and myself out of context in order to fulfil the objective of supporting the minister's recommendation to this committee. We were simply trying to suggest that a number of critical issues have been brought before this committee and deserve serious consideration. Everyone at this committee should have a chance to recommend items for the agenda.

We have clearly stated that we see the issue of organ and tissue transplantation as a serious one. There are also other critical issues, and we have recommended we start at the very beginning, which is the question of the future of our universally accessible health care system in this country. We don't want to to dismiss, undermine, or minimize the suggestions before this committee, but simply want to acknowledge the contribution of every member at this committee and give everybody equal weight to ensure there's a fair approach for determining the agenda of this committee.

The Chairman: Thank you.

Madam Caplan, can I ask you to just finish off?

Ms. Elinor Caplan: What was the point of order that was raised, Mr. Chair?

The Chairman: She wanted to clarify that her position is not an inimical one.

Ms. Elinor Caplan: That's not a point of order.

The Chairman: Direct yourselves through the chair.

Ms. Elinor Caplan: I guess this is something I feel very strongly about, personally. I said that last week at the committee. I believe there's an important opportunity for this committee at this time, given the fact that there is work that has been undertaken and done and we can be an important catalyst in doing it. I would hope the committee would decide to do that, Mr. Chair, because I think we're all here to make an important difference, and this is an area where we can make an importance difference for all Canadians.

The Chairman: Madam Minna.

Ms. Maria Minna: Thank you, Mr. Chairman. I just want to direct ourselves—because this is what both seem to have brought up—back to the last meeting. I don't recall the motion from Ovid Jackson, although we keep referring to Ovid and I suppose he should correct us. His suggestion was that we do a study on transfer payments to the provinces on health care. I thought he was talking about a comparative study, an international study. I don't remember this committee ever agreeing that we would look at transfer payments.

Given the fact that the government is looking at this budget as being a health budget, as we keep hearing, one might want to wait and see what that is. Also I don't know how we would even embark on an evaluation across the country, since we have not established any national standards on how we would measure health care from one province to the other. We don't have an evaluative mechanism or a system in place, and some people in this room resist national standards. They'd have to be identified first of all before you could even attempt that sort of thing, and we'd need an evaluative model with a report card and something to be able to even do that.

My understanding of the last committee meeting was that Mr. Jackson's recommendation was to look at the international scene vis-à-vis health care. We've had the national forum on health that has already done a report on health care in this country. It took three years to do. It was an independent group of people that had hearings and focus groups in every province, and what have you.

I think we're spinning our wheels and looking for ways to... This particular project is a big chunk of the health care system. There's been a great deal of information as to what the problems are. It looks like something that could be handled and really make a difference and change. We ought to address those issues we can have some immediate impact on and immediately change that will improve a big chunk of the system. I don't see what the problem is and why we can't handle some of the other things at the same time.

The Chairman: I want to hear from everybody.

Ovid.

• 1110

Mr. Ovid Jackson: I assume we're all here because we want to improve the health of Canadians. We're kind of getting lost in a lot of political rhetoric on all sides. Part of it is we're starting to forget what our purpose is here.

Dr. Martin is a member of Parliament and he came up with a good idea, but I don't see any reason why we couldn't work concurrently with the major problem as well as this minor one. I don't know if we've ever done that before.

I have a problem, first of all, with having a subcommittee because I think we're spread out right now and it becomes extremely difficult. If we're working and have to go gathering information, we could work concurrently by having two sets of witnesses that sort of—I don't know if this has ever happened before—get at the work plan.

I'm a very practical guy. I like to get things done. If we are going to get something done and save lives through cooperation with the provinces, we should look to ourselves to start with. Around this table here, have we all signed this document that says we want to donate our organs, or are we just talking about it because it's something good to do?

The fact of the matter is, this is part of what we want, and each journey begins with one small step. If you never get out of bed and start walking, you're not going to get anything done. You could pick this thing up and sweep it aside. Dr. Martin, who is a physician, would say “Hey, this is something that is sitting on the shelf. We have bits and pieces of it.” We could get this done very quickly, as far as I can see.

Then we have the other broader thing that encompasses a lot of other things we have to look at to make our system better. That's why I am here. So I don't want to be arguing with people about political agendas.

The Chairman: Thank you, Ovid.

Mr. Bigras.

[Translation]

Mr. Bernard Bigras: To answer Mr. Jackson's question, yes, I have signed my organ donor card.

Ms. Minna, I don't know if you were present until the end of the committee meeting—

Ms. Maria Minna: Yes, I was there.

Mr. Bernard Bigras: You were there?

Ms. Maria Minna: Yes, I was present.

Mr. Bernard Bigras: Indeed, I agree that Mr. Jackson's initial proposal dealt with a comparative study of health care systems. During the second part of the meeting, however, we agreed that there would be no comparative study—

Ms. Maria Minna: No.

Mr. Bernard Bigras: I remember a point raised by Judy.

[English]

The Chairman: I can't hear more than one speaker at a time.

[Translation]

Mr. Bernard Bigras: Yes, In understand, but can I express my view?

[English]

The Chairman: Hold on, hold on.

[Translation]

Mr. Bernard Bigras: Can I be allowed to speak, Mr. Chairman?

[English]

The Chairman: Just a second. One at a time, please. He has the table, he has the mike, let him speak. Thank you.

Go ahead, Bernard.

[Translation]

Mr. Bernard Bigras: I have two comments to make. First of all, during the second part of the committee meeting, following points raised by Judy and myself among others, I amended Judy's motion so that it would fit with the examination of the impact of transfer payments on the health care system. I remember that very clearly.

My second comment is as follows. I agree completely with Mr. Jackson: we can examine both issues concurrently, and that's where the idea of a subcommittee sprang from. Why can't a subcommittee examine this basic issue on which we all agree? Perhaps the Clerk could provide us with information. Is it possible for the standing committee to strike a subcommittee on the issue and have the standing committee start to examine the impact of transfer payments? That would enable us to rally to Mr. Jackson's idea, which is to study both themes concurrently. Thus, the debate could move forward.

[English]

The Chairman: That's a constructive suggestion, Bernard. Thank you very much.

You know, I'm a member like everybody else on the committee, and I didn't hear anybody say they didn't want to undertake this study. I think where we ran into some difficulties is just where we want to set it up in terms of priorities in a work plan we had asked our researchers to establish for us of all of the suggestions; a work plan I asked a researcher to have for this committee by the end of next week because I wanted to have it placed in a very thorough and well-thought-out methodical calendar. We have that, nonetheless.

We have a situation now where the issues that can't converge include a motion by a member of Parliament who is an associate member of this committee. We have one of the priorities established by the procedures committee, and we have as well a case where the minister agrees with both a member of Parliament who is not a government member and the deliberations of the committee that are in progress, but which had clearly indicated one of the priorities. So we had three elements that can be easily brought together, and through the course of the morning we've seen how some of these elements are there; they're willing to be brought together. We've been given, to boot, an opportunity to realize some of these objectives in very short order, without altering the work plan.

• 1115

Bernard has suggested that one of the ways to address this might be to reconstruct the committee into a subcommittee that would then report to the full committee. Judy has suggested that what we do is not forget one of the other considerations that the committee will revisit once our work plan is completed, but she hasn't said not to do this. She's considering the question of priorities.

I hope I'm not misrepresenting anybody. I'm just conveying to you what I've heard.

Keith has said that all the other issues you are talking about are important, but this one here is immediate and urgent. It should be folded into everything else, but you should start off by doing this. I thought that was more or less what you said earlier on, Keith, although it was about half an hour ago.

And Ovid—I hope I'm doing your presentation justice—essentially has said the same thing: let's see if we can be pragmatic and practical about this for a moment and make a decision about where we want to go. The other two government members have also said that this is where they'd like to go. Their position is not any less valid than anybody else's around the room, especially when we consider the context in which this suggestion, this proposal, has emerged. It didn't emerge out of the blue. It emerged out of our own discussions with the minister responding to some of those suggestions afterwards. The stimulus was the suggestion of one of the members of this committee in the previous Parliament and now an associate member of that committee. So it's not as if some éminence grise behind the scenes has caused this thing to come forward. It's been generated directly out of here.

A voice:

[Editor's Note: Inaudible]

The Chairman: No, the Minister of Health could have said whether he wanted to or not. We had already put that on our plans. If the minister didn't want it, tough luck. If it was one of the priorities, that's what we're going to do. I think that was the approach.

I was here all last week as well, and when I revisit my notes the issue was, let's get a work plan together and we can determine how we will do some things, whether we will do them concurrently or sequentially. But those are the four items that came out, and we hadn't established the priority. The priority was going to come out of the work plan once we had been presented with it. I thought that was a practical approach. It was a serious, non-partisan way of dealing with the issues—issues, by the way, that I thought, especially on Ovid's suggestion, had crossed over the floor. Judy supported it, Grant supported it; it found support everywhere. There was a little bit of a difference in the nuance in the way it was presented. All of the issues presented had widespread support. That's where I'm coming from. The fact that the minister would also like us to do this may be a bonus. What it would do is it would suggest, I would think, that maybe it might have a better chance of being immediately acted upon, because a minister buys in when we start, rather than at the end.

Just as a little bit of a digression, I was telling the clerk and the researcher this morning that on Newsworld at 8.30 a.m. they were doing a public display of some of the natural health products being tailor-made for children. While many of us were skeptical about the importance of this committee and its work, do you know that the one thing that was in front of the panellists was the committee's report? That was the reference point for virtually the entire discussion.

I don't know whether we should all pat ourselves on the back, but the fact of the matter is that the report of this committee is taken seriously, and I think is taken seriously by the public as well as those who are policy-makers within the department and within the ministry. I say that not to be encouraging or patronizing for anybody, but just to give you an indication.

• 1120

Perhaps I lean a little bit towards what Ovid said earlier on. Every big ambition gets resolved with one little step. I didn't see anybody around the room here not willing to take that little step. There's a problem with the mechanics perhaps and with the establishment of the priorities—I acknowledge that; that's not a problem—but I didn't hear anybody say they didn't want to do this. If I should have heard a negative answer from anybody, please tell me now.

Should I have heard “no” from both of you?

[Translation]

An Hon. Member: No.

Mr. Bernard Bigras: You are asking us a question. Can we...

[English]

The Chairman: I was hoping it was a rhetorical question.

[Translation]

Mr. Bernard Bigras: What I would like to say is that we must not underestimate subcommittees. I'm thinking, among others, of one issue...

[English]

The Chairman: I haven't disagreed, Bernard.

[Translation]

Mr. Bernard Bigras: Fine. I'm thinking of the whole issue of international child abduction, for example, that was examined by a subcommittee of the Standing Committee on Foreign Affairs and International Trade. Men and women, especially women, who have their children abducted end up in countries that have not signed an international convention. That is an important issue. It was studied by a subcommittee of the Standing Committee on Foreign Affairs and International Trade. The subcommittee examined that issue.

That is proof that fundamental issues like this, which affect people's future, can be examined by a subcommittee. It's not because something is being studied in subcommittee that it's less important.

Can we examine this issue in subcommittee and study a broader issue that affects—

[English]

The Chairman: Bernard, before we go on forever and a day, I agree with you that you made a very positive suggestion. My only point was that I didn't hear anybody disagree that this is a matter worthy of study. Where there appears to be some divergence—and I stress “appears”—of views is on the mechanics of how we get it done.

Let me deal with one thing at a time, if you don't mind. The one thing I wanted to deal with was whether or not we have agreement that we want to do this. That's all. It's a very simple question.

[Translation]

Mr. Bernard Bigras: I agree with you and I think we agree on this issue. As a matter of fact, I liked your summary of each of our points. However, like Mr. Jackson, I'm a very concrete and practical person. Concretely, what does this mean? We all agree on the fact that we must examine this question, but we're wondering where we will study it.

[English]

The Chairman: With respect, Bernard, that means we could step out of bed, but what's going to happen with the other one thousand steps we're going to take during the course of the day? I take one at a time.

Judy.

Ms. Judy Wasylycia-Leis: That's a very difficult question to answer, since we're not sure what you mean by whether or not we want to do this as a matter of study for the committee. In fact, it's open to interpretation. It could become a major study project for the committee, or it's something that could be dealt with in a matter of a few weeks of hearings and conclusions. I find it very difficult to—

The Chairman: Let me answer your question before you go further, so that you know where I'm headed.

Last week, this committee laid out four items. I asked the researchers to give us a work plan so that we could devise a timetable from it. What I propose to do, if we want to accept the motion that's on the floor, is get rid of all of the mechanics associated with that motion and then fit it into the work plan when we come back next Tuesday. When we get that work plan, we're going to go in camera. We're then going to go through that work plan and decide on the mechanics of how to get this done. There isn't some nefarious plot out there.

We have a motion on the floor. Do we want to undertake the study? The question is very simple. We'll worry about the mechanics afterwards.

Ms. Judy Wasylycia-Leis: Mr. Chairperson, that's hardly appropriate at this point, since it contradicts your attempt to say that all ideas are considered worthy and should be included in the work plan. We should look at the proposals and make our decisions accordingly. My question to you would be why, when other constructive suggestions were put before this committee, you didn't hold a vote to see how people felt about those ideas? I think the only appropriate course of action—

The Chairman: I'm sorry, Judy, but we did.

Ms. Judy Wasylycia-Leis: —is for you to take all of the ideas and bring us back a work plan. We can then judge on the basis of what we think the priorities are and how much attention should be given to each area. It would be very unfortunate and unfair for you to now ask us if we favour this or do not favour it, when everybody agrees it's an important issue. But we cannot say definitively if this in fact becomes the major topic of discussion for the committee's work over the next six months.

• 1125

The Chairman: Judy, you might end up having that decision made by the committee. I'm hoping to operate on consensus. What I said was that we have a work plan being developed for us on all the others, which would establish for us the priorities on which we were going to make decisions.

You have a situation today whereby you have a motion on the floor; we didn't have one last week. So all I'm suggesting is a compromise. I saw a consensus last week. And I thought I saw the same thing again this morning on this particular issue. The last thing we said last week—I want to refresh everybody's memory on this matter—was that we didn't necessarily need to have one to the exclusion of the others. We said that we might have conducted several contemporaneously.

What does that mean? Well, it might mean, if the committee saw fit, the establishment of a couple of subcommittees to deal with a series of issues that might run concurrently. But I don't want to prejudge what the committee is going to say. When you look at the work plan and you see what there is that may be involved, then you would be able to make those decisions.

But we don't have that. What we do have is a motion that asks whether you want to do this or not. So you can go ahead. I prefer to work on the basis of consensus and say, yes, that's consistent with what we said last week, so we would prefer to do it.

Ms. Judy Wasylycia-Leis: Then I would move we defer this motion until the report of the work plan.

The Chairman: We can do that as well. If you want to say let's do that, that's fine.

Keith.

Mr. Keith Martin: I think they're not mutually exclusive issues. I know I'm an associate member, but look at what perhaps can be done. I think it's important on this particular issue to strike while the iron's hot. We have a narrow window of opportunity for the committee to really make a difference.

If it's deferred for four months or six months, then the action of this committee will not have the same profound impact of what it could have at this particular point in time. Basically, getting this whole issue just over that hump to put it into reality... I think there's a consensus here that this is an important issue.

But the other really important issue—I think we all agree about this on this committee—that has been articulated by both Bernard and Judy and everybody else is that these perhaps can be dealt with. Maybe it would not be at the same time, but information can be gathered on a particular issue, such as the large issue on health care funding. Perhaps the process can be set into motion that research can be started on this while the committee is actually dealing with the organ donor situation.

So you have things working in parallel. So both are being worked on at the same time. Research is being done for compiling for the needs of the committee, but at the same time, the committee is dealing with this issue right now, which as I said, is almost now or never.

The Chairman: Ovid.

Mr. Ovid Jackson: Mr. Chair, I think just looking at what we want to put in the work plan, if we put it in the context of the work plan, then we could decide upon prioritizing or about how we would work on it as well. I think that's where we're at. If we just put it in with the rest of the stuff and bring it back and have a look at it, we might have our answers then.

The Chairman: Bernard.

[Translation]

Mr. Bernard Bigras: I've a very brief comment regarding what Keith just told us.

It's very difficult to deal with two major issues in committee without forgetting something. I was a member of the committee chaired by Charles Caccia. He has a habit of bringing many subjects before the committee. He's a hard worker. However, my experience tells me that two major issues like this cannot be considered by the committee, because we can't do everything at once. We can't chew gun and walk. It's impossible. I think that we have to work on one priority. I continue to support Judy's proposal, namely to examine the question of organ donation in subcommittee. I have no problem with that and I will be pleased to take part in that subcommittee's proceedings. The committee must really examine a single issue, otherwise we'll get lost. That's my opinion. We have to be efficient. That's all I wanted to say.

• 1130

[English]

The Chairman: Of course, this issue here is, with some of the questions that have been raised over the course of the morning, a microcosm of a larger issue, as others have said more eloquently.

I suppose you're right that maybe we should only deal with one issue at a time. There are some committees that deal with a million issues at a time. I always like to deal with the one that's in front of me.

Are there last comments by anyone? There are none. Do you want to defer this motion until next week, or do you want to—the motion is still on the floor—agree to undertake the study?

My suggestion is to eliminate all of the problems you might have. We can work on the mechanics of it once we've dealt with the motion.

I don't know. Maybe I could leave one of my limbs here as a hostage. I'm sorry, that probably wasn't in good taste.

Okay, do I have consensus on that?

Judy, you're my most stalwart supporter.

Ms. Judy Wasylycia-Leis: Since we have a motion before us, I would like to propose an amendment that this committee deal with this topic of transplantation after we have dealt with the matter of the state of the health care system in Canada, having invited stakeholders to discuss the adequacy of federal health cash transfers on our medicare model.

The Chairman: Judy, just a second. Just before you present that formally to us, I might offer an observation, just by way of being helpful more than anything else.

The way I heard the motion worded prejudges the way the committee will work out what it will do next week. I'm not sure that I would want to do that. I don't know whether you would want to do that. Maybe you might want to word it a little bit differently. I don't think that's your intention. I hope it isn't, is it?

Ms. Judy Wasylycia-Leis: My intention, Mr. Chairperson, is to find a way to ensure that all issues of critical importance before us are dealt with on a fair basis. But I think the way you have posed this motion will in fact determine our future agenda to some extent. I would prefer to have a level playing field with respect to these issues. If you insist on the motion before us, I would have to abstain because I cannot separate it from the question of our priorities as a committee.

The Chairman: Well, as a point of clarification, I didn't present the motion.

Ms. Judy Wasylycia-Leis: Okay.

The Chairman: That might not be a bad approach, Judy.

I don't have a hidden agenda. I've put it out on the table for everybody. I'm not trying to move somebody in a particular direction. It took a while for me to come to even accept other motions. But it's not my intention to steer people away from the studies that the committee has already said should go ahead for working out a work plan. We've already instructed our staff to do that. I don't know why I would stop them from doing that.

So if you want to abstain from this, it would probably be the best way to deal with it. Then we can work out the mechanics when we come back with all the other work plans that are in place. If that would be the approach you would take, then I would reconsider the motion you were considering.

Ms. Judy Wasylycia-Leis: Mr. Chairperson, if it fits with the process, I'll withdraw my amendment to the motion, hoping that you'll understand the reasons for the motion.

The Chairman: Absolutely.

Ms. Judy Wasylycia-Leis: It's to make sure we have a chance to weigh all options equally.

The Chairman: I understand that absolutely.

Bernard, I imagine you want to take probably a similar position.

Mr. Bernard Bigras: Oui.

The Chairman: Well, then can I just simply ask if the motion is accepted?

(Motion agreed to)

The Chairman: I note the two abstentions.

Okay, thank you. Again, not to prevent things, but just so we can do all the things appropriately next week—

Ms. Elinor Caplan: I wish, Mr. Chair—

The Chairman: Just one second, please.

In order to fulfil the rest of the items, I've got a couple of other motions that I have to ask for. But we can do that as soon as we have our work plan.

Okay, Madam.

• 1135

Ms. Elinor Caplan: As for the work plan, I just wanted to clarify something for the record. My understanding is that what this committee agreed to as far as the work plan was Ovid's suggestion that we look at an international comparison of health systems to see what, if any, information might be helpful to Canada.

Mr. Ovid Jackson: Maybe we can get the clerk or somebody to read that back.

Ms. Elinor Caplan: What I heard from Ms. Wasylycia-Leis today is that she said at the time that she would prefer that. But there was no consensus or agreement in this committee that this was the approach of this committee. In my view, the agreement of the committee on all sides was on Mr. Jackson's suggestion. I would like us to just be clear so there's no misunderstanding at the next meeting when the work plan appears as to what the suggestion actually was. Do the researchers have that?

The Chairman: You're accurate in your recollection. But what I also did myself was to ask the researcher to give me a work plan for all of the suggestions. What would happen is we would have good information for the committee to put in context, as it would be considering not only Mr. Jackson's suggestions, but some of the others as well.

Ms. Elinor Caplan: That's fine.

The Chairman: This is so all of us would have a sense of what one would mean, logistically speaking.

I hope that doesn't offend anybody. I hope it's illustrative of what I indicated to members a few moments ago, that we're not trying to manoeuvre or manipulate anybody, we're just trying to provide all the appropriate information to make a studied decision.

Judy.

Ms. Judy Wasylycia-Leis: On this issue, I think it's important to set the record straight. At the last meeting, a number of us came forward with suggestions. One suggestion was from Ovid. It was to do a comparative analysis of health care systems internationally. I proposed three suggestions. In fact, I submitted them in writing to the committee, and they were circulated to the committee. Bernard proposed another with respect to the legalization of marijuana for medical purposes. We also had on the table the question of a study on transplantation.

All of those suggestions, according to the rules of this committee, are of equal merit. We did not have a vote. We did not draw a consensus in terms of one versus another. We tried to be as helpful as possible by suggesting that Ovid's idea meshed well with my suggestion. It was supported by Bernard and I believe Grant Hill as well.

That's where things were left. There was no prioritizing, ranking, voting, or rating. That's the level playing field I'm talking about, Mr. Chairperson.

The Chairman: Judy, I don't know why you got upset. I just confirmed everything you said.

Ms. Judy Wasylycia-Leis: I'm responding to comments on the record around this table.

The Chairman: Judy, respond to the chair, who is providing you with a consistent position all along. I said that—this was to the government members as well—in addition to the work plan for Mr. Jackson's suggestion, we are working on a work plan for everyone's suggestions. That includes your three and those of Keith Martin and Bernard.

Once we have that in place, the committee can go ahead and make decisions in that context in the spirit of trying to maintain a consensual working environment as opposed to a majority-minority working environment.

I don't think we've deviated from that at all, Judy. You can have your partisan views, but when I say we, as a committee, that includes the staff and the chair. So rest assured that all of this is already there. Okay?

Ms. Elinor Caplan: I have one point before we adjourn. There were a couple of people sitting here today. I went over to them. I had never met them. I didn't know them. I asked them what their interest was. They said they were interested in the issue of organ transplantation. I assumed Mr. Martin had invited them.

My colleague went over and introduced herself. She asked how they heard about the meeting today. They said our agenda was on the Internet. That was how they became aware of this public meeting. They came to hear what this committee would have to say about potential work in the area of organ donation and transplantation. They had a loved one awaiting a kidney transplant who's on dialysis. I thought the committee members might be interested in that.

• 1140

[Translation]

Mr. Bernard Bigras: I hasten to add, however, that there is indeed a part that is public, but there is another part that should have been in camera, namely the part we've just discussed, future business. We could have done that amongst ourselves because, naturally, we tend to discuss things that could lead to flare-ups in camera and that's normal. In my opinion, the second part of our meeting should have been in camera, which was not the case.

[English]

The Chairman: Well, we didn't have a motion to go into in camera meetings, so I just asked people to leave unless they were interested. Quite frankly, I didn't anticipate that we would spending this much time around the issue. I thought it was going to be fairly quickly dealt with. But for the first time since Christmas 1972, I'm wrong.

Some hon. members: Hear, hear!

The Chairman: Anyway, we'll adjourn to the call of the chair. Thank you, colleagues.