Other experts, such as University of Toronto bioethicist Linda Wright, say Canada should consider some other options first - ones that might be sold more easily to the public, including doing a better job of promoting the idea of organ donation.
Canadian Blood Services hopes to get a national waiting list for organ donations up and running this year - the current one, astonishingly, is still maintained manually by the London Health Sciences Centre in London, Ont., and then faxed out to hospitals.
A key recommendation of the agency's report in June will be to improve front-line resources and personnel in emergency rooms and intensive-care units so that donors can be identified more quickly and families counselled to reach an informed decision - a top priority for Dr. Halloran, and the main factor credited with Spain's high donation rate. (One option that is being tried in New York won't be considered here: having transplant teams in "organ preservation units" trail ambulances responding to 911 calls.)
Some European countries have adopted an opt-out system - in which, with some caveats, people have to alert the government that they will not be donors. However, Canadians are divided on this approach, so it's also not being considered.
"It's really a trust factor," says Peter Nickerson, executive medical director of organ transplantation at Canadian Blood Services. For the system to work, he says, people need to believe that the final choice is theirs.
Prof. Wright, the bioethicist, says people still want organ donation to be "an altruistic act and not for payment." But altruism isn't getting the job done. And Dr. Matas argues that it's wrong that such idealism has kept the idea of compensation for organs from being tested with a government pilot project - or even seriously debated.
Shouldn't we find the status quo equally distressing? "If we don't do something," he says fiercely, "the waiting lists are going to get longer and more of our patients are going die every day."
Erin Anderssen is an Ottawa-based feature writer for The Globe and Mail.
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