Thank you very much, Mr. Chair and members of the committee, for the opportunity to speak with you today on this very important issue.

As a point of clarification and disclosure, I am a transplant physician who works at St. Paul's Hospital in Vancouver. I have nearly 15 years' experience dealing with the ramifications of transplant tourism. I also sit as the Canadian representative and councillor with the Declaration of Istanbul Custodian Group, which was mentioned earlier. This is an international organization whose mandate is to end organ trafficking.

Today I'm speaking in my capacity as a representative of the Canadian Society of Transplantation. I have also been asked to speak on behalf of the Canadian Society of Nephrology. These organizations represent health care professionals in Canada in the field of organ transplantation as well as kidney disease.

In the interest of time, I'll limit my comments today to a few key areas pertaining to the proposed bill. I'll make myself available for any further questions even after this session, if that's the will of the committee members.

First, I would like to highlight the status of this issue in Canada from a frontline perspective. The side of the practice I'll focus on is what we encounter as transplant professionals in Canada, which is really the patients who return after having engaged in the presumed purchase of an organ. It goes without saying that the issues from the donor side that we've heard already today are abhorrent. The transplant community feels strongly that these issues need to be addressed.

There are some key details that I think are worth sharing in terms of what happens and what we see. Typically, patients who are engaging in this practice have indeed been waiting for a transplant for many years. The median wait time in Canada is about five years for a kidney transplant. This is anecdotal, but typically what we see is that at some point, someone within their social network will give them advice and say, “Why don't you look outside of Canada for options?” That then leads to this act. I think a key issue that needs to be acknowledged is that there is almost always a broker involved. The act of travelling overseas to purchase an organ is being coordinated by a third party. Someone is profiting financially from this.

It's also notable, and I think important, to reflect on the fact that when we look at the demographics of who the individuals are who have engaged in this practice—I've done a number of research studies on this issue myself—we do see that it's often individuals from populations in whom there is documented reduced access to transplantation in Canada. In terms of access to transplant, that does appear to be a driving factor in some of these cases.

In terms of what happens when people come back to Canada, many require urgent or emergency care for infectious complications. To make matters more complicated for clinicians, we have very little, if any, documentation provided to us. We've had to guess whether the organ was purchased, what the donor situation was and what the matching was. That really does compromise our ability to care for these individuals when they return. We are relying solely on the knowledge, and hopefully the forthrightness, of these individuals who have come back so that we can provide care for them and do our jobs.

Importantly, in the long run these people do worse. Outcomes are much poorer for people who engage in transplant tourism compared with those who got a transplant locally. Some research I've done recently has shown that when we've looked at factors to try to deter individuals from engaging in this practice, we see that education seems to be the key issue. In particular, educating people around the dangers to them is potentially more effective than punitive measures. That is an important issue.

In terms of the current status, we do not have accurate numbers in Canada, but it does appear that, compared with 10 years ago anyway, the practice has reduced a bit, presumably on the basis of global efforts and in terms of education that we've done on the clinical side warning people of the risks.

In terms of the legislation, first of all, I'd like to express our support for legislation that aims to curb this practice, although there are a few issues that are important in terms of the details of this bill that we'd like to address.

First, our overriding priority is to advocate for our patients and their care [Technical difficulty—Editor] is within the transplantation and medical community, some [Technical difficulty—Editor] in a bad way and have resorted to this terrible act, particularly when, at least in part, this is driven by a reduced access to transplantation in our country.

This is accentuated in terms of the bill by the magnitude of the sentence and the fact that the culpability appears to be equally shared between patients and those who are coordinating the practice. The feeling generally is that it should be weighed heavier on those who are third parties who are coordinating it, versus the patients who are partaking in it.

We'd also like to distinguish between the notion of transplant commercialism and organ trafficking. They are both issues that currently are illegal within the Canadian context, but there are discussions in other countries, including the United States, that have been going on for many years about a regulated system that would be legislated to allow for transplant commercialism. Thinking about the future state of that and how this legislation would impact something like that is also worth considering.

Finally, there are some practical considerations that we're concerned about.

The proposed legislation may deter patients, if they're concerned about being penalized legally, from sharing some of the details that we rely on to know that this has occurred and to be able to care for them. Last, I would like to humbly advocate an increased investment on education on this issue, in addition to this legislation.

Thank you very much. I'll stop there.

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