I still remember the weight of Chantal Bucci’s hand in mine as she described the day her son received his heart transplant. Seated on her porch in Mississauga last spring, family photos lining the wall behind her, she spoke with a mixture of gratitude and lingering anxiety.
“Without that transplant, Marco wouldn’t be here today,” she told me, watching her now-teenage son shooting baskets in the driveway. “But knowing that other families are waiting, still hoping for that call—it haunts me.”
Marco was lucky. But across Ontario, roughly 1,400 people remain on organ transplant waiting lists, with someone dying every three days while waiting for a life-saving organ. Despite having one of Canada’s largest potential donor pools, Ontario’s donation rate continues to lag behind other provinces like Nova Scotia and Quebec.
Now, a coalition of transplant recipients and their families is pushing for sweeping changes to Ontario’s organ donation system, calling for the province to follow Nova Scotia’s lead by implementing a presumed consent model.
“The current opt-in system just isn’t working,” explains Daniel Ghelman, a liver transplant recipient who founded the Ontario Transplant Coalition last year. “Most Ontarians support organ donation in theory, but only about 35% have actually registered. That gap costs lives.”
Under the current system, Ontarians must actively register as organ donors through ServiceOntario or when renewing their health cards and driver’s licenses. The coalition is advocating for a shift to presumed consent, where adults would automatically be considered potential donors unless they specifically opt out.
Nova Scotia pioneered this approach in Canada when its Human Organ and Tissue Donation Act took effect in January 2021, making it the first jurisdiction in North America to implement presumed consent. Early data from the Canadian Institute for Health Information suggests the province has seen a meaningful increase in donation rates since implementation.
Dr. Emilia Salas, a transplant surgeon at Toronto General Hospital, cautions that while presumed consent could help, it’s just one piece of a complex puzzle.
“Changing the law is an important step, but equally important is investing in donation infrastructure—more transplant coordinators, better identification of potential donors, and consistent practices across hospitals,” she says.
Salas points to Spain, which leads the world in organ donation rates not just because of presumed consent but because of its robust hospital-based coordinator system that identifies potential donors and supports families through the process.
The Trillium Gift of Life Network, Ontario’s organ and tissue donation agency, has attempted to close the gap through public awareness campaigns and streamlined registration procedures. But critics argue these incremental approaches haven’t delivered sufficient improvement.
“When I got my new lungs five years ago, I promised myself I would work to make the system better,” says Priya Khanna, a 41-year-old elementary school teacher from London, Ontario, who received a double-lung transplant after battling cystic fibrosis for decades.
Khanna now visits schools across southwestern Ontario, sharing her story and encouraging families to discuss organ donation. “Most people I talk to assume they’re already registered or think it’s something they can put off until later. A presumed consent system would change that dynamic completely.”
The issue carries particular significance in Ontario’s diverse communities. Research from the University of Toronto has shown that certain cultural and religious groups have significantly lower registration rates, often due to misconceptions about religious teachings or distrust in the healthcare system.
“We need to engage community and religious leaders to help address these barriers,” says Reverend Michael Black
