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Newfoundland and Labrador is looking at reforming how organ donation is done but the health minister says it's unlikely the province will adopt a system where consent is assumed.
Right now the province uses an opt-in donor system where residents agree to become donors by ticking a box on their driver's licence or MCP application or renewal form.
Many European countries, including France, Norway and Spain, have presumed consent or opt-out programs. In those countries it is assumed everyone has agreed to donate their organs, unless they explicitly choose to opt out.
Some Canadian provinces, such as Saskatchewan, say they are considering a similar system.
Others, such as New Brunswick, have considered presumed consent and rejected it.
Newfoundland and Labrador Health Minister John Haggie thinks he knows why.
"It doesn't work. That seems to be the principal reason I'm getting at the moment. The jury isn't quite in yet. By itself it hasn't quite made the difference that people wanted," he said.
"So we're looking a that and trying to make an informed decision. There's no point in doing something just because it sounds right and it's popular. It's got to work."
Although Spain has seen organ donations rise and is often held up as an example of why everyone should adopt a presumed consent system, Haggie says there are other factors.
"Their organ donation rate remained at three of four per cent for 10 years after they changed the law. It was only when they did the education and support piece that their donation rate when up to 12 and 15 percent — which is very good by standards of European countries," said Haggie.
That point has been confirmed by a 2014 Canadian Blood Services briefing note which said it took an organization to coordinate organ donation and an improved education system to boost the donor rate in Spain.
Will to donate not enough
Even when people agree to donate their organs, they are rarely able to.
CBC News learned through an access to information request that 137,000 residents, about half of all registered drivers in 2016, signed themselves up as ready to donate.
But the number of organs retrieved in the province that year was 22. In 2015, 32 organs were retrieved from eight people who died in Newfoundland and Labrador, according to Eastern Health.
"Many people who consent to donate organs after their death are unable to become successful organ donors because the type of death they experience does not allow for retrieval of a viable organ or because they have a disease or a condition that makes them medically unsuitable," according to a briefing note done for the government.
Organ retrieval is coordinated by officials with Organ Procurement and Exchange of Newfoundland and Labrador (OPEN).
When a donor is identified here a team of health care professional who specialize in organ retrieval come here to harvest organs. Organ transplantation is not done in Newfoundland and Labrador. People who need transplants and are matched with a donor have transplants performed in other provinces, usually Nova Scotia.
Wait list growing
Haggie said Newfoundland and Labrador wants to improve its organ donation rate because the number of people waiting for organ transplants is increasing.
Newfoundland's wait list is combined with those of other Atlantic Canadian provinces.
"In 2002, there were 162 patients waiting for transplants in the Atlantic region. By 2012, there were 236 patients on the Atlantic Canadian transplantation wait list," says the briefing note.