Québec's Organ Donation Overhaul: Efficiency vs. a System's Soul

MONTRÉAL, QC – November 26, 2025 – A significant shift in Québec's public health landscape is underway as the provincial government moves to transfer the complex and deeply human process of organ donation and transplantation coordination from its long-time steward, Transplant Québec, to the much larger entity of Héma-Québec. The proposal, embedded within the sweeping legislative changes of Bill No. 7, has ignited a fierce debate, pitting the promise of bureaucratic efficiency against the preservation of specialized, compassionate care.

Following hearings before the National Assembly's Committee on Public Finance yesterday, Héma-Québec publicly embraced its proposed new mandate. The organization, known primarily as the manager of the province's blood supply, sees the move as a logical extension of its expanding role in public health, which already includes managing human tissues, stem cells, and cord blood. The government's goal with Bill No. 7, officially titled "An Act to reduce bureaucracy, increase state efficiency and reinforce the accountability of senior public servants," is to streamline operations and consolidate functions. In this context, merging organ donation into Héma-Québec's portfolio is framed as a move that could create a more powerful, integrated system for managing all of Québec's life-saving biological materials.

A Push for Centralized Power

For proponents of the bill, the logic is clear. Héma-Québec possesses a robust, province-wide infrastructure, decades of logistical expertise, and a proven track record of integrating new public health responsibilities. Since 2001, it has managed human tissue donation, becoming the sole distributor in late 2024 and delivering nearly 7,700 tissues to hospitals in the last fiscal year. By bringing organ donation under the same roof, Québec would align its model more closely with the rest of Canada, where Canadian Blood Services plays a national coordinating role for both organ and tissue donation.

In a brief submitted to the committee, Héma-Québec outlined its vision for a future where its operational strengths could bolster the organ donation system. The organization believes its existing relationships with hospitals and experience in sensitizing health professionals to donation referrals can be leveraged to increase the number of life-saving transplants.

"Together, we can build an even stronger organ donation and transplantation system for Québec—one that increases the number of transplants for the benefit of patients, donors, and their families," stated Nathalie Fagnan, President and Chief Executive Officer of Héma-Québec, in a press release following the hearings. The ultimate objective, she emphasized, is to serve the best interests of the Québec population by creating a more potent and unified entity.

A Mission, Not a Machine

This vision of streamlined efficiency has been met with stark opposition from Transplant Québec and its supporters, who warn that the government is fundamentally misinterpreting the nature of organ donation. They argue it is not a logistical process akin to managing blood products, but a delicate, life-saving mission that hinges on profound human interaction at a moment of intense grief. Transplant Québec has strongly opposed its dissolution, cautioning that the move could disrupt a system built over 55 years, leading to fewer donations and preventable deaths.

The concerns are not unfounded. In 2023, Transplant Québec reported a record year, with a 20% increase in deceased donors and a 17% increase in transplants. Yet, the need remains critical, with 856 Quebecers currently on the waiting list for a transplant. The core of Transplant Québec's success, and the focus of its fears, lies with its approximately 70 specialized employees, mostly nurses who provide 24/7 support to hospital teams and guide families through the extraordinarily difficult decision to donate a loved one's organs.

Critics of the bill worry that this invaluable expertise could be lost in the transition to a larger, more "enterprise-like" organization. They question whether Héma-Québec's culture, geared toward production and supply chain management, can accommodate the unique, compassionate skill set required for organ donation coordination. The fear is that if these specialists are not retained, the deep-seated trust and sensitive communication that convince families to consent to donation—a consent refused in 24% of cases in 2022—will be irrevocably broken.

The Subsidiary Compromise: A Bridge Over Troubled Waters?

Facing this significant backlash, Héma-Québec has floated a potential compromise: integrating Transplant Québec not through dissolution, but by making it a subsidiary. This proposal, highlighted by CEO Nathalie Fagnan, is a direct attempt to address the most pressing concerns voiced by stakeholders.

"This would be a unique opportunity to preserve Transplant Québec's brand identity, structure, and expertise, while enabling it to benefit from Héma-Québec's robust infrastructure and complementary strengths as we look to the future," Fagnan explained. The model implies that, at least initially, Transplant Québec would continue to operate with its current management and staff, preserving its mission-focused culture and identity. It aims to offer the best of both worlds: the specialized soul of Transplant Québec powered by the logistical body of Héma-Québec.

This subsidiary model could serve as a crucial de-escalation strategy, reassuring anxious staff and medical partners that their expertise is valued. However, the exact legal and operational mechanics of such an integration remain undefined. Whether this structure can truly shield Transplant Québec's unique operational culture from the pressures of a much larger parent organization over the long term is a question that policymakers and health leaders will need to carefully consider as the bill progresses.

A Test Case for Public Health Reform

The debate in Québec is more than a simple organizational shuffle; it represents a pivotal moment in the evolution of Canadian public health governance. It reflects a broader trend toward consolidation seen in other provinces, such as Ontario, where the Trillium Gift of Life Network now operates under the umbrella of the super-agency Ontario Health. As governments seek to manage costs and improve outcomes, the impulse to create larger, more centralized entities is powerful.

This proposed merger also unfolds against a backdrop of wider conversations in Québec about how to boost donation rates, including a stalled 2023 bill to introduce a presumed consent (opt-out) system. While Héma-Québec has stated that legislative changes like presumed consent are not a silver bullet, the structural reform proposed in Bill No. 7 is clearly seen by the government as a primary lever for improvement.

The coming weeks will be critical as Héma-Québec works with the government and Transplant Québec to chart a path forward. The outcome will not only determine the future for the 856 Quebecers awaiting a second chance at life but will also serve as a telling case study for the rest of Canada on how to balance the relentless drive for efficiency with the irreplaceable human element at the heart of public health.