QUEBEC — Quebec and Ontario will just be tinkering with organ donation rules in 2005 when what the system desperately needs is a complete overhaul, says an outspoken transplant advocate.

George Marcello, a liver recipient and head of the advocacy group Step by Step, says Canadians are dying while provinces fiddle with rules to gently encourage more donation.

"These are all just little baby steps, that's all they are," said Marcello, whose group sponsored the recent year-long, cross-country trek of Kristopher Knowles.

Knowles, from Sarnia, Ont., is waiting for his own liver transplant.

"This young man is waiting, Canadians are dying every other day and they're playing around," Marcello said. "It sucks that more is not being done."

Quebec recently passed a law stating that residents can receive new health cards only if they have indicated one way or another if they are willing to donate organs.

In 2005, Ontario will start requiring large hospitals to notify transplant officials when they have potential donors. Officials will evaluate patients, while hospitals will have to approach the family of every suitable donor.

"Once it's fully implemented, we think it will become part of end-of-life care and will have the biggest impact on numbers in Ontario," said Sue Wilson, acting president of Ontario's organ donation agency.

About 4,000 Canadians are waiting for organs. Marcello and some other transplant advocates want Canada to adopt a system where Canadians would have to opt out of organ donation in advance.

Under the system called presumed-consent, doctors would assume Canadians are willing to donate organs when they arrive in hospital.

Marcello says Canadians could be persuaded to accept the system. He pointed to surveys that suggested most Canadians were in favour of organ donation, even though most did not sign organ donor cards.

"I think Canadians are ready to support this, it's just nobody is asking them to," he said.

But Sally Greenwood of the British Columbia Transplant Society said Canadians would not accept presumed consent.

"We live in a country that is based on personal rights and freedoms," she said.

"If we start forcing upon people that we will make you be an organ donor unless you opt out, that would be many steps backwards."

B.C. has a central registry where 499,105 potential organ donors have signed up. Hospitals are required to notify the B.C. Transplant Society of potential donors.

While no statistics are available, "it's fair to say most hospitals are complying and we are capturing most suitable donors, but it's not perfect yet," Greenwood said.

Transplant officials in Ontario and B.C. say the biggest obstacle to increasing organ donation is safer lifestyles.

Helmet use is now common among snowboarders, skiers and cyclists. The majority of drivers and passengers wear seat-belts and use cars with air bags.

"Our traditional donor pool is shrinking while demand is growing," Greenwood said.

"For the general population, it's a really healthy place to live. But the transplant gap is not diminishing, that's for sure."