In this week's essay, Michael proposes a controversial solution to the problem of the shortage of organ donors in Canada.

If you drive the West Country of Ireland you will inevitably see a series of billboards on the outskirts of towns and cities. The text on the billboards reads: "DON'T TAKE YOUR ORGANS TO HEAVEN WHEN YOU DIE; WE NEED THEM HERE ON EARTH."

The billboards are an integrated part of Ireland's energetic campaign to get people to donate their organs for transplant.

It seems to be working. Ireland has one of the higher donation rates in the European Union.

The highest donation rate in the world is, perhaps surprisingly, Spain. Much of its success is due to an efficient network of transplant coordinators who counsel and encourage next of kin in the hospitals at the time of death.

Canada, on the other hand, has one of the worst donation rates in the world, although it's improving slowly.

Our rate is about a third the rate of Spain, about half that of Estonian, Belgium, the US and Italy---we donate 14.5 organs per one million of population.

There's not a lot of public discussion around the topic; we're just too nervous about death-related matters.

April is National Organ Donation Awareness Month but there doesn't seem to be much awareness and what there is isn't national.

We do not, for example, have a national plan to share organs between provinces.

The need for donated organs in Canada is severe and is going to get very much worse in the coming decades.

As health writer Andre Picard pointed out recently in The Globe and Mail, the rapidly increasing number of aging, fat Canadians is fueling a sharp rise in kidney failure; 38,000 of us are living with kidney failure. Which means more people hooked up to dialysis machines and more people waiting for kidney transplants.

And of course, many die on that wait list.

Being tied up to a machine several hours a week is not only discomforting, it is also very expensive. Dialysis costs about $60,000 per person a year. A kidney transplant costs half that.

One suggestion to increase the number of donations is the idea of presumed consent; that is, unless the person has specifically said he or she does not want organs taken, they will be harvested.

The idea is a very hard sell and not universally appealing.

To my mind, there is only one viable answer to the shortage problem---- people should be allowed to buy and sell their organs.

It sounds grisly, but makes sense.

The market, if that's the word, would be under strict government control and regulation. The buying and selling the organs could be managed by a government agency which would set fees on the recommendations of an expert panel---a life panel if you will.

The financial incentive would encourage more donation which would in turn save a lot of lives.

A legal trade in organs would wipe out the black market which is quickly becoming a major problem. Especially in what is known as "transplant tourism " where organs can be procured abroad for as much a $100,000.

It would also be economical. The major costs of transplantation are the procedure and the hospital stay. It would not increase those costs substantially.

The idea is not as radical as it sounds. There is a quiet debate in the medical profession, especially among transplant surgeons.

Some doctors have told me privately that compensating for organs is the only realistic solution to the serious waiting lists and those who die waiting.

But they don't want to go public. Not yet.

What we need is a public debate, involving ethicists, doctors, clergy, politicians, ordinary Canadians about organ donation.

This spring there will be a world congress of kidney specialists meeting in Vancouver---a perfect time and venue to have an open and candid examination of the subject.

If we don't do something radical and soon, people will continue to wait----and die.