TORONTO - As international experts in organ transplantation begin arriving in Vancouver for a conference next week, a poll suggests most Canadians strongly support organ donation but are often confused about the process.

The Ipsos-Reid poll released Friday indicates that about half of Canadians have decided to sign over their organs at the time of death, although that hasn't translated into increased donation rates over the last decade.

"The overwhelming majority of Canadians, over 90 per cent, support the concept. They have positive attitudes toward organ and tissue donation and transplantation," said Dr. Graham Sher, CEO of Canadian Blood Services, which commissioned the poll.

"But only about half the population has actually done anything about that," he said Friday from Vancouver, where he will be among 5,000 delegates attending the Transplantation Society congress.

"So there is a fairly big gap between people supporting the concept and then actually taking an action, i.e., signing up to a registry or signing their driver's licence or whatever avenue is available to them in their different provinces."

Sher said the poll and other public consultations show many Canadians are surprised to learn that Canada has a patchwork of provincial and territorial transplantation systems, but no national program that knits them together to provide equal access to donor organs.

"Canadians are telling us overwhelmingly that they want a system that ensures equitable access to donation and transplantation, no matter where you live in the country. And they're very surprised to learn that there's very little in the way of interprovincial collaboration."

Globally, Canada is ranked about halfway down the scale for the best-performing countries when it comes to both donor and transplantation rates.

At about 14 per million population, Canada's deceased donor rate is less than half that of such countries as Spain and the United States. More than 4,000 people are waiting for life-saving or life-renewing organs -- among them hearts, livers and kidneys. About 2,000 are in need of cornea transplants to restore sight.

And last year, about 215 Canadians died while on the transplant waiting list.

"That's not acceptable in a country like Canada, and it should be substantially lower than that," said Sher. "So we know there's a long way to go in terms of improving performance."

Canadian Blood Services is in the midst of finalizing recommendations for a national donor and transplantation system. The organization, which has already implemented a living kidney donor registry, was asked to put together the document two years ago by Ottawa and the provincial and territorial governments. The recommendations should be submitted by the end of the year, Sher said.

He called it fortuitous that the Transplantation Society meeting is being held in Vancouver, "because a lot of the countries are talking about the changes they've made to drive performance improvements there."

Dr. Jeremy Chapman, president of the Transplantation Society, said a key goal of the non-governmental organization is for all countries to achieve transplant self-sufficiency -- by having a donor supply that closely matches their citizenry's need for transplants.

Self-sufficiency within borders would help curtail "transplant tourism," in which people from wealthy countries travel to places such as China, India, Pakistan or Peru for transplant operations using commercially trafficked organs.

The World Health Organization estimates that 10 per cent of all transplants worldwide -- or about 10,000 per year -- involve organs procured by traffickers, including those taken from people murdered for their body parts or who willingly sell one of their kidneys.

Chapman said poor countries need to protect their populations from such practices, while affluent countries like Canada "have a responsibility to make sure patients do not rampage the world in search of the poor and the vulnerable."

Sher said transplant tourism is known to occur in Canada, the United States and elsewhere because patients who have to wait for a donor organ will look to commercial trafficking.

"Everything we're trying to design here in Canada is to prevent that from happening."

The Ipsos Reid telephone poll of 1,500 adults was conducted in March and has a margin of error of plus or minus 2.5 percentage points, 19 times out of 20.