Some 1,720 Ontario residents are waiting for organ transplants. Last year, 617 of the procedures were performed, and about 100 people died while waiting for donors.

A source in the Premier's office said he will endorse "routine-referral" legislation, which would make reporting deaths to an organ-procurement organization mandatory.

If it goes through, Ontario would be second only to British Columbia in having a law that sanctions trained experts to approach family members of suitable organ donors in an effort to obtain the kidneys, heart, lungs, pancreas, or other body parts or tissues, such as heart valves and skin, from the patient.

However, Mr. Harris is expected to wait at least 18 months to put the routine-referral law on the books, adhering to his own advisory committee's recommendation to first create the Trillium Gift of Life Network, an agency that would co-ordinate organ donations.

"The Premier feels that the system we've inherited in Ontario is too complex, and he's determined to fix it," said the source.

Although many believe that signed donor cards are enough, family members have been known to override the wishes of the deceased. More than 400,000 people in Ontario are on the donor registry.

Similar laws are believed to have helped increase organ-donation rates in B..C. and the United States, where, since 1998, the Department of Health and Human Services has routinely referred potential donor cases in all hospitals receiving medicare funds.

Failure to obtain consent has been partly blamed for Ontario's low donor rate of 14.1 donors for every million people. Toronto has the lowest organ-donation rate in the province. The Atlantic provinces have a rate of 19.5 for every million.

"Consent is often not requested because the physician decides that the family is likely to refuse or because the physician is just not comfortable with raising the issue," according to the 77-page report of Mr. Harris's advisory board on organ and tissue donation, which was obtained by The Globe and Mail.

"Frequently, consent is requested in an inappropriate location, at an inappropriate time or in an inappropriate manner" by someone untrained as a requester "or the family does not have a good feeling about how they or their loved one was treated in the hospital," it said.

Although only 3 per cent of people who die are suitable for multiple organ donation, roughly two-thirds can donate their eyes and tissue, said Bill Barrable, chief executive officer of the British Columbia Transplant Society. Fewer than one-third are unable to donate any organ or tissue.

Roughly 60 per cent of all organs transplanted are kidneys.

"Since we've had the legislation, our referrals for corneas have gone through the roof, at least five or six-fold higher," Mr. Barrable said in a telephone interview from Vancouver. However, Mr. Barrable said it was too early to evaluate how the law has worked to increase the number of organ donors. As part of his announcement today, Mr. Harris will pour more money into cash-starved hospitals to keep potential donors alive on ventilators and for transplants, the source said.

The report, done by a nine-member advisory board, made 16 recommendations on how to improve Ontario's rate of organ donation after spending four months probing the issue.

"The family of each patient determined to be a suitable donor must be informed" by a trained requester of the option to donate organs or tissue, the report said.

Mr. Harris accepted all of the recommendations, including one that the Ontario government urge the federal government to make living donors eligible for employment insurance while they are convalescing after surgery.

``Through organ donation, you can and do get something positive from a very negative situation,'' she told a news conference at the Hospital for Sick Children yesterday.

Only weeks before his death, 10-year-old Ryan watched his father filling out his organ-donor card. The youngster was so impressed that an individual could help others by donating organs upon their death, he encouraged others to sign their cards.

The number of donors in Ontario is expected to double by the year 2005 with the help of new initiatives announced yesterday by the province and hailed by Doige and other donor families and recipients.

A plan to automatically target individuals declared brain dead as potential donors gives renewed hope to the 1,720 Ontarians waiting for transplants.

Under legislation to be introduced this fall, hospitals will have to report all brain deaths to a newly created central agency to determine if organs are suitable for transplantation.

Brain dead individuals on ventilators in intensive-care units will be kept on life support while officials discuss the delicate issue of harvesting organs with family members.

Premier Mike Harris made the announcement yesterday, saying the current organ-donation system is ``too complex'' and is failing to meet the growing demand for transplants.

``It's a system that we are determined to fix,'' he told a news conference at the Hospital for Sick Children.

``We're taking steps today to make sure we have an organ donation system in Ontario that works for donors, that works for their families and works for those needing life-saving transplants,'' he said.

The proposed system, known as ``routine referral,'' is aimed at doubling the organ-donor rate by 2005. Ontario hospitals harvested organs and tissue from 150 donors last year and the province wants to increase that number to 300.

``We're not talking huge numbers,'' said Maria Kjerulf, a clinical nurse specialist who sits on the Premier's advisory board on organ and tissue donation.

She explained that while more than 83,000 people died in Ontario last year, only a small fraction of them would have been eligible donors because they were not first brain dead.

``The problem right now is donors are not getting identified,'' she said, noting that many of those who are brain dead are never considered for transplantation.

``Routine referral is just a system whereby organ and tissue donation opportunities are identified so that they can be evaluated as to whether they are going to be pursued or not,'' she said.

The province will create the Trillium Gift of Life Network, which will serve as a central co-ordination agency for transplants. Hospitals will be required to notify the network of patients who are brain dead.

Hospitals will also be required to keep those patients on ventilators unless they are aware of any opposition to donation.

A donor co-ordinator from the network will then go the hospital and meet with the patient's family and present the option of organ donation.

``Whatever the family decides, we will support that decision,'' said Kjerulf, who co-ordinates organ and tissue donation at St. Michael's Hospital.

``I've spent four or five hours with a family and then they've said, `No,` and that's okay. I've spent 20 minutes with other families and they agreed right away,'' she said.

``It depends on how the family is dealing with the crisis and what they are ready to hear,'' she said.

It takes about 12 hours from the time a person is declared brain dead to the time organs are harvested, Kjerulf said. But the process can take up to 24 hours, she noted, adding that some families need more time to make a decision.

British Columbia is the only province in Canada with a system of routine referral. It targets brain-dead patients aged 75 and under.

``It has made a difference - our cornea and tissue donations have increased five-fold,'' Sally Greenwood, communications manager of the B.C. Transplant Society, told The Star's Elaine Carey.

Most deaths of patients in hospital are eligible to donate corneas and tissue but only 3 per cent are eligible to donate organs because the death must occur while they are hooked up to a ventilator.

That only occurs in strokes, aneurysms or severe head trauma accidents where the patient would be connected to a ventilator as part of the treatment, Greenwood said.

Ontario is still drafting criteria on organ procurement, including targeted age group.

It's expected to take 18 months to decide on the criteria and enact the new law.

The province will increase funding for organ donation to more than $120 million from $47 million by 2005. Part of the money will be used for an advertising campaign to get Ontarians talking about organ donation so they make their intentions known to their relatives, Harris said.

``The goal is to try and reach all Ontarians before brain death. . . . A large part of this is about encouraging family members to talk about this now, today, while people are healthy,'' he said.

The Premier offered assurances that organ donation will always be the decision of families.

``No organs will be kept over objections of family members. Family members will have the last say,'' he said.

Currently in Ontario, there are 14.1 donors per million population. This compares to 33.8 in Pennsylvania. Routine referral is legislated in the United States.

In Pennsylvania, the first state to bring in legislation in 1994, organ donations have increased by 63 per cent, largely because of mandatory reporting, said Howard Nathan, president of the Gift of Life Donor Program in Philadelphia.