They say you can't take it with you -- but the majority of people do.

They shuffle off this mortal coil with organs and tissues that have not reached their best- before dates. Precious hearts and lungs go up in smoke while the people who need them continue to wait. And wait. And die waiting.

There are about 1,800 Ontarians on the transplant-recipient waiting list at any given time, two-thirds of them in need of a kidney. Every 2.8 days, one of them dies, says Nancy Hemrica, organ and tissue donation co-ordinator at Hamilton Health Sciences.

The tragedy is that it doesn't have to happen. The consent of just one donor can theoretically save or enhance up to 80 lives. One donor can yield eight solid organs -- heart, liver, two kidneys, two lungs, pancreas and stomach -- and as many as 80 pieces of tissue, including skin, bone, and corneas.

So why are people dying? Why does a waiting list even exist?

For one thing, there are more people in need of a transplant than are on the list. Patients don't get to the list until the 11th hour when their condition is critical.

For another, less than 2 per cent of people who die in the hospital actually meet the criteria to be a donor. Three-quarters of the 1,200 patients who die at HHS sites annually are inelegible as donors because they have died of cancer, old age, multisystem organ failure or another condition that renders them unsuitable.

From the remaining 25 per cent, take away premature babies, certain head injuries, high-risk lifestyles, death outside the controlled hospital environment, families who do not consent to donation and "you've shrunk the whole pool dramatically," says Hemrica. The numbers are reduced further by HIV or hepatitis.

Further hampering the cause is Canada's consistently poor track record in donor rates among the world's industrialized countries. The Canadian Institute for Health Information reports 13 donors per million in Canada compared to 31 per million in Spain.

Since 1994, Ontario's transplant waiting list has increased by two-thirds, a crisis that former Health Minister George Smitherman hoped to address with the Citizens Panel on Increasing Organ Donations. It found major impediments: A signed donor card can be overruled by the deceased's grieving family; some religious leaders speak out against donation, even though all the major religions officially support it; a shortage of critical care beds for organ recipients; Ontarians are confused by the Trillium Gift of Life Network name and say it provides no clue what the organization is about; they are also misinformed about the process and the protocol of organ donation.

Still, Hamilton hospitals witnessed a 60 per cent increase in organ donation from 2006 to 2007 --rising to 32 donors from the previous 20, saving or enhancing 130 lives. Hemrica attributes the increase mostly to an "amazingly high" trauma rate in 2007. "But we've been working for five years to increase public awareness -- and it has grown, people are having the discussion."

While recommendations from the Citizens Panel are being weighed, and some implemented, Hemrica says "the most important take-home message is to talk to your family" -- don't wait until circumstance creates necessity.

More information: Trillium: www.giftoflife.on.ca or 1-800-263-2833