Health observers are questioning Quebec's withdrawal from national health initiatives like the recently launched national organ donation and transplant system.

This is not the first time the francophone province has opted out of national healthcare programs, pointed out Globe and Mail columnist Andre Picard. Quebec is not a part of the national blood collection and distribution system, the national bone marrow registry or the national Health Council of Canada. It is also not a formal partner in the Canadian Patient Safety Institute.

Most of the time Quebec sends sit-in participants to these health gatherings. At times it even gets it share of the funding, like in the $41 billion health accord monitored by the Health Council of Canada.

Quebec, though has signed up for the Canada Health Infoway and the Canadian Institute for Health Information.

When the national organ donation system was launched in the middle of August, federal, provincial and territorial health ministries pooled in $35 million to run the integrated national organ system. Aside from having one of the lowest global organ donation rates at 13 donors for every one million population, Canada was one of a few nations in the developed world which did not have a national integrated approach to organ donation until now.

The establishment of the national organ donation system was prompted by the rising number of Canadians who died while waiting for transplants.

While health is a provincial responsibility, Picard emphasizes, it does not prevent provinces from cooperating, inking alliances and creation national systems because diseases and cooperation "know no borders."