There is no beating about this particular bush. New Zealand's organ donor rates are appalling. That means people die unnecessarily when they miss out on organ replacement.
That means the quality of life of many suffers when it need not. That means this country is burdened with heavy and unwarranted financial costs.
The rate of 8.1 per million is among the lowest in the world, half of Australia's, just above a third of the United States' and less than a quarter of Spain's, the world leader at 35.1 per million.
This is not a new issue. Since 2003, donor numbers have hovered below the miserly 46 reached last year. Last month, Health Minister Jonathan Coleman might have hailed the ''record'' of 46, but in fact four of those ''donors'' did not in the end donate organs.
The 46, anyway, is only six more than in 2003, albeit well up on the worst year of recent times, 25 in 2006.
Successive governments have recognised the problem, and funding for New Zealand's organ donation service has increased more than 700% to almost $2 million a year. The impact of this seems to have been negligible. Just throwing more money about is not initiating significant change.
Decisive attitude changes are required. Although about 52% of us say yes on our driver licences to being a donor, it appears this can account for little.
\Amid the trauma of death and patients on life support, it seems we are so sensitive to the family's grief that the matter of organ donation is not sufficiently or appropriately pursued.
No matter what the licence says - and that indication might not even be considered - it appears medical staff seek consent from all the family before they will extract organs. This is despite a change in 2008 which allowed for individual donors to give ''informed consent'' to at least two witnesses.
For a start, few will ever go to that trouble in advance of their sudden death. Staff also have to consider matters like the family's spiritual and cultural values. Sadly, the end result is we consign others to death and/or a more difficult life.
Some countries, such as Austria (and Wales is following suit this year), have an ''opt out'' system where it is presumed, unless otherwise stated, that you are a donor. That could well help here, although Spain has increased numbers in another way.
It has specialists who deal with the families of possible donors. They are present at hospitals and are on hand to immediately spend time with relatives and work with them.
Does New Zealand spend more money in this area, with commensurate savings to other parts of the health budget and the economy?
The donor rate in New Zealand is so low that cultural beliefs can, at most, only be part of the problem. Somewhat ironically, while Maori and Polynesian groups appear less likely to favour organ donations (donor rates on licences are much lower in more heavily Maori and Polynesian areas), they are more likely to require donations because of more common kidney failure.
Basically, attitudes need to change across all the population as well as in hospitals. If culture - Pakeha, Maori or Pacific Island - stands in the way, it has to adapt to the health needs of the modern world.
Recent waiting list figures show 640 people waiting for a kidney transplant from a deceased donor, 24 for livers, eight for hearts and 14 for lungs. Patients regularly drop off the list because they are too ill, or die.
New Zealand's donor rate, for a variety of reasons, is disgraceful. Vigorous efforts are required to change this, even sometimes at the risk of upsetting surviving families.
Our primary duty should be to help save the lives of other members of our community - even in our most acute distress.
Everyone in our society should come to expect that, when circumstances make this possible, organ donation is expected and is the right thing to do.
