Annual statistics on organ replacement in Canada, 2011 to 2020

• Canada’s deceased donor rate in 2020 was 19.2 donors per million population. Although this represents a 12% decrease compared with 2019 (most likely due to the pandemic), it is a 28% increase since 2011.
• Canada’s living donor rate in 2020 was 12.9 donors per million population. This is a 21% decrease from 2019 (most likely due to the pandemic) and is the lowest rate in the last 10 years.
• A total of 2,594 solid organ transplants were performed in Canada in 2020. This is a decrease of 14% since 2019 (most likely due to the pandemic) but an overall increase of 22% since 2011.
• In 2020, a total of 41,670 Canadians (excluding Quebec) were living with ESKD, an increase of 31% since 2011.

In 2020 alone, 208 people per million population began renal replacement therapy to treat ESKD, an increase of 16% compared with 2011. Trends in ESKD treatment over the last 10 years (excluding Quebec) include the following:

• There was a 16% decrease in the proportion of patients with late referral, defined as being seen by a nephrologist less than 90 days before starting dialysis (from 30% in 2011 to 25% in 2020).
• Initial treatment of ESKD shifted from 2011 to 2020, with a 33% increase in home dialysis, a 7% decrease in institutional dialysis and a 17% decrease in pre-emptive kidney transplantation. 2020 treatment options may have been affected by the COVID-19 pandemic; please see below for more information.
• Adult patients (age 18 and older) waited less time for deceased donor kidney transplants, with the average duration on dialysis prior to transplantation decreasing 8% between 2011 and 2020 (excludes pre-emptive kidney transplants).
  • In 2020, adult patients spent an average of 3.9 years on dialysis before receiving a deceased donor kidney and 1.5 years before receiving a living donor kidney (excludes pre-emptive transplants).
• Based on 2020 data, 83% and 90% of deceased and living donor grafts survived at least 5 years, representing essentially no change compared with 2011 (82% and 90% survival for deceased and living donation, respectively).

While ESKD statistics currently exclude Quebec due to under-reporting starting in 2011, Quebec did resume dialysis data submission to CORR in late 2020 and will be included in future CORR reports.

For patients with terminal organ failure, transplantation offers improved quality of life and survival. Transplantation can occur only in parallel with organ donation, an area where Canada continues to steadily improve. However, despite these improvements in organ donation numbers, the demand for transplantation still outweighs available organs donated. This results in lengthy wait times for patients with terminal organ failure.

Table 1 Number of donors, by donor source and year, Canada, 2011 to 2020

Notes
* Donation (in particular, living donation) was affected by the COVID-19 pandemic; please see below for more information.
^† For related and unrelated living donation values, Quebec is not included due to under-reporting from 2012 to 2020; total living donation values do include Quebec.
N: Number
Source
Canadian Organ Replacement Register, 2021, Canadian Institute for Health Information.

Table 2 Status of adult and pediatric solid organ transplant wait-lists in Canada as of December 31, 2020

Notes
* Includes single and en bloc kidney transplants.
† Includes whole, islet and segment pancreas transplants, and pancreas–kidney combination transplants.
‡ Total includes intestine and combination transplants.
N: Number
This table provides national-level aggregate data (as reported in CORR’s e-statistics); numbers might not match record-level data that is presented in the companion data tables.
Source
Canadian Organ Replacement Register, 2021, Canadian Institute for Health Information.

The COVID-19 pandemic has placed an unprecedented burden on Canadian and global health care systems. This has resulted in the shifting of priorities and resources to address the surge of critically ill COVID-19 patients, with impacts being experienced by Canada’s organ replacement, donation and transplantation programs (including an overall decrease in organ donations and the postponement of most living donor kidney transplants Reference 11).

Dialysis

• There was a 6% increase in home dialysis between 2019 and 2020 (excluding Quebec).

Organ donation

• Between 2019 and 2020, there was a 15% decrease in total organ donations across Canada.
  • There was a 20% and 7% decrease in donation after cardiocirculatory death (DCD) and after neurological determination of death (NDD), respectively, across Canada.
  • There was a 29% and 10% decrease in unrelated and related living donation, respectively (excluding Quebec).

Organ transplantation

• In Canada, organ transplants decreased 14% between 2019 and 2020.
• Pre-emptive kidney transplants decreased 18% between 2019 and 2020 (excluding Quebec).

Table 3 Difference in solid organ transplantation in Canada (excluding Quebec) between 2019 and 2020

Notes
* Includes single and en bloc kidney transplants.
† Includes whole, islet and segment pancreas transplants, and pancreas–kidney combination transplants.
‡ Total includes intestine and combination transplants.
N: Number
This table provides national-level aggregate data (as reported in CORR’s e-statistics); numbers might not match record-level data that is presented in the companion data tables.
Source
Canadian Organ Replacement Register, 2021, Canadian Institute for Health Information.

Organ donation and transplantation numbers often fluctuate, and not all trends observed may be due to the pandemic. Reference 11 However, many of the above statistics were showing consistent increases in trending over the past 10 years (including NDD and DCD numbers, and lung and kidney transplant numbers) before the start of the pandemic in Canada in early 2020.

End-stage organ failure is complex, with treatment options and donation practices/processes continuously evolving to optimize outcomes. By collecting and reporting on data in an ongoing and systematic way, CORR can assist with decision-making to monitor system performance and drive improvements.

• Canadian Organ Replacement Register (CORR)
• Organ replacement in Canada: CORR annual statistics, 2021
• e-Statistics on organ transplants, waiting lists and donors (July 2021)
• Data Quality Documentation for Users: Canadian Organ Replacement Register, 2011 to 2020 Data
• Archived reports