Organ donation practices in Canada could do more to improve health and save lives

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Organ donation practices in Canada could do more to improve health and save lives

December 18, 2014—An estimated two-thirds of deceased patients who are eligible to donate organs in Canada do not make it through the complex organ donation process to help the 4,612 people on wait lists across the country, according to a new study by the Canadian Institute for Health Information (CIHI).

The study, Deceased Organ Donor Potential in Canada, examines data on more than 100,000 hospital deaths a year. The report finds significant variation across Canada in terms of the ratio of potential to actual donors, the organ donation practices of the provinces and between teaching and community hospitals.

“Organ donation is a complex process, which involves identifying potential donors, getting consent from the families and procuring the organs around the time of death,” said Kathleen Morris, director of Health System Analysis and Emerging Issues. “While it may not be possible to convert every potential donor, the data suggests that Canada can go further in improving the health or saving the lives of Canadians waiting for organ transplantation.”

Among the provinces, Quebec had the highest deceased organ donor conversion rate in Canada, at 21% of eligible deaths—nearly double that of all the Prairie provinces. Quebec also accepted the highest percentage of donors older than 60, at 34%. In contrast, the Prairies were among the lowest users of donors older than 60.

Even after adjusting the numbers to provide the most conservative estimates at the Canada-wide level, the study finds that two-thirds of potential donors younger than 70—approximately 1,050 a year—did not result in transplants. Each deceased donor provides 3.4 organs on average, which suggests that 3,577 organs could have been available for transplant if donors were better identified and managed through the appropriate steps of organ donation.

The study identifies 2 areas where there is strong potential to increase the number of donors and where there is wide variation in practice across Canada: donation after cardiocirculatory death (DCD) and older donors.

DCD—also known as non-heart-beating death—involves patients who have no chance of recovery and are expected to die imminently. In Canada, historically, most transplantable organs came from patients who were declared dead by neurologic criteria, i.e., brain death. With organ shortages worldwide, many countries have expanded organ donor practice to include DCD-originated organs. In Canada, however, this practice has been adopted by only certain provinces since 2006.

The study reports that as of 2012, there were 5 Canadian provinces practising DCD:

  • British Columbia (13%)
  • Alberta (3%)
  • Ontario (24%)
  • Quebec (4% )
  • Nova Scotia (6%)

The study also finds that Canadian health care teams are more likely to identify and procure organs from younger donors than from older donors. There was significant international and provincial variation in the number of donors older than 60:

  • Overall, 23% of Canadian donors were older than 60 between 2008 and 2012.
  • Up to 45% of deceased donors in Spain were older than 60 in 2009. Spain is a world leader in deceased organ donation, with the issue of organ donation central to its end-of-life care practices.
  • Within Canada, Quebec had the highest percentage of donors older than 60, at 34%, followed by Nova Scotia, at 26%.
  • In contrast, fewer than 10% of deceased donors in Alberta and Manitoba were older than 60.

The study suggests that community hospitals may be an important source of donors:

  • In Ontario, teaching hospitals were 60% more likely to convert potential donors into actual donors than community hospitals. However, 54% of potential donors identified in the study died in community hospitals. The study makes this comparison for Ontario only, where comprehensive organ procurement data is mandatory and available for analysis.
  • A separate Quebec study published by the Collège des médecins du Québec found similar results: close to a third of potential donors died in non-teaching hospitals without trauma units or donor coordinators.

“What this study clearly identifies is that while there have been some improvements, provinces and regions need to increase collective investment and effort to address the critical demand for organs,” said Dr. Sam Shemie of Montreal Children’s Hospital and a key advisor for the study. “No willing donor should ever have his or her wishes unfulfilled.”



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