Two-thirds of eligible organ donors in Canada don't get through process: report

This Friday, Feb. 21, 2014 photo shows Organ donation paperwork is shown at Mid-America Transplant Services in St. Louis, Feb.21, 2014. (hitney Curtis)

TORONTO -- While thousands of Canadians wait for transplants that could alter or save their lives, many potentially willing organ donors are never identified or don't make it through the complex donation process, says a report by the Canadian Institute for Health Information released Thursday.

"We know that each year, more than 500 Canadians who die in hospital donate their organs," said Kathleen Morris, director of health system analysis at CIHI. "What we found, using very conservative estimates, is that only about one-third of people who are clinically eligible to donate an organ actually become a donor."

The report said there are untapped donors among deceased patients over age 60 and among those with irreversible brain damage who are declared dead after their heart stops -- called donation after cardiocirculatory death, or DCD.

"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 Morris. "While it may not be possible to convert every potential donor, the data suggest that Canada can go further in improving the health or saving the lives of Canadians waiting for organ transplantation."

CIHI said there are more than 4,600 Canadians on waiting lists for a kidney, liver or other organ transplant. According to the latest statistics available, there were 2,124 organ transplants in 2012, but 256 people died waiting for a donor.

The report found that Quebec had the highest rate of organ donors from medically eligible deceased patients, at 21 per cent, while the Prairie provinces had the country's lowest rate at 10 to 11 per cent.

Each deceased donor provides an average of three solid organs to recipients, 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, CIHI said. Deceased patients can also provide donor tissues like corneas, skin and bone.

Despite a public perception to the contrary, there is no age limit for someone to become a donor, as long as the person's organs are healthy. In Ontario, for instance, the oldest donor to date was 93. Yet CIHI found that two-thirds of eligible potential donors under age 70 -- or about 1,050 a year -- did not result in transplants.

At 34 per cent, Quebec was the province that accepted the highest percentage of donors older than 60, while Alberta and Manitoba were the lowest users of donors 60-plus, at nine per cent each.

The CIHI report showed there is great variation in organ donation rates among provinces, but also among hospitals. Teaching hospitals are more likely to identify and secure donors than are smaller community hospitals.

"We know that people are dying on transplant waiting lists and we know the longer they wait, the more disabled they get," said Dr. Sam Shemie, an intensive care physician at Montreal Children's Hospital and an adviser for the study.

A transplant can improve quality of life, increase longevity and reduce costs to the health-care system, said Shemie, pointing out that a kidney transplant does away with the need for onerous and expensive ongoing dialysis.

"We want to save as many lives as possible and what we want to try to do is to offer all forms of donation in all places, and that currently is not the state of the system in Canada."

One of those forms of donation is DCD, which involves patients who have devastating and irreversible brain damage from a stroke, a motor vehicle accident or a cardiac arrest from which they were resuscitated, but not soon enough, he said.

DCD refers to a person with no hope of recovery being removed from life-support with the family's consent, after which their heart stops beating, resulting in death.

Historically, most transplantable organs have come from patients who were declared brain-dead. But with a worldwide shortage of organs for transplant, countries such as Spain and the U.K. have expanded organ donation criteria to include DCD-originated organs.

In Canada, however, the practice has only been in place for eight years -- in British Columbia, Alberta, Ontario, Quebec and Nova Scotia.

"What we've seen in Canada since 2006, led by Ontario, has been a progressive increase in the number of DCD cases, such that there's been around 400 Canadians who have been organ donors after DCD and well over 1,000 transplants that have occurred that could not have occurred if this option had not been available to Canadian families," said Shemie.

Ronnie Gavsie, president and CEO of the Trillium Gift of Life Network in Ontario, agreed there are not enough donors to meet the needs of patients desperate for a life-saving transplant.

As of Wednesday, there were 1,578 Ontarians waiting for a transplant; 114 died this year before an organ could be found.

Yet Gavsie said donations in the province are up 16 per cent in 2014 compared to last year, with 518 donors providing organs to 1,048 recipients.

She attributed the increase in part to the adoption of a more formalized approach to donation, a process that has continued to evolve with the addition of five regional medical leads, each of whom will help educate fellow physicians and support donation performance among hospitals in their geographic area. By this March, Trillium also hopes to have a designated "donation physician" in all 62 hospital corporations across the province.

Despite such improvements in Ontario and some other regions in the country, Shemie said all the provinces need to expand their organ donation practices to address the critical shortage of organs.

"No willing donor should ever have his or her wishes unfulfilled" and no Canadian should die on a transplant waiting list because an inadequate system has failed to identify willing donors, he said.