Ontario hospitals are transplanting organs from only about half of the deceased patients who would be medically eligible to donate, according to a report that reveals for the first time how individual hospitals are contributing to the province’s organ-donation rate.
New figures released Monday by Trillium Gift of Life Network, which co-ordinates deceased donations in the province, show that Ontario hospitals managed to “convert” 52 per cent of potential donors into actual donors between April and December of last year, short of the provincewide goal of 63 per cent.
Hospitals in the Greater Toronto Area fared particularly poorly, with an average conversion rate of just 43 per cent. The network is now planning a slew of efforts to increase conversion rates, especially in Toronto and its suburbs.
The new report marks the first time any Canadian province has released conversion rates by hospital, said Ronnie Gavsie, the president and CEO of Trillium Gift of Life Network, and the hope is that making each facility’s performance public will reward the standouts and spur the laggards to do better.
Increasing conversion rates is important because opportunities for organ donation are so rare, and so many are waiting in line.
At the end of 2012, there were 4,432 people waiting for organ transplants in Canada, the vast majority of whom needed a kidney, according to the Canadian Institute for Health Information.
The institute said 230 Canadians died waiting for organs the same year.
Less than 3 per cent of people who die are medically suited to give away their heart, liver, lungs or other major internal parts. At the start of the nine-month period covered by the report, only 42 of Ontario’s more than 150 hospitals have the critical-care equipment necessary to keep oxygen flowing through a dead person’s body, preserving the organs until they can be retrieved for donation.
Today, 56 of Ontario’s hospitals have that capability and all will be required to report potential donors to TGLN by the end of this year.
There are a handful of reasons potential donors do not become actual donors, Ms. Gavsie said. Some hospitals do not notify her network quickly enough to facilitate a transplant, she said.
The report showed that, on average, the 42 designated hospitals reported potential organ donors to the network 93 per cent of the time. The target is 100 per cent. But that indicator only measures whether hospital staff reported the potential donor, not how swiftly they shared the news.
Another challenge is persuading family members to approve organ donation when the loss of a loved one is fresh and emotions are raw.
“I think consent itself is imperative for there to be conversion and the biggest driver of consent is registration,” Ms. Gavsie said. “If this person has registered a wish to be an organ donor and there is proof of that wish given to the family, we are more likely, in fact highly likely, to get family consent. Whereas if we don’t have any proof of what the individual wanted, that rate of consent, or conversion, goes down dramatically.”
Ontario defines a successful conversion as a case in which a deceased person’s organs are successfully transplanted into a patient in need. If, for example, a snowstorm grounds the helicopter that was to deliver a retrieved heart, that instance would not count as a conversion, Ms. Gavsie explained.
The report divides the 42 hospitals into regions. Outside the GTA, the conversion rate was 61 per cent for the southwestern region, 60 per cent for the northern, 71 per cent eastern and zero for the Simcoe-Muskoka region, which saw just one potential donor during the 9-month period covered by the report.
Within the GTA, conversion rates vary widely. The Rouge Valley Health System in Scarborough and West Durham, for example, converted just 3 of 15, or 20 per cent of potential donors.
The William Ostler Health System, made up of hospitals in Brampton and Etobicoke, converted 7 of 21 potential donors for a rate of 33 per cent.
St. Michael’s Hospital in downtown Toronto boasted one of the best conversion rates during the nine-month period. It converted 24 of 29 potential donors, a success rate of 83 per cent.
Andrew Baker, the chief of critical care at St. Michael’s, said the hospital has made a concerted effort to improve its organ-donation rates, something that required a profound culture change among the staff.
“That change in culture doesn’t just happen by accident. It needs to be deliberate,” Dr. Baker said, adding it can be a challenge to find the time and resources to focus on organ donation if the leadership isn’t there.
“In a busy hospital, where there’s pressure for the operating room, [it can be difficult] to say, ‘We want to use the operating room now for three or four or five hours to retrieve organs for patients we can’t even see.’ And the patient in front of us has died, of course.”
Trillium Gift of Life Network is planning to put a physician in charge of the donation program at all 42 designated hospitals; implement a new process to speed up referrals; and train the network’s staff to deal more sensitively with recent immigrants, who have historically low donation rates.
This article has been updated to reflect current numbers of critical-care equipment available in Ontario since the publication of a report from Trillium Gift of Life Network.