Inside the walls of Sudbury’s Health Sciences North, every new nurse receives a 30-minute training session on organ donation. Every death is reported to the provincial agency that oversees transplants. And a few times every week, a donation co-ordinator – an experienced and compassionate nurse who is the hospital’s ace in the hole when it comes to donation rates – joins morning rounds in the intensive-care unit to make sure no potential donors are overlooked.
It’s a system that, combined with the Sudbury area’s impressive donor-registration rates, has helped make Health Sciences North a positive outlier at a time when the number of Canadians whose organs were donated after death has taken its first drop in a decade.
In 2018, organs from 762 deceased donors were given to grievously ill patients, down from 803 in 2017, according to a new report that also revealed Canada’s deceased donor rate fell to 20.6 per million in 2018, lower than in the previous two years.
The national figures from the Canadian Institute for Health Information (CIHI,) released on Thursday, are certain to provoke more introspection about how Canada can do better – especially when four provinces are already trying to do that by passing or considering laws that would make organ donation automatic unless people pro-actively opt out.
But organ-donation rates can be increased in other, less controversial ways.
For a how-to guide, policy makers might want to look to Health Sciences North, which has managed to consistently “convert” more suitable donors into actual donors than most other large hospitals in Ontario, the province that runs neck and neck with British Columbia for the highest deceased donor rate in Canada.
A medically suitable, or potential, donor is usually a person in good health who is on life support after a fatal brain trauma. Even for registered donors, families have the final say.
“It’s all about minimizing missed opportunities,” said Bhanu Nalla, an intensive-care doctor and the lead physician for the organ donation and tissue transplantation committee at Health Sciences North.
That philosophy, and making donation part of the hospital’s culture, has helped Health Sciences North exceed the provincial targets for conversion rates for at least the past five years.
In 2018-19, the Sudbury hospital’s conversion rate was 92 per cent, meaning the families of 12 of the 13 medically suitable donors who died in the intensive-care unit agreed to donate their loved one’s organs.
The provincial average was 58 per cent.
The year before, in 2017-18, Health Sciences North achieved a 100-per-cent conversion rate. The three years before that, the conversion rates were 67 per cent, 69 per cent and 91 per cent, well above the provincial average.
The performance of Health Sciences North can be tracked because Ontario is the only province with a central agency, the Trillium Gift of Life Network, that reports conversion rates and related metrics to hospitals and the public.
“That creates a great deal of urgency and accountability for hospitals,” said Ronnie Gavsie, president of the Trillium Gift of Life Network. “Public reporting is a tremendously powerful tool."
The Ontario numbers are also a reminder of just how few medically suitable donors die in the 69 Ontario hospitals or hospital networks with life-support facilities.
Many smaller hospitals see only one or two potential deceased donors a year, meaning their conversion rates can swing from 100 per cent in one year to zero in the next.
At Health Sciences North, a 490-bed hospital that serves an area of about 600,000 people, the number of medically suitable donors is in the high single digits or low teens every year.
Another powerful tool for converting potential donors, Ms. Gavsie said, is Ontario’s 58 physician organ-donation leaders and Trillium’s 88 co-ordinators, most of them nurses embedded in hospitals.
She pointed to Health Sciences North’s veteran co-ordinator, Pam Nicholson, as a reason for the hospital’s success.
Ms. Nicholson, who has held the job for 13 years, approaches grieving families with care. She introduces herself and determines whether the family is ready to talk about organ donation. Have they eaten? Slept? How long have they been at the hospital? Are they waiting for other relatives to arrive?
“Then, typically," Ms. Nicholson said, "I would ask them to tell me about their loved one and we would have a conversation about the person that’s in the bed in the ICU.”
For Nancy Griffin, speaking with Ms. Nicholson about her husband, Rich Griffin, who had a hemorrhagic stroke at the age of 52 in 2015, provided some comfort.
“It didn’t feel obtrusive or demanding,” Ms. Griffin said. “She was very respectful, very empathetic.”
More importantly for Ms. Griffin, her husband, a popular morning radio host, had expressed a desire to donate.
“I could hear his voice in my head when I was filling out the forms,” Ms. Griffin said, recalling how she scanned the paperwork to decide which of her husband’s organs to donate. “I could hear him saying, ‘Yeah, check the whole thing. What am I doing with it?’ "
Sudbury’s 56-per-cent registration is among the highest in Ontario, thanks in part to the local Irish Heritage Club, which for more than two decades has drummed up support through presentations at schools and registration drives outside Dairy Queens and at St. Patrick’s Day dances.
The traditional approach of urging people to be organ donors would be turned on its head in places that embrace presumed consent. In Nova Scotia, a law is set to take effect next year under which everyone is presumed to be a potential donor unless they actively opt out. Alberta, Quebec and Prince Edward Island are considering following suit.
Another way to boost organ donations, Ms. Gavsie said, would be to beef up hospital-level co-ordination, tracking and public education.
Ontario’s deceased donor rate was 23.2 per million last year, according to CIHI, down slightly from the year before, but still well above the rate in Atlantic Canada (14.1 per million) Alberta, the Northwest Territories and Yukon (16.2 per million) and Quebec (19.5 per million.)