The number of organ donations from deceased Canadians has surged in recent years, boosted by improvements in the organ donation system, such as having specialized hospital staff to identify and refer potential donors, according to new data released on Thursday by the Canadian Institute for Health Information (CIHI) and Canadian Blood Services.
But the national deceased organ donation rate still lags other countries such as the United States and Spain.
"The organ donation system used to be poor. It's getting better. We're gratified," says Sam Shemie, medical adviser for deceased donation at Canadian Blood Services. "But there's great room for further improvement, and the question going forward will be how to get there."
The national deceased organ donor rate increased to 20.9 donors per million population in 2016, up 42 per cent since 2007. Ontario, Quebec and B.C. led with the highest deceased donation rates in the country. In total, 758 deceased donors were recorded in Canada in 2016, up 17 from the previous year.
These new numbers were published in three separate reports: Canadian Blood Services' Donation and Transplantation Interprovincial Programs Report, and its Organ Donation and Transplantation Report: System Progress Report; and CIHI's Canadian Organ Replacement Register Annual Statistics.
In spite of the increase, the deceased organ donor rate falls shy of the target of 22 donors per million population, established in a 2011 national strategy developed by various organ donation organizations and Canadian Blood Services. It also stands far below Spain's deceased organ donor rate of 43.4 per million population and the U.S. rate of 31 per million population.
In 2016, 260 patients died in Canada while waiting for a transplant. The reports also showed an 11-per-cent decline in living donations since 2007. In 2016, there were 544 living donors.
Dr. Shemie, who is an intensive care doctor at the Montreal Children's Hospital, McGill University Health Centre, says the latest data reflect improvements, particularly in the past five years, in the way deceased organ donations are managed in Canada. These measures include ensuring that hospitals have nurse co-ordinators, intensive care doctors and other staff who are specialized in organ donation; that potential donors are identified and referred to organ donation organizations; and that families are routinely approached about the option to donate. A major factor has also been an increase in donations after circulatory death, where patients are not brain dead but will not survive.
Dr. Shemie says continued improvement in the organ donation system will require co-ordination between federal and provincial governments and health-care agencies, and investment in the implementation of best practices.
Although anecdotal reports suggest deaths from the opioid epidemic may be contributing to the number of organ donations, the national numbers do not capture how many donors died from opioid overdose.
"We have heard from practitioners out there and in emergency departments that that is happening," says Juliana Wu, manager for the Canadian Organ Replacement Register at CIHI. However, she says, the data do not include the causes of donor deaths.
In B.C., the proportion of organ donors who died from drug overdoses appears to have increased in the past few years, BC Transplant said in an e-mailed statement. "Donors whose toxicology drug screens tested positive for different drugs in their system at the time of hospital admission have increased as a proportion of the total number of donors," it said.
In Ontario, however, the increase in deceased organ donors has been a result of measures such as mandatory referrals from hospitals, rather than opioid-related deaths, says Jennifer Long, communications adviser for the Trillium Gift of Life Network, the agency responsible for organ donation in that province.
Over the past five fiscal years, the proportion of organ donors who have died from drug overdose in Ontario has remained constant at around 3 per cent to 5 per cent, Ms. Long says.
"I understand other provinces or jurisdictions in the states had experienced an increase in organ donation as a result of opioid-related deaths, but in Ontario, that hasn't been the case," she says.
Similarly, in Alberta, the proportion of deceased organ donations from individuals who have died from drug overdose has remained relatively flat, hovering within an average of 8 per cent and 11 per cent between 2013 and 2016, according to Alberta Health Services.