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General hospitals doing poor job of procuring transplant organs

There were a total of 1,898 organ donors: 1,118 at transplant hospitals and only 780 at general hospitals even though there was little difference in the characteristics of patients, such as their diagnosis and age.

Owen Franken/iStockphoto

Hundreds of organs that are desperately needed for transplant are being wasted each year because general hospitals are doing a poor job at procurement, a study shows.

The research, published in Tuesday's edition of the Canadian Medical Association Journal, reveals that organs are collected from five in every 100 patients with catastrophic brain injury at Ontario hospitals with transplant programs, compared with 1.4 in every 100 patients in general hospitals.

"The data suggest that there are a lot of missed opportunities," Dr. Donald Redelmeier, a senior scientist at the Institute for Clinical Evaluative Sciences and lead author of the paper, said in an interview. "We could be doing so much better."

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The researcher stressed that fingers of blame should not be pointed at general hospitals, but, rather, efforts need to be made to make procurement easier. "A request for organ donation requires substantial initiative and maintaining donor viability takes a lot of work," Redelmeier said.

In hospitals where transplants are performed – there are seven in Ontario – a culture exists where promoting donation is the norm, and staff have the training and skills to deal with these complex patients. That is not always the case in general hospitals. In practical terms, there is a lot of disincentive for procuring organs because brain-dead patients require a bed in the intensive-care unit and around-the-clock care.

"Ultimately it's institutional norms and attitudes that make the difference," Redelmeier said.

The new research shows that, from 1994 to 2011, there were 79,746 patients with traumatic brain injuries treated in Ontario hospitals; 22,515 were in transplant hospitals and 57,231 in large general hospitals. (Data from small rural and remote hospitals were excluded.)

There were a total of 1,898 organ donors: 1,118 at transplant hospitals and only 780 at general hospitals even though there was little difference in the characteristics of patients, such as their diagnosis and age.

(Organs are procured almost exclusively from patients who are brain dead because, while a person is technically dead, their other organs can remain functional.)

Researchers calculated that had the general hospitals procured organs at the same rate as transplant hospitals, there would have been an average of 121 more organ donors a year in the province.

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That is notable, particularly when you consider that there are roughly 500 organ donors a year in Canada. A donor can give up to eight organs for transplant, though the average is four.

"Organ transplantation is one of the miracles of modern medicine, but the greatest drawback is the lack of organs available for transplant," Redelmeier said. "We can't afford to miss opportunities."

The good news in the findings is that the rate of organ donation more than doubled in the study period. "Public awareness campaigns are working," Redelmeier said. "But, in many cases, organs are not being donated despite the wishes of the patient."

At the end of 2011, there were 4,543 patients waiting for organ transplants in Canada, according to the Canadian Organ Replacement Registry. Most of them (3,406) were waiting for a new kidney.

In 2011, a total of 2,124 organ transplants were performed in Canada, more than half of which were kidney transplants.

Canada's organ donation rate, 15 per one million population, is one of the lowest in the developed world.

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