Craig Johnston, organ and tissue donation co-ordinator with Trillium Gift of Life Network carries blood samples from a dying patient to match organ transplants with recipients at Sunnybrook Critical Care Unit.Moe Doiron/The Globe and Mail
Canada's overall organ donation rate is up over the last decade, but the country is still falling short of other wealthy nations and its own transplantation goals, according to a new report from Canadian Blood Services.
Canada's deceased donation rate is now 18.2 per million people, up 29 per cent from 14.1 per million people in 2006.
"While that is gratifying, it's clearly not enough," said Sam Shemie, a critical care doctor at Montreal Children's Hospital and a medical advisor to Canadian Blood Services.
Canada has yet to reach the CBS's target of 22 deceased donors for every million people – a goal set five years ago – or to come close to the high watermark achieved by world-leader Spain, which boasts a deceased donation rate of nearly 40 per million.
Still, the modest increase from 460 deceased donors in 2006 to 651 last year now puts Canada "among the top 20 in the world," Dr. Shemie said.
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The trend for living organ donations was not as encouraging. They fell by 8 per cent between 2006 and 2015.
Canada managed to stave off the steeper decrease in living donations seen in some other countries, such as Australia, by beefing up its Kidney Paired Donation program, said David Landsberg, director of the renal transplantation program at St. Paul's Hospital in Vancouver.
The cross-Canada matching effort led to 391 kidney transplants from living donors between 2009 and 2015.
"Our [living donation] rate is flat, but when you look at the rest of the world ... you can see that we're actually doing quite well," said Dr. Landsberg, who also chairs the Living Donation Advisory Committee for CBS.
The Canadian Blood Services report, released Friday, attributed the increase in deceased donations largely to a recent policy change that allows organs to be donated after cardiac death, not just brain death.
Donations after a patient's heart stops beating now account for 21 per cent of total deceased donations. That figure is even higher in Ontario and B.C., two of the four provinces that posted deceased donor rates above 20 per million people. The others were Quebec and Nova Scotia.
The report says standout provinces like Ontario and B.C. have also made important improvements on the ground, including appointing donation physicians at hospitals and making it mandatory for hospitals to alert provincial donation co-ordinators of potential deceased donors.
Saskatchewan, which posted the lowest deceased donor rate in the country last year, has yet to mandate either of those changes or to fully implement a donation-after-cardiac-death program, the report says.
Earlier this year, a Conservative MP from Edmonton proposed a private member's bill that would have created national legislation for transplantation, including a national intent-to-donate registry. The Liberal government killed the bill before a committee could study it.
"Canadians cannot be happy," with the country's patchwork system for organ donation, said Philip Halloran, former editor-in-chief of the American Journal of Transplantation and director of the Alberta Transplant Applied Genomics Centre.
Dr. Hallaron supported the private member's bill from Ziad Aboultaif, whose son, now 24, underwent three liver transplants, because he believes a national regime could save more lives.
Individual provinces handle transplants as part of their health-care systems. Canadian Blood Services, whose main job is managing the country's blood supply, operates the Canadian Transplant Registry, which provides real-time data for organ listing and sharing across provincial boundaries.
Mr. Aboultaif's bill might have established something more: A national intent-to-donate registry that would have allowed Canadians from every province to make their wishes for organ donation known.
The CBS said it may look at a establishing a national intent-to-donate registry in the future, but for now its focus is on bringing the lagging provinces up-to-speed with their better performing counterparts.
More than 4,600 patients in Canada are currently waiting for organs.
Kelly Grant