Blueprint provides national strategy for boosting organ donations, transplants

TORONTO - Canada must do better to help its citizens receive life-saving and life-enhancing transplants, says Canadian Blood Services, which released a blueprint Wednesday for boosting organ and tissue donations across the country.

The blueprint includes 25 recommendations on how provinces and territories can work together to create a national strategy to improve Canada's transplantation rate.

If implemented, the plan "would result in a 50 per cent increase in the number of organ transplants in Canada and a doubling of the number of tissue donors — saving and improving the lives of thousands of Canadians," said Dr. Graham Sher, CEO of Canadian Blood Services (CBS).

The demand for donor hearts, kidneys and other organs, as well as tissues like bone and skin, far outstrips the supply, Sher said from Ottawa.

"In Canada, we have seen stagnant performance for over a decade in organ and tissue donation and transplantation," he said. "Today, we do not meet the needs of Canadian patients. And with advances in medicine and an aging population, the demand for organ and for tissues will only increase.

"Almost every day and a half, someone in this country dies while waiting for an organ transplant."

In 2010, the latest year for which statistics are available, more than 4,500 Canadians were on the waiting list for donor hearts, livers, kidneys and lungs. But only 2,150 organs were available for transplant and close to 250 people died while waiting for a replacement organ.

Having no national integrated system means inequitable access to donor organs and tissues across the country. Wait times for organ transplants in some parts of Canada are two to three times higher than in some other regions.

Dr. Peter Nickerson, CBS medical director for transplantation, said provincial and territorial donation levels fluctuate.

"We've gone from Alberta having one of the highest donation rates a decade ago to down to one of the lowest donation rates, in the five to seven per million (population) range," he said.

Ontario has improved its rate to 15 per million residents from about 10 per million a decade ago; Manitoba had a donor rate as low as five per million in 2005, but in 2010, that figure had risen to 15.4 per million.

"Nova Scotia has had peaks of having 25 donors per million, but they've consistently been in the sort of 17 to 25 range," Nickerson said, adding that improved donation rates usually reflect increased government investment in organ procurement programs.

"But the point is, even at 15 we're not doing enough. The U.S. is at 26 (per million). It's exciting to say you've gone from 10 to 15 or 17, we're all encouraged that we've done that," he said. "But all you're saying is we're at the better part of mediocrity.

"What we really want to say is we're making a system change, we're making a transformational change that will see us performing as one of the top countries in the world."

The reasons that Canada lags other countries are many and varied, said Sher.

"Why have some Canadians who have consented to be organ and tissue donors not been provided the opportunity to donate?" he asked. "Because their family wasn't asked? There were not enough intensive-care beds or operating room time? Or because it wasn't simple enough to confirm their donor status?

"Why are some people living with blindness today because they can't get access to a corneal transplant? The lack of co-ordination in eye and tissue banking results in inconsistent approaches to quality ... and an insufficient supply of tissues with widespread inefficiencies across the health system."

Sher said more than 80 per cent of tissues — such as bones, tendons, skin and heart valves — transplanted into Canadians come from the United States. If implemented, the strategic plan would also aim to improve tissue donations within Canada to reduce dependency on fluctuating foreign sources, he said.

Canada trails several other industrialized countries in organ donation rates. Spain and the United States, for instance, have organ donor rates at least double that of Canada.

"Canada can and must do better," said Sher.

Provinces and territories, which are unanimous about the need for a national strategy, will assess the blueprint over the next year before deciding how to incorporate some or all of the recommendations, he said.

One consideration will be cost.

Canada will spend about $5.6 billion in the next 10 years if transplant levels remain static. Investing another 15 per cent would increase the number of transplants by 50 per cent, Sher calculated.

Over 10 years, spending an extra $80 million a year would deliver more than 7,000 additional organ transplants — translating into a cost of about $100,000 per life saved or improved, he said.

The annual cost of non-organ tissue acquisition and transplantation is estimated at $40 million to $47 million. The blueprint calls for provinces and territories — excluding Quebec, which has a separate tissue bank — to jointly provide another $37 million per year.

"That will deliver a doubling in the number of tissue allografts available for transplantation in this country," Sher said. "And in excess of something like 1,100 additional corneal transplants each year."

Ronnie Gavsie, CEO of Ontario's Trillium Gift of Life Network, said while the goals of the proposed national strategy are ambitious, she is optimistic that such a program could improve overall transplant numbers in the country.

Still, it will take some time to achieve, she said.

"Right now the recommendations comprise a vision for a national strategy, but there's still a lot of work to do."