New CIHI study highlights that Canada needs to retrieve more organs for transplants

Dec 23 2009

The availability of donated organs in Canada rose by more than one-quarter (28%) over the past decade, but this increase is not keeping pace with demand. More than 1,000 Canadians donated organs in 2008, up from 812 in 1999, according to a new study released today by the Canadian Institute for Health Information (CIHI). With an increase in the number of Canadians with organ failure, combined with medical advancements that are keeping these patients alive longer, the results show an increase in the demand for organs.

CIHI's study, Organ Donor Activity in Canada, 1999 to 2008, found the gap between supply and demand is increasing for kidney transplants. Over the last 10 years, there was a decline in the number of kidney transplants in Canada relative to the number of kidney failure patients, with 6 kidney transplants per 100 patient years of dialysis in 2008, compared to 8 kidney transplants per 100 patient years of dialysis in 1999(1). Canadians with end-stage renal disease (or kidney failure) are typically treated with dialysis before a kidney becomes available for transplant. Dialysis is a renal replacement therapy that cleans the blood and removes wastes and excess water from the body.

"Our study shows that despite a significant increase in the number of kidney donations over the past decade, we are no further ahead when it comes to meeting demand," says Jean-Marie Berthelot, Vice President of Programs at CIHI. "This is partly due to a rise in diabetes-related kidney failure cases in Canada. With obesity on the rise in the country, the number of new patients with end-stage renal disease associated with diabetes has nearly doubled over the past decade, from about 1,000 new cases in 1996 to nearly 1,900 in 2008."

Living donors accounted for more than two-thirds of the increase in available organs; deceased donor rates not rising as quickly

The number of living donors has exceeded the number of deceased donors for the past 8 years and accounts for 69% of the increase in donors over the past decade. A living donor can only donate one organ or part of a liver or lung, and living donors are most commonly used in kidney transplantations. During the study period, the greatest relative increase in the use of living donors was seen in partial-liver transplantation.

In contrast, the rate of deceased donor organs has not risen as quickly. A deceased donor can provide up to six organs for transplantation. On average, however, 3.6 organs per deceased donor were transplanted in 2008.

"The need for transplantable organs has never been greater," explains Dr. John Gill, Associate Professor of Medicine, University of British Columbia - Division of Nephrology at St. Paul's Hospital in Vancouver. "The option of organ and tissue donation should be offered to all patients who die in Canadian hospitals and should be incorporated as an essential component of end-of-life care."

"In 2008, there were 492 deceased donors, which is surprisingly low given the number of eligible deaths that occur in Canada annually and falls well behind international standards," says Dr. Sam Shemie, Medical Director (Donation), Organs and Tissues, Canadian Blood Services. "People who die after catastrophic brain injuries, such as trauma and strokes, typically provide the largest proportion of deceased donors in Canada. As mortality rates from these injuries are reduced, hospital services must become more effective and efficient in identifying and managing donors in order to increase the number of transplants. Public health policies to encourage people to express their wishes to be organ donors will also help improve the situation."

Last year, about 215 Canadians died while waiting for an organ transplant.

Living donors most likely to be relatives, increasing in age

CIHI's study found that living donors are most likely to be relatives and family friends who have a close relationship with the recipient. Blood relatives accounted for almost two-thirds (64%) of living donors in 2008, while spouses accounted for 16%. In addition, one in six (17%) living donors were unrelated to the recipients.

This year's study also found an increase in the average age of living donors in Canada. While most living donors are younger than 55 years of age, the greatest increase in the number of living donors occurred in the 55-and-over age category, which experienced a 61% increase.

Technological advancements are changing the scope of organ donation

While most organs are retrieved after a patient is deemed to be brain dead, referred to as neurological death, four provinces (British Columbia, Ontario, Quebec and Nova Scotia) are now retrieving organs for donation after cardiac death. Cardiac death is defined as the irreversible absence of circulatory and respiratory function. The number of organ donations following cardiac death is growing, but still remains quite small. In 2008, fewer than 10% of donors were donors after cardiac death.

"We are seeing an increase in the number of donated organs, along with changing demographics of donors and technological advancements leading to donation following cardiac death," says Claire Marie Fortin, Manager of Clinical Registries at CIHI.

Source: CANADIAN INSTITUTE FOR HEALTH INFORMATION