Organ Donation and Transplantation in Canada 216 System Progress Report Update
Canadian Blood Services, 217. All rights reserved. Extracts from this report may be reviewed, reproduced or translated for educational purposes, research or private study,but not for sale or for use in conjunction with commercial purposes. Any use of this information should be accompanied by an acknowledgement of Canadian Blood Services as the source. Any other use of this publication is strictly prohibited without prior permission from Canadian Blood Services. Production of this report has been made possible through financial contributions from Health Canada and the provincialand territorial governments. The views expressed herein do not necessarily represent those of the federal, provincial or territorial governments. For more information, please contact: Donation and Transplantation Canadian Blood Services 18 Alta Vista Drive Ottawa ON K1G 4J Canada 613-739-234 Email: donation.transplantation.secretariat@blood.ca 2 ORGAN DONATION AND TRANSPLANTATION IN CANADA - System Progress Report 216 Update
Organ Donation and Transplantation in Canada 216 System Progress Report Update Record outcomes from organ donation and transplantation 2,93 In 216, 2,93 lifesaving or life-enhancing transplants were performed in Canada. In 216 2,83 organ transplant procedures were performed in Canada. 4,492 people on Canada s organ transplant wait-lists. 26 patients on wait-lists died before receiving transplants. 9 8 7 6 4 3 2 1 Donor and transplants per million population in Canada, 26-216 63.7 6.1 62.4 62.2 62.2 62.1 64.3 17. 14.1 Living Donors PMP Deceased Donors PMP Transplants PMP 16.8 14.7 16.4 14. 1.3 14. 16.4 13.7 1.2 1. 1. 1.6 67.2 66.3 16.6 1.7 LIFESAVING TRANSPLANTS PERFORMED FROM 78 DECEASED DONORS AND 44 LIVING DONORS 1.6 16.6 26 27 28 29 21 211 212 213 214 21 216 71.4 1.7 18.1 78.1 1. 2.9 Patients on Transplant Wait-list by Province CANADA 4,492 Transplanted Organs 31 KP 61 623 387 22 32 697 839 29 79 11 136 1731 Transplant results presented here refer only to kidney, liver, heart, lung, and whole pancreas transplants. 3 ORGAN DONATION AND TRANSPLANTATION IN CANADA - System Progress Report 216 Update
Deceased donation performance results The deceased donation rate in Canada is on par with Australia and the United Kingdom, despite Canada adopting a more conservative definition in tracking donation performance than is typically used by the international community. Canada remains at less than half of the rate shown by Spain. 4 4 3 3 2 2 1 1 Canada United States Australia Spain United Kingdom 43.4 31. 21.4 2.9 2.8 26 27 28 29 21 211 212 213 214 21 216 Canada has shown a sustained improvement in deceased donation to a degree which represents an important achievement for our country. This is the result of the collective efforts of the provincial ODO s, transplant programs, and ODT researchers including CIHR/CNTRP and intensive care units in Canada. Organ donation after death accounts for the majority of transplants; a single donor has the potential to provide as many as 8 organ transplants, with a typical donor making 3 to 4 transplants possible. * For the DPMP metric, most countries report actual donors, a figure that only requires an organ to be removed or an incision made in the operating room for the purposes of transplantation. Canada, however, reports utilized donors, a metric that requires at least one organ to have been transplanted into a patient. Annual reports on organ donation and transplantation activity issued by the National Health Service in the United Kingdom (212 21) estimate differences of between four to eight per cent when comparing actual donors and utilized donors. When comparing the utilization of donation after circulatory death internationally, Canada still does not rank among the highest rates internationally. This represents a critical area of potential for the future. DCD donors per million population Canada Australia United Kingdom Spain Canada s national deceased donation rate has increased by 42 per cent since 27, from 14.7 to 2.9 DPMP in 216, with results for 216 exceeding the rate in 21 (18.1) by 1 per cent. Despite this recent increase, the national deceased donation rate remains below the target of 22 DPMP proposed in Call to Action, a strategic plan to improve organ and tissue donation and transplantation performance for Canadians. 1.6 9.2 dpmp.3 4.8 48 NDD Donors 78 Deceased Donations 174 DCD Donors This document can be found at blood.ca 4 ORGAN DONATION AND TRANSPLANTATION IN CANADA - System Progress Report 216 Update
National performance: Continued success hinges on donation after circulatory death If Canada is to continue improving its deceased donation rate, it must increase the number of donors making donations after circulatory death (DCD). Donations made in 216 by DCD donors represent 23 per cent of the total number of donations made by deceased donors and the area of the organ donation and transplantation system with the greatest potential for growth. Deceased donation in Canada 26-216 8 7 6 4 3 2 1 4 NDD DCD 22 42 43 46 67 86 64 121 136 174 46 463 439 444 42 448 4 489 47 13 84 26 27 28 29 21 211 212 213 214 21 216 Quantitatively, DCD accounts for the largest increase in deceased donation over time and the greatest future donation potential. DCD has been implemented in of 11 provincial ODOs. Two other provincial ODOs are beginning implementation. 216 deceased donation rates by province DCD Performance among provinces varies The degree to which provincial variability in performance affects variability in national performance trends is an important consideration. In 212, the ODT community set a first-tier target of 22 DPMP, and national donation rates are presently continuing to approach that target at 2.9 DPMP in 216. Deceased donation by province 21-216 4 3 3 2 2 1 1 21 216 Deceased donation by province 21 216 (dpmp) APPROXIMATELY 1in4 DONATIONS ARE MADE THROUGH DCD BC AB SK MB ON QC NB NS NL Canada: 2.9 3 2 21 216 2 2.3 16.1 12.2 13.2 1 1 12.1 2.2 17.2 2.4 18.2 2.1 2.3 12.4 16.1 8.8 12.2 13.1 12.1 19.4 2.2 2.8 2.4 1.6 17.2 18.4 18.2 1.2 13.2 BC AB SK MB ON QC NB NS NL 216 donation rates for SK/MB based on best available data, and may overestimate provincial rate by.7-.9 dpmp ORGAN DONATION AND TRANSPLANTATION IN CANADA - System Progress Report 216 Update
Canada s living donation rate (i.e., organ donation rate by living donors) in 216 was 1. DPMP, which is down from 4% from 1.7 DPMP in 21. This rate which is primarily made up of kidney donors, but does include liver and lung donors has decreased by 11 per cent since 26 Living donation in Canada 26-216 (dpmp) 2 1 1 16.8 14.6 Total Kidney Liver 11 % DECREASE IN LIVING DONATION SINCE 26 1.7 1. 13.4 13. 2.1 2.3 2. Number of living donors by province 26-216 3 2 2 1 1 Living donor rates by province 26-216 (dpmp) 3 2 2 23.7 21 (Liver) 216 (Liver) 21 (Kidney) 216 (Kidney) BC AB SK MB ON QC ATL 19.8 18. 19.8 19. 21 (Liver) 216 (Liver) 21 (Kidney) 216 (Kidney) 2.3 18.3 26 27 28 29 21 211 212 213 214 21 216 1 1 7. 11.6 6.7 6.7 8. 7. Living donation offers advantages to recipients, including better short-term and long-term health outcomes relative to deceased donation. International living donation rates, 26 216 (dpmp) 2 2 1 1 Canada Spain United States Australia United Kingdom 18.6 16.1 1. 11.1 7.9 2.6 In 216 there were 44 living donor transplants a 3% decrease from 21; however, the Kidney Paired Donation (KPD) program saw its second most successful year since its 29 inception and has facilitated 474 transplants as of 216. Living donor transplants 29, 21, 216 6 4 3 1 BC AB SK MB ON QC ATL Kidney KPD Liver 26 27 28 29 21 211 212 213 214 21 216 27 21 216 6 ORGAN DONATION AND TRANSPLANTATION IN CANADA - System Progress Report 216 Update
Transplantation performance results In spite of the increases in transplant numbers, Canada still has a shortage of organs. Approximately 4, patients are waiting for transplants at any given time. Since Canada will continue to have a shortage of organs into the future, there is a need to provide equitable access to the limited number of donated organs for all potential recipients. Patients waiting for transplants in 216 4,492 CANADIANS WAITING Number of solid organ transplants in Canada by donor type 26 216 3,421 433 26 KP 117 MULTI/OTHER 26 Between 26 and 21, Canada s transplant rate (which includes organs from both deceased and living donors) increased from 63.7 to 71.4 transplants per million population, and in 216 this rate climbed even higher to 78.1 transplants per million population. This represents an 9 per cent increase relative to 21 and a 23 per cent increase relative to 26. The number of transplant procedures in 216 (2,83) represents a 32 per cent increase from 27. Transplants per million population in Canada by organ type, 26 216 189 *Does not includes islet patients (49) 48* 2 26 PATIENTS DIED ON THE WAITLIST IN 216 Transplant results presented here refer only to kidney, liver, heart, lung, and whole pancreas transplants. 7 ORGAN DONATION AND TRANSPLANTATION IN CANADA - System Progress Report 216 Update
Kidney transplants by province per million population, 26 216 Heart transplants by province per million population, 26 216 7 6 4 3 2 1 27 21 216 Can BC AB SK MB ON QC ATL 7 6 4 3 2 1 27 21 216 BC AB SK/MB ON QC ATL Lung transplants by province per million population, 27 21 Liver transplants by province per million population, 27 21 12 1 8 6 4 2 27 21 216 BC AB SK/MB ON QC ATL 2 1 1 27 21 216 BC AB SK/MB ON QC ATL *216 heart, lung, and liver transplant rates for Quebec not available Transplant results presented here refer only to kidney, liver, heart, lung, and whole pancreas transplants. 8 ORGAN DONATION AND TRANSPLANTATION IN CANADA - System Progress Report 216 Update
Acknowledgements This report acknowledges the generosity of organ donors and their families, and those patients with end-stage organ failure who depend on all organizations involved to improve opportunities for donation and transplantation. This report was made possible through the dedicated efforts of the members of the Organ Donation and Transplantation Expert Advisory Committee. It includes input from the Canadian Institutes of Health Research, the Canadian National Transplant Research Program, the Canadian Institute for Health Information, the Deceased Donation Advisory Committee, the Donation and Transplant Administrators Advisory Committee, the Kidney Transplant Advisory Committee and the Living Donation Advisory Committee. Data Sources The Canadian data collected for this report was compiled from a number of sources and standardized\ and validated to the greatest degree possible by experts from Canadian Blood Services. Source material was derived from figures compiled from the Canadian Transplant Registry, and materials published by the Canadian Institute for Health Information and the Canadian Organ Replacement Register. Canadian Blood Services personnel also collected and validated 21-216 data from the various provincial organ donation organizations. The international donation and transplantation data collected for this report was compiled from a number of sources and standardized and validated to the greatest degree possible by experts from Canadian Blood Services. Source material was derived from figures compiled from the International Registry on Organ Donation and Transplantation, the Organ Procurement and Transplantation Network in the United States, and the Organizacion Nacional de Trasplantes in Spain. In accordance with Canadian Institute of Health Information (CIHI) standards, demographic data for estimates per million population (PMP) are based on Statistics Canada, Demography Division. Estimates of population (211 Census and administrative data), by age group and sex for July 1st, Canada, provinces, territories, health regions (21 boundaries). For the purpose of this calculation, PMP rates for British Columbia are based on the combined populations of British Columbia and Yukon, PMP rates for Alberta are based on the combined populations of Alberta, Northwest Territories and Nunavut, and Atlantic population includes New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador. For deceased donation by province, rate for Nova Scotia is based on the combined populations of Nova Scotia and Prince Edward Island. 9 ORGAN DONATION AND TRANSPLANTATION IN CANADA - System Progress Report 216 Update