Organ donation in Canada: The large gap between what is and what could be

Through remarkable advances in transplantation, organ donation saves and improves lives and is cost effective. However, Canada’s organ donation record is mediocre, with less than half the donation rates of leading countries. One-third of Canadians who need a transplant will never receive one.

While Canada has seen modest improvements over the past decade, the Canadian Institute for Health Information’s recent report, Deceased Organ Donor Potential in Canada, reveals that there is a large and troubling gap between the number of people who could be organ donors and the number who actually donate. This valuable and informative report demonstrates: 

• Most potential organ donors are not recognized or identified by health-care professionals in hospitals. (The report acknowledges limitations to the data on donation potential, which is based on indirect estimates.)
• Donation services vary significantly across the country. Whether a potential donor becomes an organ donor depends to a great degree on the province, city, hospital and area within the hospital in which he or she receives care.  
• One form of donation — donation after circulatory death (DCD) — is still not offered in all provinces and cities. This type of donation substantially improves donation rates and the availability of transplants for Canadians who need them. 

In April 2011, Canadian Blood Services, working in collaboration with the Canadian and international organ donation and transplant communities, delivered a series of recommendations to provincial and territorial governments to improve donation and transplantation services. The report identified several fundamental requirements to improve the organ donation system:

• Leading practices and professional education in deceased donation for health-care professionals in hospitals. 
• Organ donation experts, both nurse coordinators and donation physician specialists, who ensure organ donation is offered to all families in all hospitals when appropriate.
• Organ donor registries that are consistent across the country, easily accessible, available online and used to legally authorize organ donation based on the expressed wishes of the donor.
• Medical record reviews that find missed donation opportunities.
• A committed hospital culture that recognizes that when death is inevitable and there is an opportunity to save many lives through organ donation, this should be a health-care service priority.
• Better measurement and reporting of donation and transplant outcomes.  

In many countries, national audits on organ donor potential like the CIHI report have led to better organ donation systems. CIHI used indirect data to estimate donation potential in Canada. For Canada to get the most out of its audits, we need standardized, system-wide medical record reviews to identify missed donation opportunities.

Every life lost while waiting for transplant is preventable. The CIHI organ donation potential report demonstrates the glaring discrepancy between what could be achieved and what actually happens in our system. It also emphasizes the importance of Canadian Blood Services’ collaborative work with governments and organ donation programs toward implementing these proven lifesaving and life-enhancing solutions. Canadians whose lives depend on them are counting on it. 

See the Canadian Institute for Health Information’s Deceased Organ Donor Potential in Canada report.