Hospital Newsletter
Program to share kidneys across provincial borders marks 1,000 kidney transplants for hardest-to-match patients
In the spring of 2014, Arnold Dysart became the first recipient of a kidney through a Canadian Blood Services program designed to help the hardest-to-match patients. Now, 10 years later, the Highly Sensitized Patient program has reached the milestone of 1,000 transplants — thanks to the collaborative efforts of transplant programs, health-care professionals, organ donation organizations, and most importantly, the generosity of organ donors and their families.
A “highly sensitized” patient is one who has a very high level of antibodies that react to foreign tissue. This makes finding a donor match more difficult. In fact, half of those seeking a match through this program are compatible with only 1 in 10,000 other people. Put another way, that’s 1-2 potential matches in a crowd the size of a sold-out NHL game, assuming every fan were willing to donate a kidney.
Arnold was one of those patients. He’d had a transplant previously, with a kidney from his brother, after being diagnosed at age 28 with IgA nephropathy — a condition which causes proteins to build up in the kidneys. But after 17 years, that donor kidney had failed, and the search for a new kidney was complicated by the fact that he’d become highly sensitized. It’s a possible outcome of a previous organ transplant; others are highly sensitized because they’ve developed antibodies during pregnancy, or in response to blood transfusions.
“These three populations of patients, especially if they have a broad degree of sensitization, often can’t find a donor in their province,” Dr. Nickerson, a Manitoba physician who has cared for highly sensitized patients. says “To really maximize the chance of them getting a transplant, you need to have access to the entire kidney donor pool in the country.”
That access is what’s provided by the Highly Sensitized Patient program, which Dr. Nickerson helped launch in 2013. It is a national organ sharing program operated by Canadian Blood Services in collaboration with all provincial donation and transplant programs.
Read the full story to find out how the program began and how it reached this incredible milestone.
Plasma Protein and Related Products E-formulary
As announced in Customer Letter # 2024-29, the Plasma Protein and Related Products (PPRP) Customer Table of Information is being removed from the blood.ca, and it is being replaced with an electronic formulary list (e-formulary). The e-formulary has been launched to provide customers with an electronic, searchable list of PPRP available from Canadian Blood Services.
The e-formulary can be found at formulary.blood.ca. Additionally, links to the e-formulary can be found on the Canadian Blood Services website in two separate places:
- The Plasma Protein and Related Products page under Hospital Services
- The National Formulary page
E-formulary Features
The e-formulary home page provides customers with the list of available products that can be sorted by each column heading (see Figure 1). There are also links to convert the page to French, print the list, and navigate to the Canadian Blood Services Online Ordering portal.
Customers can choose to search products using the Simple Search which supports searching by brand name (e.g., Adynovate), manufacturer (e.g., Grifols), and product class (e.g., Factor IX). More complex searches can be completed using the Advanced Search function which provides the option to search by more characteristics as well as the ability to include multiple characteristics in your search (see Figure 2).
Additional details about products can be found by clicking on a specific product in the table (see Figure 3). Storage requirement and expiry date format for a product can also be found on the product-specific page. There are currently updates underway to make improvements to the e-formulary, so the appearance may change over time.
The National Plan for the Management of Shortages of Immunoglobulin (Ig) Products
The National Plan for the Management of Shortages of Immunoglobulin (Ig) Products is now available on nacblood.ca.
Through the support of Health Canada and Provincial and Territorial Ministries of Health, work to develop a framework and guidance for the appropriate allocation of immunoglobulin (Ig) products to patients in the setting of short-term or more prolonged shortage situations culminated with the delivery of a comprehensive, evidence-based and informed national Ig shortages plan intended to:
- Maximize the effectiveness of a shortage response;
- Ensure consistency and collaboration across provincial and territorial jurisdictions;
- Support fair and equitable allocation of scarce Ig products in times of severe shortage, ensuring that the most appropriate individuals receive product regardless of provincial/territorial jurisdiction;
- Identify priority patients for timely and uninterrupted supply; and,
- Adopt a proactive approach to inventory management through escalating inventory phases.
The work to develop this comprehensive Ig shortages management plan was initiated in September 2022 and builds upon the interim guidance that was developed during the height of the COVID-19 pandemic which subsequently received approval from the Provincial/Territorial Conference of Deputy Ministers in September 2020.
The approach to developing The National Plan for the Management of Shortages of Immunoglobulin (Ig) Products emphasized and provided for the broad engagement of relevant parties which included patients and patient organizations, the blood provider, jurisdictional representatives, blood coordinating offices/programs from across the country, Ig prescribers, clinicians, and clinical societies. Representatives of the National Advisory Committee on Blood and Blood Products (NAC), Health Canada, Canadian Blood Services, and the Provincial/ Territorial Blood Liaison Committee (PTBLC) provided subject matter expertise, advice on approach, strategic level issues and risks, as well as clinical and governmental perspectives.
Working groups were created to inform and develop the ethical framework as well as the triage and adjudication criteria and process design. Engagement sessions were conducted to review and refine the triage and adjudication criteria with clinicians across each of the following specialties: hematology, immunology, neurology, dermatology, rheumatology, infectious disease, and transplantation. The ethical framework was also shared with these groups to help inform and guide the discussions.
The National Plan for the Management of Shortages of Immunoglobulin (Ig) Products, including the list of suitable alternative therapies, is a living document and will require regular review and revision over time. Specifically, review will occur as new information becomes available and after every activation or shortage simulation exercise.
Organizations and groups in the Partners for Life program contribute more than one third of blood products Canadian Blood Services collects annually
As it can often take more than one donor to save a life, Canadian Blood Services’ Partners for Life program brings people together with the common goal of supporting patients in our communities who rely on blood and blood products.
With more than 12,000 Partners for Life teams — including over 80 teams affiliated with Canadian hospitals — these dedicated groups contribute more than 300,000 units of blood and plasma every year that help keep Canada’s Lifeline and our inventory of blood products strong.
The Partners for Life program offers volunteers the chance to recruit donors to be part of a lifesaving team. Partners for Life teams can donate together and have the benefit of being able to track their collective impact by seeing the number of donations they make every year. The program also provides tools and resources to help teams recruit more donors, raise awareness for the importance of blood and plasma donation and/or raise funds to support ongoing research and innovation Canadian Blood Services is leading.
The Partners for Life program also makes it possible for teams to partake in larger campaigns alongside other teams. This is the case with Sirens for Life, a national initiative engaging first responders across Canada to build on their role as lifesavers by donating blood and plasma. Much like our hospital partners, first responders have the unique first-hand experience of seeing the need for blood products in real-time which motivates these donors to be meaningful contributors to Canada’s Lifeline.
Taking place seasonally every year, Sirens for Life is one powerful example of a Partners for Life campaign that helps close the gap on open appointments in regions across Canada.
To discover whether your hospital has a Partners for Life team you could join, or to easily start your own Partners for Life team, contact give@blood.ca or visit blood.ca/partners.
Informed Consent for Blood Transfusion
Informed Consent for Blood Transfusion is a new interactive, online course located on the professional education website that has been developed with the support of the Canadian Blood Services’ BloodTechNet Award Program. The objective of the course is to support health-care professionals in understanding the basics of informed consent in the transfusion medicine setting.
The course is self-paced, may be completed over multiple sessions and is estimated to require approximately 45 minutes to complete.
The following chapters are included in the course:
- Basics of consent
- Basics of transfusion
- Risks of transfusion
- Special considerations
- Alternatives to transfusion
- Case study & course survey
Our new resources for health-care professionals
To support best practices in transfusion medicine, Canadian Blood Services develops educational resources in collaboration with subject-matter experts from across Canada.
Visit our professional education website, a trusted resource hub for health-care professionals across the country, and check out these new resources:
- Surveillance report 2023. The 25th anniversary edition of Canadian Blood Service’s surveillance report is now available in English. This annual report describes surveillance of transmissible blood-borne infections and emerging threats of concern. High quality and timely surveillance are central to the safety of the blood supply. This includes monitoring of transmissible disease markers that the blood is tested for and investigation of any reports of possible transfusion transmission, as well as a horizon scan for any new pathogens that may pose a risk. Non-infectious surveillance of donor health and safety are also included.
- Outil d'inspection visuelle. The Visual Inspection Tool is now available in French. A bench-level tool for personnel in the hospital setting who handle blood components for transfusion, it uses photos to depict variations in the typical appearance of blood components, along with descriptions of the conditions or characteristics that may change the appearance of red blood cells, platelets, plasma and cryoprecipitate. The Visual Inspection Tool is an educational resource meant to inform the user about visual variability of blood components and its causes. Whether or not a blood component is suitable for transfusion is determined by local hospital policy and procedures. The Visual Inspection Tool replaces the Visual Assessment Guide.
- Platelet component inventory, indications & ordering. This one-page PDF summarizes available platelet types at Canadian Blood Services: their properties, inventory, indications/contraindications and ordering information. Available to download in English and French under “Additional resources” in Chapter 19, Pathogen-reduced platelets.
- Breakthroughs in blood, advancements into action. Breakthroughs in blood is a webinar series for sharing groundbreaking findings in blood research and promoting best practices in transfusion. On our professional education website, you’ll find webinar recordings and resources to support practice change. The resources are for health-care professionals, hospital administrators, policy makers and researchers.
- The International Collaboration for Transfusion Medicine Guidelines’ (ICTMG) Use of Intravenous Albumin guideline: Moving evidence into practice (date of webinar: September 6, 2024). Resources are coming soon to the Breakthroughs in blood page and will include:
- Mythbusters: A downloadable document addressing common myths about intravenous albumin that encourages evidence-based decisions regarding its use.
- Q&A: A summary of frequently asked questions about albumin addressed by the panelists of the webinar.
- Social Media Package: A downloadable set of images optimized for social media that can be used to share information about the recent ICTMG Albumin guideline and common myths about intravenous albumin on various platforms.
- Restrictive or liberal transfusion strategy in myocardial infarcation and anemia (MINT Trial) (date of webinar: December 1, 2023). Visit the Breakthroughs in blood page to access the webinar recording and other resources, including the publication, presentation slide deck, and a Q&A.
- Sickle cell disease education program for healthcare professionals was developed by the Sickle Cell Awareness Group of Ontario (SCAGO). This online resource offers 13 modules and is certified for up to 13 Mainpro+® credits. The program provides equitable, high-quality education for health-care providers, supporting the needs of people with sickle cell disease.
Also, see the latest updates from the National Advisory Committee on Blood and Blood Products (NAC) on our transfusion medicine home page.
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