Organ donation specialists may increase organ donations in Canada

The integration of donation physician specialists into hospital teams in Canada could help increase organ donations, states a commentary in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.130050

Deceased donation rates in Canada are well behind those in many other countries with advanced organ transplant programs. These low rates mean that many patients die before a donor is found; in 2010, 16% of transplant candidates died awaiting a kidney, pancreas or both; 19% of lung transplant candidates, 22% of liver transplant candidates and 24% of heart transplant candidates died before a match was found.

Donation physician specialists are usually critical care specialists who have expertise in organ and tissue donation. The United Kingdom, Australia, Spain and parts of the United States have donation physician programs, although the roles of the physician specialist vary by country, from directly caring for donors to administrative roles.

"Donation physician programs are associated with improvements in deceased donation rates," writes Dr. Sam Shemie, Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, with coauthors. "In Spain, the role is credited with increasing the donation rate to more than 30 donors per million population; this is one of the highest rates in the world."

In 2011, Canadian Blood Services recommended introducing donation physician specialists as part of a plan to increase the rates of organ donation and transplantation in Canada.

However, there is concern over potential conflict of interest with donation physician specialists who provide direct care in the intensive care unit and have a role in organ donation. Most programs separate the roles of donation team members from providing end-of-life care.

"A recommendation from expert consultation on donation and transplantation cohosted by Canadian Blood Services and the Canadian Critical Care Society in 2011 is that there be clear definition and separation of the roles of all people involved in the donation and transplantation system and transparency through full disclosure of roles and responsibilities to families and other professionals," the authors conclude. "Funding mechanisms should support giving patients an opportunity to donate without creating incentives to increase the number of organs donated through undue pressure."

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