Transplantation

New data report on eye and tissue banking in Canada


Tuesday, August 06, 2019

“It was as if someone had taken a teaspoon of sand, dumped it in my eye, taken their thumb and ground it in, and every once in a while, gave it a little poke with a twig.” That’s how Loreen Hardy-Ramey describes living with Fuchs endothelial dystrophy, a hereditary eye condition.

Without the cornea transplant the Arnprior, Ont. woman received in the summer of 2016, Hardy-Ramey’s pain would have continued as her sight faded.

“I say it was my eightieth birthday present because I received this gift just days after my birthday,” she says. Now she’s looking forward to the birth of her great-grandchild, who she’ll be able to see with both eyes.

A new report from Canadian Blood Services provides insight into eye and tissue banking across Canada. Since 2012, Canadian Blood Services has collected data from all Canadian eye and tissue programs on behalf of the Eye and Tissue Data Committee. The 2017 Canadian Eye and Tissue Banking Statistics report, developed with the support of eye and tissue banks across Canada, is the first one where five consecutive years of data are available. This ongoing accumulation of data allows for new insight into provincial and national trends.

Eye and tissues for donation include corneas and other eye tissues, bone, skin, heart tissues, tendons and other musculoskeletal tissues. Depending on the tissue, they can be collected from deceased or living donors.This report presents data on eye and tissues and does not include data on organ donation.

With the data contained in this report, provincial eye and tissue programs can better understand what’s happening in their region and use this understanding to inform how they operate. National organizations use this data to shape their discussions on national practice and policy.

The data also has the potential to support future research by providing a broad dataset to work with. Looking at the data from different provinces can also offer insight into potential ways to share knowledge and resources, while also providing a more nuanced understanding of provincial demand and reliance on internationally-sourced grafts. 

 

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Loreen Hardy-Ramey, a woman in her eighties, stands beside her husband Noel.
Loreen Hardy-Ramey, a cornea recipient from Arnprior, Ont., with her husband Noel.

In 2017…

  • Canadian eye banks distributed 3,820 corneas for transplant
  • Canadian tissue banks distributed 12,652 musculoskeletal, cardiac and skin grafts for transplant
  • Tissue was recovered from more than 4,500 deceased donors and 294 living donors
  • Canadian eye and tissue banks received more than 50,000 deceased donor referrals for potential tissue donation

 

 

 

 


Canadian Blood Services – Driving world-class innovation

Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration. Find out more about our research impact

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.

I’m fascinated by the power of stem cells: Q&A with Dr. Nicolas Pineault


Friday, July 19, 2019

For more than two decades, Dr. Nicolas Pineault has worked in stem cell biology. Since joining Canadian Blood Services in 2012 as a development scientist at the Centre for Innovation, he has conducted research in stem cells from cord blood, bone marrow cells and platelets. Dr. Pineault is an adjunct professor at the University of Ottawa (uOttawa).  

Because July is Cord Blood Awareness Month, we talked to Dr. Pineault about his ongoing research in cord blood, as well as his passions and other new projects. 


Q. Tell us about yourself and the work you’re currently engaged in. 

A. I've been working in the field of stem cell biology since my PhD studies, which I did at the University of British Columbia from 1995-2001. Before joining Canadian Blood Services in 2012, I was a research scientist in the research and development division at Héma-Québec. My other passions in life are hockey, sports, camping and spending time with my family.  

At Canadian Blood Services, I oversee two areas of development and research. First, together with my senior research assistant Roya Pasha, I support the operation of the stem cell manufacturing branch of the organization, including the public cord blood bank located here in Ottawa. We also provide technical and knowledge support. For instance, we developed a thaw protocol for cord blood units distributed by Canadian Blood Services, and optimized various processes used in the stem cell manufacturing business.  

My second area of research is studying the impact that stem cell expansion has on the capacity of cord blood stem cells to support engraftment. This research occurs here in our lab at head office and at the animal facility of uOttawa, and is mainly conducted by the graduate students, honour students and post-doctoral fellows whom I supervise and support. 

Q. What are the biggest challenges that currently exist in cord blood research?  

A. Two areas of work are very popular in the field of cord blood hematopoietic research. The first area is improving the engraftment activity of cord blood to lead to faster recovery of transplant patients. This is done either by tricking stem cells to move to the bone more efficiently after transplant, or by expanding stem cells so that more cells are available for transplantation. Our lab does a lot of research in these areas. Another exciting area of work is gene editing, which could one day provide a long-term cure for patients with common hemoglobinopathies such as sickle cell anemia and beta-thalassemia. This approach tries to genetically correct point-mutations in the DNA of the patients’ stem cells so that their progeny-like red cells can produce normal red cells.  

Q. How do you see the role of your research in improving outcomes for Canadian patients?  

A. Stem cell transplantation is used to cure over 80 diseases, including leukemia and immunodeficiencies, and new exciting possibilities are emerging that may cure other diseases or disorders such as autism and cerebral palsy. So, our work focuses on maximising the quality of stem cell products processed and produced at the Canadian Blood Services to improve outcomes of stem cell transplant for Canadian patients.   

Q. What’s your next project? 

A. We're currently working on a project for the stem cell manufacturing lab in Ottawa about donor-lymphocyte infusion, or DLI products. The objective of this project is to demonstrate that the DLI product retains its quality attributes following changes in production requested by The Ottawa Hospital, namely freezing smaller volumes in new bags. In my wish list, I would love to bring in and optimize the technology that can be used to correct sickle-cell mutation in hematopoietic stem cells. This disease is one of the most common genetic disorders in humans, and current treatment options are not curative. 

Q. Why do you care about your work? 

A. I never thought as an undergrad student in biochemistry at Laval University that I would one day work in the field of stem cell biology. This changed after I did my first immunology course and spent a summer internship at the R&D department of the Red Cross in Quebec City. Since then, I have always been fascinated and impressed by the power of stem cells, and by the incredible research that surrounds these special cells. This is one of the passions that fuels my energy for my line of work. 

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Dr Nicolas Pineault wears a lab coat and holds a blue plastic container in a stem cell lab
Dr. Nicolas Pineault

Canadian Blood Services – Driving world-class innovation

Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration. Find out more about our research impact

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.

Organ and tissue donation by those who choose medical assistance in dying: new guidance for professionals


Tuesday, June 25, 2019

new publication in CMAJ (Canadian Medical Association Journal) aims to help health care teams navigate clinical issues surrounding organ and tissue donation by patients who choose to donate after medical assistance in dying (MAID) or withdrawal of life-sustaining measures. 

 

In collaboration with the Canadian Critical Care Society, the Canadian Society of Transplantation, and the Canadian Association of Critical Care Nurses, Canadian Blood Services brought together medical, legal and ethics experts to inform this work, as well as patient partners who brought unique perspectives and thoughtful insight. 

The new publication, Organ and Tissue Donation for Medical Assistance in Dying and Other Conscious Competent Patients: Expert Guidance for Policy, makes key recommendations, including:  

  • Protection for patients – the decision to have MAID or withdrawal of life-sustaining measures must occur before any discussion of organ donation. 
  • Choice – medically suitable conscious competent patients who provide first-person consent to end-of-life procedures should be given the opportunity to donate organs and tissues. 
  • Consent – the patient must be able to provide first-person consent and be able to withdraw consent for MAID or donation at any time. 
  • Donor testing – physicians, transplant teams and other staff should try to minimize the impact and disruption of donating (such as testing) for the patient. 
  • Determination of death – the dead donor must be respected, meaning vital organs can only be removed from deceased donors after determination of death according to accepted criteria. 
  • Conscientious objection – health-care professionals may choose not to participate in MAID or withdrawal of life-sustaining measures, but they should work to support the patient’s wishes to donate.

 

For access to professional education resources related to leading practices and clinical guidelines visit Canadian Blood Services' professional education website

This report and the published manuscript have been endorsed by the Canadian Critical Care Society, the Canadian Society of Transplantation, and the Canadian Association of Critical Care Nurses.

 

Learn more:  CMAJ podcasts — Organ Donation After MAID 

In this interview, Dr. James Downar (co-author of policy guidance) and Dr. Jennifer Hancock (an intensive care physician in Halifax) take listeners through considerations of having a patient who requests medical assistance in dying (MAiD) or withdrawal of life-sustaining measures (WLSM) and who also requests to have his or her organs donated.

https://soundcloud.com/cmajpodcasts/181648-guide

 


Canadian Blood Services – Driving world-class innovation

Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration. Find out more about our research impact

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.

Canadian Blood Services’ scientist recognized for his mentorship of graduate students


Wednesday, May 22, 2019

Congratulations to Canadian Blood Services' Dr. Jason Acker, who was awarded the University of Alberta Graduate Students’ Association Graduate Student Supervisor Award at a ceremony on March 22, 2019. This award recognizes "those faculty members who excel in the supervision of graduate students”. What makes this award even more special – Dr. Acker was nominated by one of his graduate students, Ruqayyah Almizraq. We chatted to Dr. Acker to learn more.

Dr. Jason Acker
Dr. Jason Acker and Ruqayyah Almizraq at the University of Alberta Graduate Students’ Association award ceremony

 

Q: Tell us more about this award?

"I have been very fortunate to have had the opportunity to mentor and work alongside an outstanding group of graduate students over the past 17 years that I’ve been at the University. While the GSA Graduate Student Supervisor Award is intended to recognize faculty who excel in the supervision of graduate students, I think this award really recognizes the environment that we create to allow students to explore and grow as researchers. At Canadian Blood Services we have been very intentional in providing our scientists and clinicians with the resources and tools to create a supportive environment for our trainees to excel in transfusion science research. This award is a testament to our pursuit of excellence in training the next generation of transfusion scientists.”

Q: What makes this award so special for you?

“I am particularly humbled by this event as it was a student-nominated award presented by the Graduate Students’ Association which I received. To be nominated by the graduate program would have been great, but to be nominated and selected by the students is extra special!

I do not see myself as the wise man sitting on the mountain and the students as the seekers of knowledge or wisdom. I see myself as the experienced tour guide who has been fortunate to have traveled many of the back roads and trails of an interesting scientific discipline. While I may be worldly in my travels, I am not the world’s traveler and as such I do not have all of the answers nor have I come to my final destination. I enjoy traveling together with my students as I am a learner too!"


Canadian Blood Services – Driving world-class innovation

Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration. Find out more about our research impact

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.

Lessons from afar: International experts share organ donation experience


Thursday, May 23, 2019

Canadian Blood Services’ Donation Physician Network (DPN) connects clinical care physicians and provides access to educational resources including webinars on leading practices, clincial case studies, literature and emerging issues. In the spirit of international collaboration, experts in organ donation and transplantation from the U.K. and Australia recently shared lessons they have learned over the past decade as part of a series of webinars hosted by the DPN

Lessons from afar

Dr. Helen Opdam of Australia and Dr. Dale Gardiner of the U.K. provide valuable perspectives in their presentations, respectively titled "Lessons from Down Under" and "Lessons from Across the Pond".

“Canada, Australia and the U.K. have a lot in common. I think if we can share our experiences, then we can evolve and improve our systems much more quickly than if we work in isolation,” says Dr. Helen Opdam, National Medical Director of the Australian Organ and Tissue Authority and Senior Intensive Care Specialist with the Austin Hospital in Melbourne.

Watch Dr. Opdam’s webinar, Lesson from down under

“We’ve been on a 10-year journey, which I think Canada and Australia have also been on,” says Dr. Dale Gardiner, Deputy National Clinical Lead for Organ Donation, U.K., and Adult Intensive Care Medicine Consultant. “My first lesson that we’ve learned in the U.K. is that success is possible.”

Watch Dr. Gardiner’s webinar, Lesson from across the pond

The U.K. and Australia share many similarities with Canada, politically, socially, legislatively and geographically. For the past decade, all three countries have been working to improve organ donation rates to increase the availability of organs for patients in need.

“I was asked in setting up this presentation to finish with giving some pointers to Canada, and I felt that was a bit presumptuous, because I feel that Australia has a lot to learn from Canada,” says Dr. Opdam, “What I really think I can do is share with you what actually happened in Australia, and it’s very much up to you to draw some lesson from that.”

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Dr. Helen Opdam

 

Related blog posts:

Visit Canadian Blood Services' Professional Education website to discover more resources and information related to organ and tissue donation and transplantation. 


Canadian Blood Services – Driving world-class innovation

Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration. Find out more about our research impact

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.

University of Alberta’s Timothy Caulfield receives James Kreppner Award


Tuesday, May 14, 2019

The 2018 Canadian Blood Services’ James Kreppner Award has been awarded to Timothy Caulfield, professor and research director in the Health Law Institute at the University of Alberta.   

Valued at $50,000, the award will support Professor Caulfield’s project to analyze the marketing practices of private cord blood banks, assess their claims, and consider how regulatory tools can help ensure services marketed are done in a scientifically informed and evidence-based manner.    

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Canadian Blood Services' James Kreppner Award awarded to Timothy Caulfield

“The entire Health Law Institute team is thrilled about this award, and we truly appreciate the opportunity to dig into the complex issues associated with donation, blood products and policy development,” says Professor Caulfield. “The research seems both timely and needed. We are lucky to have an award of this nature and hope our work will reflect James Kreppner's fearless analysis of controversial issues.”  

James Kreppner was a former board member of Canadian Blood Services, a lawyer, and a strong advocate for patients’ rights and blood safety. He suffered a severe form of hemophilia-A – a genetic disorder that makes it difficult for blood to clot, and his condition often required transfusions of blood products. In 1985, he became infected with HIV and hepatitis C through tainted blood products.  

Mr. Kreppner became a key figure in establishing the public inquiry into contaminated blood and testified twice before The Krever Commission. He was also a long-time volunteer and member of the Canadian Hemophilia Society before his passing ten years ago on May 14, 2009.   

This annual award named in his honour supports one high-quality research project that explores legal and policy questions relevant to the products and services provided by Canadian Blood Services. The award’s research priorities include the legal and regulatory aspects of (a) donation, collection, storage, and use of blood, blood products, and hematopoietic stem cells; and (b) organ and tissue donation and transplantation.   

Through a series of funding programs and research collaborations, the Canadian Blood Services’ Centre for Innovation conducts and supports research in key priority areas, including projects that span the translational continuum from “bench to bedside.”  

The 2019 competition for the James Kreppner Award will open for applications in Fall 2019 and will support one project with up to $50,000 for a period of one year.   

Find out more about current and past James Kreppner Award program projects:  

Further reading:  


Canadian Blood Services – Driving world-class innovation

Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration.

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.

Nominations now open for the 2019 Canadian Blood Services Lifetime Achievement Award


Monday, May 13, 2019

Do you know someone who has made an outstanding contribution to the blood system in Canada?   

Who can be nominated?  

Recipients of the Canadian Blood Services Lifetime Achievement Award are individuals whose landmark contributions are recognized as both extraordinary and world class in the field of transfusion or transplantation medicine, stem cell or cord blood research in Canada and/or abroad. 

To be nominated for the Canadian Blood Services Lifetime Achievement Award, an individual must have contributed significantly to improving the safety and/or quality of blood, blood products, stem cells and/or cord blood or has made noteworthy improvements or advances in transfusion or transplantation medicine practice. Their record of publication should be of significance and their professional reputation should be aligned with the goals and reputation of Canadian Blood Services, reflecting a quality culture driven by excellence. 

The award will be presented on September 23, 2019 in Ottawa at the annual national Honouring Canada’s Lifeline event where we honour our donors, volunteers, peer recruiters and partners from across the country and across our products for their outstanding dedication and achievements. 

 

What's the nomination process? 

Nomination requirements 

  • Provide a short introduction and summary in 150 words or less of the nominee’s contribution to improving the safety and/or quality of blood, blood products or stem cells, or contribution to advances in transfusion medicine practice. 
  • Present a brief biography including academic, research, clinical and administrative positions, awards or recognitions. 
  • Outline how the work of the nominee is set apart from the work of others in the field. 
  • Provide a nominee’s full current curriculum vitae and contact information for the nominee including full name, mailing address, telephone number(s) and email address. 
  • Provide name and contact information for the nominator(s). 

Note: Candidates should be unaware that they have been nominated for this award. 

Submit nominations in writing to the address below:  

By mail:  

Canadian Blood Services Lifetime Achievement Award Nominating Committee 

c/o Dr. Isra Levy, Vice President, Medical Affairs and Innovation 

Canadian Blood Services 

1800 Alta Vista Drive 

Ottawa, Ontario K1G 4J5 

By email:  

isra.levy@blood.ca    

 

Submission deadline: May 30, 2019 

The nominator of the awardee, and the nominee selected, will be notified by the end of June 2019. 

 

Past honourees 

The Canadian Blood Services Lifetime Achievement Award came into existence in 2002. To date, the Canadian Blood Services Board of Directors has selected the following individuals for this prestigious award: 

• Dr. John Bowman, 2002 

• Ms. Marie Cutbush Crookston, 2002 

• Dr. Morris A. Blajchman, 2003 

• Dr. Peter Pinkerton, 2004 

• Dr. John Freedman, 2006 

• Dr. Hans Messner, 2007 

• Mr. Justice Horace Krever, 2008 

• Dr. Gail Rock, 2009 

• Dr. Victor Blanchette, 2010 

• Dr. Allen Eaves and Dr. Connie Eaves, 2011 

• Dr. Celso Bianco, 2012 

• The Canadian Hemophilia Society, 2013 

• Dr. John Dossetor, 2013 

• Dr. Gershon Growe, 2014 

• Dr. Bruce McManus, 2015 

• Dr. David Lillicrap, 2016 

• Nancy Heddle, 2017 

• André Picard, 2018 

  

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2019 Canadian Blood Services Lifetime Achievement Award

Canadian Blood Services – Driving world-class innovation 

Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration. Find out more about our research impact.

Recordings from the CCCF 2018 Deceased Donation Scientific Symposium now available online


Wednesday, May 08, 2019

Canadian Blood Services, Trillium Gift of Life Network and the Canadian Donation and Transplantation Research Program partnered to host the Deceased Organ Donation Symposium that took place at the Critical Care Canada Forum (CCCF) on November 7 – 8, 2018.

The CCCF is a national forum attended by hundreds of health care professionals, primarily physicians, working in critical care. The Deceased Organ Donation Symposium is an opportunity for these health care professionals to engage in discussions about relevant and emerging topics in deceased donation.

A key event at the symposium was the unopposed plenary on brain death. Recent legal cases that challenge the acceptance of brain death as death are concerning to the critical care community. To better understand the issues surrounding brain death, experts presented medical, legal, ethical and international perspectives. 

The two-day symposium program reviewed the changing demographics of deceased organ donors; provided updates on evolving donation science, clinical leading practices, and advancements in perfusion technology; and highlighted new research on physician attitudes toward organ donation as well as donor family experiences along the donation pathway. 

Having generated much esteem and excitement, the brain death plenary and symposium sessions were recorded to ensure those who were unable to attend have the opportunity to access and share this important information. Videos from this session are now available on Canadian Blood Services' professional education website. 

Canadian Critical Care Forum (CCCF) – Deceased Donation Scientific Symposium 2018 - Videos

Videos from this session were recorded in partnership with Trillium Gift of Life Network and the Canadian National Transplant Research Program at The Canadian Critical Care Forum between November 6 to 9, 2018. 

View videos here


Canadian Blood Services – Driving world-class innovation

Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration. Find out more about our research impact

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.

Expert guidance seeks to improve identification of potential organ donors


Tuesday, April 23, 2019

Publication supports the critical care community in donor identification and referral allowing more potential organ donors to save more lives, and more donor families to be enabled to fulfill their loved one’s wishes

Just published in the Canadian Journal of Anesthesia: Potential organ donor identification and system accountability: expert guidance from a Canadian consensus conference

A Q&A with lead author Dr. Samara Zavalkoff

Deceased donation rates in Canada lag behind leading countries. A key area of focus to improve the system for all Canadians is to ensure health care professionals are able to identify and refer potential organ donors. If they are not equipped to identify and refer potential organ donors to organ donation organizations (ODOs) in a timely manner, patients on transplant waiting lists are left waiting and the wishes of potential donors and their families remain unfulfilled.

A Potential Organ Donor Identification and System Accountability (PODISA) Workshop was held September 20-21, 2016 in Ottawa. A collaboration between Canadian Blood Services and the Canadian Donation and Transplant Research Program (CDTRP), this workshop engaged representatives from critical care, neurocritical care, emergency medicine, donation, transplantation, research, health care administration, family partners, and patient safety and quality organizations. The results have now been published in the Canadian Journal of Anesthesia.

To better understand the importance of donor identification and referral, we spent some time with lead author Dr. Samara Zavalkoff a pediatric intensivist at Montreal Children’s Hospital. 

 

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Dr. Samara Zavalkoff

Who are you and what do you do?

My name is Samara Zavalkoff and I am a pediatric intensive care physician at the Montreal Children’s Hospital. I look after children of all ages who are critically ill.  I am an expert in patient safety and quality improvement. I have a keen interest in organ donation.

 

Can you tell us a bit about donor identification and referral?

Donor identification and referral is the process of recognizing when a patient who is gravely ill, dying or brain dead, has the potential to become a deceased organ donor and should be referred to an organ donation organization for follow up.

What are the issues that prevent potential donors from being identified as potential donors and referred to organ donation professionals?

Many reasons prevent identification and referral. They include:

  • lack of proper education for health care professionals about how and when to identify potential donors,
  • discomfort of healthcare professionals in discussing organ donation with family members,
  • preconceived notions about what a family may want in terms of donation,
  • limited access to resources to support identification and referral,
  • little or no consequence when a potential organ donor is missed because many provinces do not have legislation that requires doctors to refer potential donors,
  • lack of understanding about the impact a potential organ donor could have on a transplant candidate waiting for a life-saving organ, and
  • circumstances whereby health care professionals become overburdened with other tasks and concerns when a patient reaches end-of-life.

Why is donor identification and referral so important?

Donor identification and referral is the first and most essential step in the deceased donation process. If a potential donor is not identified and referred, organ donation cannot happen. Failing to identify and refer a potential donor can have catastrophic consequences for transplant candidates awaiting an organ. A patient on the transplant list may die if a suitable donor is not found in time. Circumstances when a doctor does not identify and refer a potential organ donor, should be considered critical patient safety events.

Is it law that doctors in all provinces have to refer potential donors?

Today, referral of potential organ donors is law in only five provinces. Currently, British Columbia, Manitoba, Ontario, Quebec and Nova Scotia require that the provincial organ donation organization must be notified when death is imminent or established.

Would you consider this workshop a success?

Very much so. These guidelines are the result of a workshop hosted by Canadian Blood Services and the Canadian Donation and Transplant Research Program (CDTRP) that engaged representatives from critical care, neurocritical care, emergency medicine, donation, transplantation, research, health care administration, family partners, and patient safety and quality organizations. We gathered experts from areas across the organ donation community in Canada, including the very important perspectives of patients and donor families. They are the ones most impacted by donor identification and referral.

Ultimately, the meeting generated 37 expert consensus statements to establish best practices for healthcare professionals and the healthcare system with respect to donor identification and referral.

Why is collaboration among the healthcare community so important when it comes to potential donor identification and referral?

Donation opportunities are rare. Of 250 000 Canadians who die each year, only 2000-4000 will meet eligibility criteria for donation, and yet only 600 will become donors. In contrast, well over 4000 Canadians are waiting for an organ transplant.

This huge gap between actual donors and waiting recipients, the low-volume nature of organ donation and the high cost to patients if they do not receive a donated organ are the reasons that the healthcare system – and every professional working within it – must be highly coordinated in identification and referral of potential organ donors. Together, we must ensure that there are no missed opportunities in this complex process.

What are the outcomes from this collaboration?

Some of the key consensus statements developed as a result of the workshop are described as follows at both the professional and the system level. 

At the healthcare professional level, key statements include:

  1. donation should be consistently addressed as part of end-of-life care but only after a decision to withdraw life-sustaining treatment;
  2. healthcare professionals should know how and when to identify and refer potential donors; and
  3. transplant candidates should be informed of local allocation guidelines and performance.

At the healthcare system level, key statements include:

  1. national adoption of clinical criteria to trigger identification and referral;
  2. dedicated resources to match donation activities, including transfer of a potential donor;
  3. performance measurement through death audits;
  4. reporting and investigation of missed donation opportunities;
  5. recognition of top performers; and 
  6. missed donor identification and referral should be considered a preventable and critical patient safety incident

Why is it so important for Canadian patients that every potential donor is identified?

When we fail to identify and refer a donor, harm is caused to another patient who is awaiting an organ transplant. This harm is disconnected, as we don’t know the name or face of this patient on the transplant list, but it is a critical patient safety issue and an example of harm that should be prevented.

What is the impact on patients (donors and/or recipients) and their families?

Every Canadian who meets eligibility criteria has the right to be considered for organ donation. Every time a potential donor is not identified or referred, we deprive the patient and their family of fulfilling their wish to become a donor. For some families, organ donation is an important part of their grieving process and helps them attach meaning to their loved one’s death.

For transplant recipients, optimal compliance with donor identification and referral means the difference between life (receiving a transplant) and potentially death.

How can we make donor referral part of standard component of end-of-life care?

Making donor referral a part of end-of-life care falls into four key areas:

  1. The community needs proper data tracking in the form of donor audits across the country. We need to know the details (understand) of when and where and why donors are not being identified and referred. We need this data on an ongoing basis in real-time so the impact of interventions can be quickly measured.
  2. There is a need for education of healthcare professionals to know when and how to identify and refer potential donors.
  3. There is a need for legislation and policy to support compliance with donor identification and referral. For example, ALL provinces should have required referral legislation and an accreditation body that evaluates hospital performance in this area.
  4. It is essential that we advance the idea that failing to identify and refer a potential organ donor in a timely manner is a source of preventable patient harm and a public health concern. For every potential donor that is not identified and referred, a patient on the waitlist continues to wait.

In February Dr. Zavalkoff presented about this topic to the Donation Physician Network via webinar. A recording of that session can be found below. Additional webinars designed for Donation Physicians can be found on Canadian Blood Services' Professional Education website

Further reading

About the collaboration that enabled this expert guidance

Canadian Blood Services works with the Organ and Tissue Donation andTransplantation (OTDT) community to improve national system performance. We do this through the development of leading practices, professional education, public awareness and data analysis and reporting. We also manage clinical programs that support interprovincial sharing of organs. 

The Potential Organ Donor Identification and System Accountability (PODISA) Workshop was held September 20-21, 2016 in Ottawa. It was an important collaboration between Canadian Blood Services and the Canadian Donation and Transplant Research Program (CDTRP). This workshop engaged Pan-Canadian representatives from critical care, neurocritical care, emergency medicine, donation, transplantation, research, health care administration, family partners, and patient safety and quality organizations. The results have now been published.

This important evidence-based leading practice:

  • provides a national framework and consistent approach for donor identification and referral and system accountability,
  • spearheads a culture shift around organ donation and end-of-life care, and
  • unlocks potential opportunities for national collaboration, to support implementation, with patient safety and quality organizations.

 

The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.

 

Winning science research writers announced


Friday, April 05, 2019

To give our research trainees an opportunity to showcase their research, while honing their writing skills, Canadian Blood Services teamed-up with Science Borealis and the Centre for Blood Research, to launch our first-ever Lay Science Writing Competition.


“It’s important for researchers to be able to explain what they do in an engaging and understandable manner to those who don’t work in research. This competition is a great opportunity for trainees to hone their skills in public science communication.”

Dr. Dana Devine

Canadian Blood Services Chief Scientist


Whether it was the chance to be published or the prizes, many trainees responded to the challenge, submitting entries that reflect a breadth of research in blood, plasma, stem cells, and organs and tissues. Within the competition theme of “Research that matters”, each entry was to describe the impact of their individual or lab’s research on the transfusion and transplantation system and/or on our society. A jury of professional communicators and scientists was given the challenging task of reviewing and judging the submissions on their writing and storytelling merits, assigning a ranking and selecting the top 3 science research writers.

…and the winners of the 2019 Lay Science Writing Competition are:

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Winners Lay Science Writing Competition 2019

Our sincere congratulations to all!


“The competition provided an excellent opportunity to further develop my communication skills and expand the reach and impact of my research.”

Dr. Jennie Haw,

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Jennie Haw

1st prize winner, CIHR Health Systems Impact fellow and Canadian Blood Services researcher: Dr. Jennie Haw


Over the coming weeks, we’ll share each of the prize-winning entries on the R.E.D blog, so watch this space to learn more about these budding writers and their research.

The 2018 Canadian Blood Services Lay Science Writing Competition was organized by the Canadian Blood Services’ Centre for Innovation with welcome support from Science Borealis and the Centre for Blood Research at the University of British Columbia.