The latest government figures show that more than 4,500 Canadians are on the transplant waiting list. And one in five will die before a donor organ becomes available. Other countries have a much better track record and have a lot to teach Canada. An article
published this week in the Canadian Medical Association Journal says Canada needs to have organ donor specialists. I think the Canadian people are the ones who need the heart transplant.
The authors of a commentary in CMAJ - from Canadian Blood Services and the Canadian Critical Care Society Consultation Group - are calling for the creation of a brand new kind of specialist: an organ donor specialist. Donor specialists - who function in that capacity in other countries - have special training and expertise in organ and tissue donation, and diagnosing brain death. They're involved in education, training, quality improvement and advocacy. In Spain, they play a front line role; they identify potential donors, and take care of everything from approaching donors or next of kin to organ retrieval. In the UK, donor specialists don't take care of every donor patient; instead, they promote organ donation and provide expert knowledge and leadership.
The commentary in CMAJ says that Spain credits donor specialists as a big reason why it has one of the highest rates of organ donation in the world. Spain has 30 organ donors per million. By comparison, Canada has around 15 organ donors per million. Organ donor specialists have also helped Australia boost its organ donor rate by 56 percent and in the UK by f47 percent. At the University of Pittsburgh Medical Center, a leader in organ donation, hiring an organ donor support team led by specialists has increased the number of organs transplanted by anywhere from 31 to 44 percent depending on the organ being donated.
In all of these examples, donor organ specialists came on board and then the organ donor rate went up. That doesn't prove organ donor specialists were the reason. Still, researchers think they played a major role.
Critics are concerned that in some places (for example, the University of Pittsburgh), the donor organ specialists just happen to also be intensive care unit doctors. That means there's a chance that the donor specialist is or was at some point involved in caring for the patient in the ICU - thus putting the doctor in a conflict of interest between caring for the patient and trying to promote organ donation. In Spain, the risk of conflict of interest is even more obvious, since the transplant specialist and the entire program receive funding based on transplant success - meaning the number of potential and actual donors cared for.
Australia and the UK have gotten around that conflict by receiving funding independent of how much transplant success they generate. Spain deals with the conflict issue by informing the families of donors of their role and funding up front. The UK declares that an ICU doctor who cared for the potential donor must never be the one to approach the family regarding organ donation.
Bringing donor organ specialists into the mix makes a lot of sense to me. The fact that we don't have specialists to call in immediately means all too often, it falls to the doctor who has been caring for the patient to ask about organ donation. Having told family members that a loved one has died, I can tell you it's emotionally exhausting and fraught with difficulty to switch to making a pitch for organ donation.
There other reasons why Canada has a lower rate of organ donation than other countries. Compared to the U.S, Canada has a lower rate of deaths in young people due to trauma. That is a good thing. However, that fact alone reduces the number of potential donors.
As well, in Canada, there are financial disincentives to organ donation. Doctors get paid fairly well to transplant organs but much less to sit down with a family and discuss organ donation with next of kin. Hospitals that care for organ donor patients in Canada get short-changed as well. U.S. hospitals receive roughly $60,000 in government funding to do the transplant and to provide intensive medical care for each donor patient. In Canada, it's more like $6,000 - making it a money-loser to preform transplants. The best organ transplant programs in Canada must borrow funds from other programs to squeeze out an extra liver transplant or two.
To boost the organ donor rate in Canada, there are several things we should do. Most organ transplants occur only after the deceased patient is declared brain dead. That lengthens the time needed to get approval for the donation and thus reduces the likelihood that the donor organ will be viable. Since 2006, we've had organ donation after cardiac death - meaning organ donation can take place within minutes after the heart stops. Precautions are put in place to verify that cardiac death has taken place, and that families are not approached in haste. Donation after cardiac death has resulted in hundreds of donor organs that might not have been available otherwise.
To take full advantage of organ donation after cardiac death, it is imperative that Canada and the provinces put public funds into establishing organ transplant units within easy reach of every urban centre in every region of the country. As well, we should look at ways of making organ donation more accessible to rural parts of Canada.
I also think we need an effective public campaign to recruit donors and a well-organized national organ donation program - one that puts incentives into organ donation. More important, we need to learn from the example of Spain and make organ donation into a point of national pride.
Even Canada, with its poor record of organ donation, has stories of families making that difficult choice - as we learned earlier this month. Toronto Police Constable John Zivcic
died in the line of duty, and his organs were donated, a decision that helped turn one person's tragedy into the salvation of others.
Have you noticed how quiet we are about organ donation? This wondrous act of heroism is sometimes spoken of in hushed whispers that almost suggest a sense of shame. The death is tragic, but the act of generosity fills me with a sense of awe.
If, as a nation, we do this, there is no reason why we cannot follow the shining example of Spain and other nations like it.
Judging by the results of our organ donor poll, I'd say Canadians are up to the challenge!