Nova Scotia

Transplant teams thrilled with spotlight on organ donation in N.S.

From the co-ordinators who make the call to the lab workers who make sure there's a match, transplant teams are welcoming the debate about donation laws in Nova Scotia.
As a recipient transplant co-ordinator, Lesa Chisholm spends her days making sure recipients tests are up to date, and they're prepared for transplantation. (Carolyn Ray/CBC)

There are 186 people in Atlantic Canada who are waiting to hear Lesa Chisholm's voice on the phone.

She's the recipient transplant co-ordinator based in Halifax. It's her job to tell them they're about to receive a life-saving transplant.

"I've had a few people, when I've called, and they've said, 'Do you realize what time it is?' when it's two o'clock in the morning," she said.

It all changes when she tells them she is Lesa Chisholm from the transplant program.

"It's wonderful," she said.

Last week, Nova Scotia's premier announced the province would change the law, moving Nova Scotia to a presumed consent system.

Once that happens, people will have to register to opt out of being a donor, instead of the current system of opting in.

It's the first jurisdiction in North America to make the move, and it's one that has put the donation system in the spotlight.

For those who work behind the scenes in transplantation, the public debate is welcome.

"Parents are going to have a discussion with their children, spouses with spouses, so everybody knows what everybody wants to happen. And then, you know, if people aren't in agreement with this and want to opt out, they can opt out," said Chisholm.

Each binder represents someone in Atlantic Canada waiting for an organ donation. There are currently 186 people in need of a liver, kidney or heart. (Dave Laughlin/CBC)

Chisholm spends her days surrounded by shelves of binders. Dozens of them fill the transplant co-ordination office. Each one represents someone from Atlantic Canada who is in need of an organ.

"We have about 154 kidney patients waiting for transplant, 29 livers and three hearts," she said.

She studies the files, making sure all tests are up to date, and everything is in place for recipients to be listed.

The best part of her job, she said, is when she makes the call.

Chisholm laughs at some of the reactions she's heard. There have been a lot of expletives. Some people have even asked if she's playing a prank.

"I'm calling people in the middle of the night, Christmas morning, it doesn't matter," she said.

"Patients are excited, some are scared, and some are thinking a lot about the donor family at that time, too. There's questions about that."

But the phone call doesn't guarantee the transplant will go ahead.

Dr. Rob Liwski leads the team that tests the cells of donors and recipients, making sure they'll be compatible. (Carolyn Ray/CBC)

Once a potential recipient is flagged, the transplant laboratory starts performing a cross-match test. It's the final piece of the puzzle to make sure the recipient's body won't reject the organ.

Previous pregnancies, transfusions or other transplants could play a role in disqualifying a potential match.

"We all have different proteins on ourselves that help us fight our infections, but it turns out that all of us have slightly different proteins," said Dr. Rob Liwski, the medical director of the lab.

"If you're looking for a donor outside the family and often in the family, these protein differences can make your immune system as a patient react against the donor."

Process cut in half

This step in the process once took as long as five hours, but Dr. Liwski and his team were able to cut that time to less than two.

"Which is very important, especially when an organ is being imported from another province and has already travelled to our centre for many hours, and then it's actually sitting there waiting for us to make a decision whether we can go to transplant."

They did it by making what seemed like small changes. They started using trays instead of tubes, they cut down on the length of incubation time.

Their process was so successful, they now have more accurate results, and laboratories across North America have adopted their procedures.

Dr. Liwski is also happy to see the spotlight on donation.

He hopes that the more people become informed, the more they'll appreciate the donation process.

"For many patients this is a life-saving procedure. And it's a miracle that from one deceased donor, you can transplant eight different patients and give them a much better quality of life and give them opportunity to live."

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