Alberta has shortest kidney transplant waits

Discrepancies raise spector of sharing organs between provinces

Sharon Kirkey, CanWest News Service

August 29, 2006

Photograph by : Getty Images

Albertans are nearly four times as likely as people in Ontario to get a kidney from a dead donor within three years of starting dialysis, according to research that found "striking" differences in kidney transplantation in Canada.

It's not fair to decide who lives and who dies based on where the lines are drawn on a map, say doctors writing in this week's Canadian Medical Association Journal.

The study of more than 7,000 dialysis patients found those under 40 waited a median eight years in Ontario and 7.8 years in B.C., for a new kidney, compared to three years in Alberta. Median means half waited longer, half waited less.

"If I was a patient just starting dialysis in B.C. and I didn't have a potential for a living donor, I might consider moving," says co-author Dr. John Gill, a kidney transplant physician at Vancouver's St. Paul's Hospital.

"It's a very powerful message that we've got these discrepancies, we need to understand them," Gill says. "We need to understand where in our donor process things are falling apart."

The deceased donor rate in 2005 was the lowest ever, at 12.8 donors per million population, according to the Canadian Organ Replacement Registry. Quebec had the highest rate, at 17.9, while Manitoba (5.1) had the lowest.

The team raises the possibility of sharing scarce organs between provinces or buying the kidneys of dead donors in "non-Canadian jurisdictions."

But lead author Dr. Marcello Tonelli says the price for sharing kidneys might be the organs fail more rapidly or some never work at all because of the increased delay between "procurement" and the transplant surgery.

"To me, it's not about opening a debate about organ sharing. We need to increase rates of both living and deceased donors for kidney transplantation," says Tonelli, a nephrologist and epidemiologist at the University of Alberta.

"Even in Alberta, average waiting times are three years or more, and that's too long."

An estimated 1.9 million Canadians have chronic kidney disease, according to the Kidney Foundation of Canada.

In 2003, there were 29,551 Canadians on dialysis -- a number that is expected to double over the next decade.

In a surprising finding, the study found patients living more than 300 kilometres from a transplant hospital were just as likely as those who lived only a few kilometres away to get a transplant. But things fell apart when they looked at differences in seven geographic regions.

The study involved 7,034 people who started kidney dialysis between 1996 and 2000. They were followed until they died, received a kidney or the study ended, in 2002.

About 11 per cent of the patients received a transplant from a deceased donor. Of the remainder, 5.8 per cent received a kidney from a living donor, and 46 per cent died while waiting.

Patients in Alberta were 3.7 times more likely than those in Ontario to receive a kidney transplant from a deceased donor.

The differences in organ-donation rates could be due to fewer people dying of brain death and the availability of transplant co-ordinators and surgeons, or an ethically diverse population that can make it tougher, because of language barriers, to get informed consent form next of kin.

Copyright © 2006 The Edmonton Journal

This article posted September 3, 2006.