Toronto: No ICU Beds - No Transplants

Theresa Boyle

Queen's Park Bureau

Twelve patients scheduled for transplant surgery at the University Health Network have been bumped at the last minute because the intensive care unit was full.

The cancellations have occurred since the start of the year, hospital president Tom Closson said yesterday.

"It's terrible for the patients because these are very sick people and these organ transplants are lifesaving for them," he said.

The shortage of intensive care space sent Markham resident Wally Dotto on an emotional roller coaster last weekend.

The 52-year-old printer has an aggressive form of liver cancer. He was in bed late last Friday night when he got the call he was anxiously awaiting - a liver was available for transplant.

He and his wife, Sandra, raced down to the hospital where they spent an anxious and sleepless night getting ready for surgery the next morning. Dotto was prepped for surgery; he had x-rays taken and more than 10 vials of blood collected.

"We were very, very emotional the whole night," he said.

But early Saturday morning, Sandra met with the transplant surgeon and got the bad news. Another patient had suffered a cardiac arrest and had taken the intensive care bed that was supposed to go to her husband.

"My wife came back to my room, closed the curtain and started crying," Dotto recounted. "To say the least, I was very angry. She was very emotional.

"It was horrible. The worst part of it was looking at the faces of my wife and children," said the father of four.

Closson said the University Health Network, which includes Toronto General, Toronto Western and Princess Margaret hospitals, is working to increase the number of ICU beds available so that such mishaps can be avoided in future.

When the transplants were cancelled, the organs did not go to waste because they were sent to transplant centres elsewhere, Closson said.

"When an organ becomes available, from the perspective of the person who's supposed to be receiving it, there is some sense of ownership. So if it goes somewhere else you can imagine how people feel."

He attributed the problem, in part, to the success of an organ donation campaign launched by the province a year ago. More families are choosing to donate the organs of deceased relatives, but the infrastructure is not yet in place to do the transplants.

"I guess you could say we should have grown faster than we are growing and I think both ourselves and the Ministry of Health didn't anticipate how quickly this supply of organs was going to materialize," Closson said, noting in at least one case, the organs had to be sent out of the province for transplant.

Closson said staff at the hospital have gone through scenarios like Dotto's a total of 12 times and are left feeling heavy hearted.

"We obviously apologized to the family and to him. We think it's terrible," he said.

The hospital is well aware of the jeopardy patients are placed in as they go back on the transplant list.

"There's always a risk," he said.

"There a potential here to have another liver within months," he said, expressing optimism that Dotto will eventually get his transplant.

Closson said the intensive care unit was particularly full last weekend.

"We did four transplants and there were eight cardiac arrests. We just have an awful lot of sick people here."

In January alone, he noted, the hospital did 42 transplants, twice the usual number.

Darwin Kealey, president of the Trillium of Life Network, the provincial agency that co-ordinates transplants, confirmed the number of transplants is increasing. Some 122 transplant operations have been conducted in Ontario since the beginning of the year, an increase of 35 to 40 per cent over the same period last year, he said.

Closson said about half of the transplants performed in Ontario are done at the University Health Network. While there are five other transplant centres in the province, only his hospital has had to turn people away.

Compounding the problem is the fact more "living donor" transplants are being conducted, he noted. So, for example, pieces of lung or liver tissue are removed from a living donor patient and then transplanted into a recipient patient. That means there are two patients involved, taking up even more space in intensive care.

As well, advances in science mean transplants can be done on sicker patients. But they need even extra time to recuperate in intensive care, Closson noted.

Transplants patients need to stay in intensive care for weeks and currently they take up to 70 per cent of the space in the unit, he said.

"We're having difficulty meeting the demand. We don't have enough capacity. There has been a big growth in transplants," Closson lamented.

There are 14 permanent beds in the medical-surgical intensive care unit. That number has recently been bumped up to 18 because the hospital has taken two beds away from the cardiac intensive care unit and two beds for the cardiovascular intensive care unit.

But it's still not enough.

A new transplant centre is scheduled to open at the hospital in November. It was to have only 20 beds, but consideration is now being given to increasing that number to 30.

Meanwhile, the hospital is looking for a temporary fix.

"We're going to try to get the physical capacity in on a short-term basis to bridge us to November," Closson said, adding the hospital is trying to find another four to six beds.

But even that will take up to eight weeks because it will require some capital construction, he explained. Then there's the problem of staffing the beds.

"We also have to look at whether we can find the nurses to staff them," Closson said, noting the nursing shortage is particularly severe in intensive care.

"This is a giant juggling act at the moment, but you can't put somebody into an operating room if you don't have anybody to take care of them when they come out of the operating room."

Paul Cantin, press secretary to Health Minister Tony Clement, acknowledged transplants are on the rise since the province kicked off an organ donation campaign a year ago.

"There has been a public awareness campaign to try and get people to be more aware of the issue around organ donation. It would appear to be evidence of the success of that program that there's now more opportunities available," he said, adding efforts are being made to increase the capacity.

But opposition politicians condemned the government for not having the proper infrastructure in place.

"Everyone was giving them big stars when they came out with this organ donor campaign and trotted out the celebrities," said Liberal MPP Sandra Pupatello (Windsor West).

She recalled how former premier Mike Harris launched the campaign with much fanfare, accompanied at news conferences by hockey analyst Don Cherry and Maple Leaf Tie Domi.

"Typical Tory health-care planning. They're all about headlines," she said.

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This article posted April 5, 2003.