Transplant experts advocate a Canada-Wide organ donation system

April Lindgren, CanWest News Service

April 13, 2007

TORONTO -- Ontario may encourage more organ donations if it follows British Columbia's lead and subsidizes expenses for living donors, but leading transplant experts say a Canada-wide organ donation system will save a lot more lives.

"There should be a national list that enables any Canadian on any given night to have the resource of (an organ) donor that resides within any place in Canada," Dr. Francis Delmonico, director of medical affairs for the Transplantation Society, told CanWest News Service on Friday. "That makes common sense."

The society, made up of international transplant researchers and physicians, issued the call for a national system Friday during a scientific meeting in Montreal.

The pressure from leading experts in the field comes at a time when Ontario is considering adopting a British Columbia-style program that compensates living donors of kidneys or livers for lost income and other costs associated with the donation.

Health Minister George Smitherman, who in the next few weeks is expected to release an advisory panel report on how to boost Ontario's organ transplant rate, said earlier this week living donors represent a "real opportunity" for improvement.

Delmonico, a professor of surgery at Harvard University and adviser on transplantation to the World Health Organization, said living donors have an ethically defensible place in the system as long as they are only reimbursed for out-of-pocket expenses and not paid for the organ itself.

"I'm only asking that every country try and maximize opportunities with deceased donations. If we can do more deceased organ transplantation where there is no risk to a donor, then that makes common medical and social sense. Canada needs to wrestle with this problem because its donation rate has declined and Canadians are not being well served."

The number of transplants of all organs from living and deceased donors in Canada peaked in 2000 at 61.3 per million population.

Since then, it dipped as low as 55.5 before rising last year to 59 transplants per million population.

Donor rates vary widely throughout the country.

According to 2005 data from the Canadian Institute for Health Information, Alberta and Ontario had the highest incidences of living donors with rates of 19.9 per million population and 19.8 per million population respectively. British Columbia had the next highest living donor rate with 18.1 per million population while Quebec, where the rate was seven per million population, was at the bottom of the list.

At the same time, however, Quebec in 2005 had the highest rate of organ donation by the deceased. Its rate was 17.9 donors per million population.

The comparable rate in Alberta was 14.4 while British Columbia was at the back of the pack with 5.9 organ donations from deceased donors per million population.

Dr. Philip Halloran, a University of Alberta professor of medicine and editor of the prestigious American Journal of Transplantation, said in an interview Friday his 30-year campaign for a national system to co-ordinate organ donors constantly runs into opposition from those who insist health care is a provincial responsibility.

He noted while Canada and the United States had similar transplant rates 20 years ago, the Canadian rate has fallen 40 per cent behind since 1987 when the Americans introduced a new national organ donation system.

His data show there were 28,108 organ transplants in the United States in 2005.

If Canada performed organ transplants at the same rate, there would have been 3,091 such procedures in this country. Instead, there were 1,905.

Halloran suggested a national program would also improve access to organs from living donors.

"People in Ontario may want to donate to their relatives in Alberta," he noted. "And there are also complex programs where they can be paired so that if they can't donate to someone (in their own province), there is a system where they can donate into a pool and have their relatives receive a kidney from a pool of living donors. All of this requires resources and administration" and national co-ordination, he said.

Ontario health ministry spokesman Jeff Rohrer said all organs that become available for transplant in Ontario are put to good use.

"There are rare circumstances where an organ cannot be used in Ontario and then there is a certain amount of sharing among jurisdictions. In terms of a national strategy, it is something we would look to the federal government for."

In 2006, Ontario sent 13.5 livers, nine hearts, two kidneys, four lungs and one pancreas to other jurisdictions.

Copyright © 2007 CanWest News Service.

This article posted May 5, 2007.