Organ donor pool to expand

By including victims of heart failure, Ontario hopes to dramatically boost number of transplants

Tanya Talaga, Health Reporter

June 27, 2006

Ontario will become the first province in Canada to accept organs taken from people who have died of a heart attack, a move that will expand the potential donor pool by the hundreds.

The Trillium Gift of Life Network, the provincial agency in charge of organ and tissue donations, is expected to make the announcement today at the Ottawa Hospital, where they have called a news conference with the parents of a donor.

The Trillium board of directors proposed moving toward organ donation after cardiac death last fall in an effort to increase the donor pool.

Until now, transplant organs have been retrieved only from patients who have been declared brain dead -- the donors' organs are artificially maintained on a respirator until they can be transplanted. Brain death means the cessation of all brain function, with no possibility of patient recovery.

With so-called donation after cardiocirculatory death (DCD), the federal Canadian Council for Donation and Transplantation recommends an absence of a pulse, blood pressure and respiration for five minutes before two physicians pronounce the patient dead and the organs eligible for consideration.

They also have criteria for retrieving organs from people who have a cardiac arrest after life support is removed.

Under the new guidelines, hospitals that have the surgeons and the skills will start with kidney transplants and expand to lungs and livers as expertise develops.

Scientists at the Ottawa Hospital recently estimated that, had they been able to retrieve organs from cardiac arrest patients, they would have had access to another 28 kidneys -- a 30 per cent increase -- over an 18-month period.

"This is long overdue ... It could possibly raise the pool by what I feel is 20 per cent' George Marcello, organ donation advocate who has undergone two liver transplants

"This is long overdue," said George Marcello, 50, an organ donation advocate who has undergone two liver transplants. He created Step by Step, a group committed to increasing organ donor awareness, and has been actively campaigning for DCD for four years.

Marcello had his first liver transplant in 1995 following complications from hepatitis C. In 2005 he developed thrombosis during a trip to Europe and received another liver transplant. "It could possibly raise the pool by what I feel is 20 per cent," he said, basing his estimate on the European experience.

Research from the United States, where donation after cardiac death is practised in some areas, shows a similar rise in donation rates. DCD is also practised in Australia and Japan, according to the Canadian Council on Donation and Transplantation.

There are nearly 1,800 people waiting for an organ transplant in Ontario. In 2004, 122 of them died.

But every year 30,000 people die in Ontario hospitals and only about 1.5 per cent -- or 450 people -- meet the brain-dead criteria.

If eligible cardiac-arrest patients were added to the pool, it could mean hundreds more donors, though not all would be medically suitable and not all hospitals would be able to do the transplants.

There are also ethical questions that arise from donations from cardiac-arrest patients, namely the pronouncement of death. In some cases, people have been resuscitated after the heart has stopped beating.

The non-profit council, whose representatives span the national transplant community, recommended donation after cardiac death last year.

These recommendations -- found in detail on the group's website at http://www.ccdt.ca -- came after a year-long, national process on how to proceed with DCD.

Quebec has started a pilot project on organ donation after cardiac death.

Copyright © 2006 Toronto Star Newspapers Limited.

This article posted August 13, 2006.