Waits for kidney transplant vary dramatically by province, study suggests

Canadian Press: Sheryl Ubelacker

August 28, 2006

TORONTO (CP) - For Canadians on dialysis, the wait for a kidney transplant can vary by several years depending on their home province, although patients in rural or remote areas fare just as well as city dwellers when it comes to obtaining a life-saving organ, a study concludes.

Researchers found that dialysis patients in Alberta, for instance, were almost four times more likely to receive a replacement kidney from a deceased donor than were their counterparts in Ontario during the five-year study period.

Wait times for a new kidney were also shorter in Saskatchewan, Atlantic Canada's four provinces and Quebec compared with Ontario, while transplant recipients had similar or slightly longer waits in British Columbia and Manitoba, the University of Alberta study found.

"We can say that you're going to be waiting one to three years longer in Ontario than you would in Alberta," said nephrologist Dr. Marcello Tonelli, lead author of the study appearing in Tuesday's issue of the Canadian Medical Association Journal.

But Tonelli stressed that his province struggles like others across the country to close the gap between growing demand for replacement kidneys and stagnant or slightly declining rates of organ donations.

"Although you're better off if you're in Alberta, waiting times are still very long if you're here -- three to five years," he said Monday from Edmonton.

"The differences (among provinces) just tell part of the story. Patients in every region have to wait too long . . . So we need to increase donations everywhere."

The good news from the study -- an analysis of more than 7,000 Canadians on dialysis between January 1996 and December 2000 -- is that patients in rural or remote communities received kidney transplants at the same rate as those in urban areas, he said.

"We expected to find a problem in rural-and remote-dwelling people, specifically that they would have low rates of transplantation . . . In fact, we were very pleasantly surprised to find that the system is working well in looking after and serving the needs of remote-and rural-dwelling patients. We found no evidence that there was any disparity there at all."

Still, demand is increasing. One factor fuelling the need for kidney transplants is the rising rate of diabetes, which can destroy the detoxifying organs. Patients with high blood pressure are also at risk for kidney failure.

Tonelli said gaps in demand and donor organ supply are behind the regional differences, not that one province is superior to another in providing transplants.

"If you look at Alberta and Ontario, the donation rates are actually quite similar," said Tonelli. "What's different is there's just so much more demand, so many more people lining up in Ontario waiting for an organ."

Each of the seven regions across Canada keep a transplant waiting list to supply patients within their borders. So a donor organ in Saskatchewan would go to a recipient within that province, for example.

Dr. Cameron Guest, chief medical officer for Ontario's Trillium Gift of Life Network, said he is not surprised by the study's finding that Ontarians have a longer wait for new kidneys than most other provinces.

But he said the provincial transplant planning and co-ordinating network is undertaking a number of initiatives to boost organ donations. A law passed in January, called Routine Notification and Request, will soon require all hospitals in the province to identify potential donors and their families to the agency. It is also encouraging inclusion of donations after "cardiac death" -- in which life-support is withdrawn when no meaningful recovery is possible -- as well as the currently accepted brain death criteria.

In the United States, where donation after cardiac death is widely accepted, organ donation rates have increased by 20 per cent, Guest said.

Tonelli said it's difficult to alter demand for replacement kidneys, even though doctors and other health providers are working hard to help patients avoid the diseases that lead to kidney failure.

"But one thing we can do, which is in our power to do, is to increase donation rates, both from living donors (who give one of their two kidneys) and from deceased donors in every region," he said. "We need people to step up and donate."

Copyright © 2006 The Canadian Press.

This article posted September 2, 2006.