Organ donation: The ultimate gift

Organ transplants: the big picture
It isn't easy getting an organ. In 2006, there were 2,160 transplants performed in Canada, but 4,240 Canadians remained on a waiting list, and 243 people — one person every 36 hours — died while waiting. Only 10 per cent of people who need an organ qualify for a waiting list because there aren't enough organs available. The people who get listed are those expected to have the best quality of life after transplant.

Where are all the organs?
There are many reasons why organs are scarce. Factors such as our aging population have increased demand while decreasing supply. Fewer injury deaths have also contributed to the shortage. There is also variation across Canada in the way hospitals identify potential donors and approach families, and it is not mandatory for them to do so at all.

Transplant data shows that donation rates in Canada are lower than other countries, leaving room for improvement. Every year since 2001 there have been more living donors (who are able to donate a kidney, or a part of the liver, lung, small intestine or pancreas) than deceased donors. But deceased donors are still critically important. Their organs can benefit up to eight people (and their tissues can help up to 75 more) instead of just one.

How does a patient qualify?
To qualify for an organ, patients must have an "end stage" disease, meaning their condition is terminal and untreatable. Since there's a significant chance of dying from the procedure or of rejecting the new organ in the first year, patients are put on a waiting list only when the risk of transplant is less than the risk of living with their failing organ. Transplant programs also consider a patient's attitude and psychological health. People unwilling to make lifestyle changes (for example, maintaining a healthy diet or quitting smoking) to keep their new organ healthy are not allowed on a list.

Waiting lists are constantly adjusted as patients are added, removed or given greater priority because their condition has become more life threatening. Other factors affecting wait time include blood type and organ size, since these must be compatible between donors and recipients. Patients are given an estimate of the wait, but they can never know for sure where they are on the list.

New avenues for acquiring organs
Fortunately, some new approaches on the horizon may make more organs available.

Hospital reporting: Several provinces now require hospitals to notify organ agencies when a deceased person could be a donor.

Donor criteria: Many programs are making greater use of donors who have healthy organs regardless of age, and are using more organs per deceased donor. Donation after cardiac death (after a heart stops in hospital, with no chance of recovery), which is just beginning to be used in Ontario and Quebec, could increase organ availability by 10 to 30 per cent.

Paired exchange: An option for people who wish to give an organ to a friend or family member but cannot because of incompatible blood types. The potential donor and recipient are matched with another pair in the same situation, and the organs are exchanged between them.

Consent models: Donating is usually left up to your next of kin (if you want to be a donor, tell your family). We assume people aren't donors unless they "opt in" to indicate otherwise. Ontario is looking at a mandatory declaration model, in which people over 15 must state a donation preference (yes, no or undecided) to receive a health card. Your donation preference would then be followed in the event of your death.

Incentives: Encouraging living donors by reimbursing the costs associated with donating. British Columbia and Ontario have programs that offer living donors up to $5,500 for accommodation, travel, meals, lost income and medical costs.

For more facts, check out our heart health Q + A.

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