Legal and Social Affairs Division
Every year, the number of Canadians awaiting organ transplantation surgery surpasses the number of organs available for transplant. On average, 225 patients die each year while awaiting a transplant.
In Canada, the third week in April – this year, 19–25 April – is National Organ and Tissue Donor Awareness Week.
The House of Commons Standing Committee on Health studied this issue more than 15 years ago. In 2001, the federal government established the Canadian Council for Donation and Transplantation; in 2007, its responsibilities were transferred to the Canadian Blood Services (CBS).
Statistics on organ donation and transplantation are compiled by the Canadian Institute for Health Information (CIHI). The federal government contributes funding to support CBS’s efforts to improve organ and tissue donation and transplantation rates in Canada, and the work of CIHI.
Defining organ donors
There are three ways of looking at organ donors in Canada. They are:
- Living and deceased – Although much of the discussion in this HillNote refers to deceased donors, from whom multiple organs and tissues can be donated, living donors are also common in most provinces in Canada.
- Brain death and cardiocirculatory death – Deceased donors can be identified either following brain death (sometimes called neurologically determined death). Or they can be identified following a serious brain injury or other terminal condition where the individual is not brain dead (sometimes also called non-heart-beating or cardiorespiratory death).
- Potential and actual – Although many Canadians may consider that anyone who has consented to be a donor as a potential donor, in fact, very few people are ever identified as a potential donor. Potential donor refers to those individuals who have been identified as suitable candidates for donation at the time of their death. Actual donor refers to those deceased individuals from whom at least one organ has been retrieved and transplanted into a recipient.
Organ donor rate: A global comparison
According to CIHI data, Canada’s deceased donor rate in 2012 was 15.5 donors per million population (DPMP), a 17% increase since 2003. This rate varies by region.
Figure 1 – Deceased Organ Donor Rate by Region
Canada’s living donor rate consistently surpassed the deceased donor rate between 2003 and 2010. However, in the two successive years – 2011 and 2012 – these rates coincided.
In 2012, Canada recorded 1,079 organ donors – 540 deceased and 539 living. On average, 3.2 organs are retrieved and transplanted from each deceased donor.
Canada’s deceased organ donor rate appears about average compared with other countries. While it is well below the rate of 25 DPMP in the United States and 35 in Spain, it is about twice New Zealand’s rate of 8 DPMP.
Canada’s rate is roughly on par with the rate in nations with which it is often compared on other health issues, such as the United Kingdom, where the rate is 18 DPMP, and Australia, where it is 15.
Figure 2 – Actual deceased donors, 2012
Addressing barriers to donation
Numerous barriers can affect the likelihood that a possible donor will become an actual donor. These barriers include:
- poor identification and referral of possible donors by medical personnel;
- inability to satisfactorily confirm brain death or failure to confirm cardiocirculatory death in a timely fashion;
- no available organ retrieval team or equipment;
- overwhelmed hospital resources;
- failure to obtain consent from family members;
- medical unsuitability of the donor;
- an unanticipated medical crisis that prevents organ retrieval;
- failure to successfully retrieve or maintain organs; and,
- inability to identify a suitable recipient or successfully transplant the donor organ.
Under Canada’s current inclusion and exclusion criteria, which determine the potential donor pool, certain measures could help increase the proportion of potential donors who become actual donors. These include increased training for medical personnel, additional resources for hospitals, and encouragement for families to discuss donor intentions.
Without optimizing these factors, donor consent alone is insufficient to ensure successful donation.
CIHI notes that Canada’s base of potential donors could be increased by accepting individuals beyond the age of 70 years and by updating the exclusion criteria for donation to better reflect evolving practices in Canada and internationally. CIHI notes as well that improved identification of individuals following cardiocirculatory death is necessary.
Canada’s organ donor potential
Few Canadians will become organ donors upon their death, regardless of their willingness to donate, since several conditions must be met.
A breakdown of in-hospital deaths (the first condition of suitability) in 2012 indicates that there were:
More referrals and proper follow-up of potential donors following cardiocirculatory death presents an opportunity for substantially increasing Canada’s deceased organ donor rate.
Specifically, of the estimated 3,088 potential donors in 2012, only 540 became deceased donors.
Of the actual donors, however, only one in eight became donors following cardiocirculatory death, despite an estimate from hospital statistics that this category should be proportionally the same as donors following brain death.
Canadian Blood Services. “Organs & Tissues.”
Canadian Institute for Health Information. “Organ Replacements.”
Norris, Sonya. Organ Donation and Transplantation in Canada. Publication no. 2011-113-E, Parliamentary Information and Research Service, Library of Parliament, Ottawa, 21 November 2014.