In Canada, the third week of April is National Organ and Tissue Donor Awareness Week.
Every year, the number of Canadians awaiting organ transplantation surgery surpasses the number of organs available for transplant. This HillNote provides an overview of organ donation in Canada. The note includes donation rates; compares Canadian and international donation rates; lists some of the barriers to donation; and discusses Canada’s organ donor potential.
Organ Transplant Jurisdiction in Canada
How does Canada compare to other countries in terms of organ donor rates? What is the potential to increase the number of organs that become available for transplant?
The House of Commons Standing Committee on Health studied this issue more than 20 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 in Canada, and the work of CIHI.
Defining Organ Donors
There are different ways of looking at organ donors in Canada.
- 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 2019 was 21.8 donors per million population (DPMP), a 59% increase since 2010. The figure below illustrates how this rate varied by region between 2010 and 2019.
Deceased Organ Donor Rate in Canada, by Region, 2010-2019
Source: Prepared by author using data obtained from CIHI, Organ Donors, 2010-2019 – Data tables, Figure 32, 3 December 2020.
As shown in the figure below, Canada’s deceased donor rate has surpassed the living donor rate since 2014, which has remained largely unchanged since 2010.
Organ Donor Rate in Canada, by source, 2010-2019
In 2019, Canada recorded 1,434 organ donors – 820 deceased and 614 living. On average, 3.2 organs are retrieved and transplanted from each deceased donor.
Canada’s deceased organ donor rate is within the top third of countries surveyed by The International Registry of Organ Donation and Transplantation. While the rate is well below the rate of about 37 DPMP in the United States, 33 DPMP in France and almost 50 DPMP in Spain, it is well above New Zealand’s rate of 13 DPMP.
Canada’s rate is roughly on par with the rate in other nations with which it is often compared on other health issues, such as the United Kingdom, where the rate is 25 DPMP, and Australia, where it is 22 DPMP. For more information on international data, please see the Library of Parliament publication Organ Donation in Canada: Statistics, Trends and International Comparisons.
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 measures 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:
Initiatives to increase the number of referrals and follow-up of potential donors could help increase Canada’s deceased organ donor rate. A presumed consent approach has been implemented in several countries and has recently been put into force in Nova Scotia.
Canadian Blood Services. “Organs & Tissues.”
Sonya Norris, Strategies to Optimize Organ and Tissue Donation and Transplantation, Library of Parliament, 1 April 2020.
Author: Sonya Norris, Library of Parliament