Canada has one of the worst organ donation rates in the Western world. Its rate of 13 donors per one million people lags behind the United States, with a rate of 20 per million.
About 4,000 Canadians are currently waiting for transplants, 70 per cent of whom need a kidney. In 2005, 283 patients in Canada died while waiting. On average someone dies every three days in Ontario while awaiting a transplant and more than 1,700 patients are on organ-transplant waiting lists. Between 1994 and 2004, the number of Ontarians on waiting lists for organ transplants doubled while over the same period transplantation increased by only 17 per cent.
The low organ donation rate is often attributed to four factors:
• It is a very difficult subject to discuss with family.
• People are reluctant to discuss their own mortality.
• Many people are indifferent or oblivious to the fact it could affect them, a family member or a friend.
• Donation goes against religious beliefs.
For the record, the Roman Catholic, Episcopalian, Lutheran and Greek Orthodox faiths encourage donation. All four major denominations of Judaism support and encourage organ and tissue donation. Islam supports organ transplant as a priority for saving lives. Buddhism has no official position but considers it a matter of choice, while Sikhism supports a positive stand.
Historically, in Canada, organs have only been taken from a person who is declared brain-dead, meaning the brain shows no sign of life. But brain death (from strokes, injury or trauma) occurs in only about 1.5 per cent of in-hospital deaths. In Ontario, about 30,000 people die in hospitals every year — that rate leaves a potential donor pool of just 450 individuals. Subtract from that the number of donors deemed medically unsuitable plus the number of families that decline to consent and there is an even smaller number of potential donors.
One donor’s generosity can save the lives of up to seven people and improve the lives of up to 75 others through tissue donation. Organs that can be donated include kidneys, heart, lungs, liver, pancreas, bowel and stomach. The number of organs, on average, that can be recovered from each deceased donor is 3.6.
In 2006, organ donation after cardiac death (DCD), rather than solely using neurological criteria, was among a series of initiatives announced by the Trillium Gift of Life Network (TGLN), the donation agency of the Ontario Ministry of Health. DCD marks a new era for organ donation in Canada, with the opportunity to increase the number of donors from 10 per cent to 30 per cent.
DCD was first practiced at the Ottawa Hospital in June 2006. Since then it has been practiced on at least 45 occasions and more than 100 lives have been saved.
The Ontario Government has been very active working with TGLN to increase organ donation. A series of strategies, announced in August 2007 and unique to North America, will help alleviate the shortage. Last summer, the federal, provincial and territorial governments agreed to set up a national organ donation registry to be managed by Canadian Blood Services, with the mandate to co-ordinate organ donations across the country. Specifically, the agency will create and manage three electronic registries and be responsible for communications and public education.
Canadians have a limited understanding of organ donation. Most people assume signing their driver’s licence or a donor card will be enough. However, it is very important to advise your family of your wish to donate. The need for organ donors has never been greater. Canadians must respond accordingly. Governments, advocates and the medical community can only do so much.
Emile Therien retired as president of the Canada Safety Council in 2006 and is a volunteer with the Trillium Gift of Life Network and the Kidney Foundation. His daughter, Sarah Beth, died of sudden cardiac arrest at the Ottawa Hospital on June 17, 2006. In death, Sarah Beth became a medical pioneer. For the first time in Canada cardiac death, not brain death, was the criterion for allowing her organs to be transplanted. Sarah Beth’s kidneys were taken and transplanted into two individuals who are now living full, healthy lives. Her corneas were also transplanted into two patients, allowing both to regain full sight.
Why employers should care
Business case for transplant support
Outside of being the right thing to do, there is a business case for employers to encourage workers to become organ donors. The costs, both in dollars and time, to the health-care system from things such as kidney dialysis are enormous.
Employees who are on dialysis can’t fully contribute to the workplace, often missing work or going on disability. About 35,000 Canadians suffer from kidney disease and every day an average of 14 people across the country learn their kidneys have failed.
It costs $60,000 per year to keep a patient on dialysis, eating up about one-third of hospital medical budgets. With current trends, the cost could rise as high as 50 per cent within 10 years. And because dialysis ties up so many resources, the health-care system has less time and money to deal with other health issues that are keeping workers off the job.
Job-protected leave for organ donorsOntario is introducing legislation to make it easier for individuals to donate their organs. The Employment Standards Act would be amended to provide unpaid, job-protected leave for employees who donate all or part of their kidney, liver, lung, pancreas or small bowel to another individual. Donors would have to be employed by the same employer for at least 13 weeks to be entitled to the leave. In 2007, Ontario implemented an organ donation strategy that includes a program to reimburse living organ donors, who comprise about 30 per cent of donors, for out-of-pocket expenses and lost income associated with the donation.