More Canadians are donating organs, but it's still not nearly enough to keep up with demand, new research shows.
According to a new study released today by the Canadian Institute for Health Information, more than 1,000 Canadians donated organs in 2008, up 28 per cent from 812 in 1999.
But demand for organs has also risen during that period, fuelled by an increase in the number of Canadians with organ failure, as well as medical advancements that are keeping patients alive longer.
With supply lagging demand, last year, about 215 Canadians died while waiting for an organ transplant.
CIHI's study, "Organ Donor Activity in Canada, 1999 to 2008," found the gap between supply and demand is particularly apparent among kidney patients.
"Our study shows that despite a significant increase in the number of kidney donations over the past decade, we are no further ahead when it comes to meeting demand," Jean-Marie Berthelot, the vice president of programs at CIHI, said in a news release.
He said this is partly due to a rise in kidney failure cases in Canada that are caused by diabetes.
"With obesity on the rise in the country, the number of new patients with end-stage renal disease associated with diabetes has nearly doubled over the past decade, from about 1,000 new cases in 1996 to nearly 1,900 in 2008."
Increase in living donors
The number of living donors accounts for 69 per cent of the increase in donors over the past decade. Kidney transplants are most likely to use living donors, who typically donate one of their two kidneys.
The greatest relative increase in the use of living donors in the last decade was seen in partial-liver transplants, in which donors donate a part of their liver.
Living donors are most likely to be relatives of the recipient, the CIHI study found. Blood relatives accounted for almost two-thirds (64 per cent) of living donors in 2008, while spouses accounted for 16 per cent. Only 17 per cent of living donors were unrelated to the recipients.
The deceased donor rate has not risen as quickly as the rate of living donors.
In 2008, there were 492 deceased donors, which is "surprisingly low given the number of eligible deaths that occur in Canada annually and falls well behind international standards," says Dr. Sam Shemie, medical director of the organs and tissue donation program of Canadian Blood Services.
And while deceased donors can donate up to six organs, on average, they donated about 3.6 organs per donor in 2008.
Shemie notes that people who die after catastrophic brain injuries, such as head trauma and strokes, have typically provided the largest proportion of deceased donors in Canada. But as death rates from these injuries have fallen, hospitals need to be more efficient in identifying and managing donors in order to increase the number of transplants.
One new approach is helping to change the scope of organ donation: accepting donors who have died of cardiac death, not brain death.
Typically, most organs are retrieved after a patient is deemed to be brain dead, where there is a window of a few hours to retrieve the organs. But four provinces (British Columbia, Ontario, Quebec and Nova Scotia) are now retrieving organs for donation after cardiac death, though the numbers remain quite small. In 2008, fewer than 10 per cent of donors were donors after cardiac death.
"The need for transplantable organs has never been greater," says Dr. John Gill, Associate Professor of Medicine at the University of British Columbia--Division of Nephrology at St. Paul's Hospital in Vancouver.
"The option of organ and tissue donation should be offered to all patients who die in Canadian hospitals and should be incorporated as an essential component of end-of-life care."
