To ensure transplant success for all Canadians every hospital should be have the following procedures in place
Donation after cardiac death (DCD) may allow potential donors previously not eligible for deceased organ donation to now donate their organs expand the opportunity for people who wish to be donors to donate – and increases the availability of deceased donor organs.Read More
What is Donation After Cardiac Death?
There are two primary types of deceased organ donation: donation after circulatory determination of death (DCD) or donation after neurologic criteria (DND). In cases of DCD, “life-sustaining therapy is withdrawn and organs are recovered after death is declared by absence of circulation”.(1) Shemie et al. has provided national recommendations for donation after cardiocirculatory death in Canada.(2) Expanding the donor pool to include DCD donors is important given that the number of patients dying from neurologic death is decreasing.(3)
Success of Donation After Cardiac Death
A recent article published in the Canadian Medical Association Journal (CMAJ) by Rao et al. (2017) evaluate the effect of introducing DCD in 2006.(1) The researchers found that implementation of DCD led to an increase of 57% from 578 donors in the pre-DCD era (2002/2003 to 2005/2006) to 905 donors in the recent DCD era (2010/2011 to 2013/2014). Early kidney transplant outcomes from DCD donors in Ontario have also been reported to be excellent and similar to those from DND donors.(4) Another study from a Canadian transplant program of kidneys from DCD donors also reported favorable outcomes.(5) Finally, another recent Canadian study also showed that simultaneous pancreas and kidney transplants from DCD donor have comparable outcomes to NDD donor organs.(6)
Which provinces have a DCD program?
British Columbia, Ontario, Quebec and New Brunswick currently has donation after cardiac death programs.
First DCD Donor in Canada
Sarah Beth was the first DCD donor in Canada. You can watch an interview with her parents at:
Hospital Donation Physicians promote a culture of donation inside their hospital by providing educational support and sharing expertise with hospital staff. Their role is to help ensure that no family misses the opportunity to create a life-saving legacy for a loved one by choosing donation.Read More
Why are they important?
Donation physicians are in-hospital physicians with key responsibilities in deceased organ and tissue donation. These donation physicians provide leadership to improve donation performance, accountable to their respective hospital and are remunerated for their activities. The Canadian Blood Services recommends the implementation of donation physician specialists to improve donation and transplant systems in Canada.(1) Specifically, their role may include “donor identification, direct care of potential donors, education of the public and of health care providers (HCPs), and administration of the decreased donation program.”(2) In other countries, donation system changes that included a hospital donation specialist role was associated with an increase in deceased organ donation rates.(1) Shemie et al. developed an ethics guide to help inform the hospital donation physician role.(3)
British Columbia, Manitoba and Ontario have hospital donation specialists.
Making it mandatory for hospitals to contact the provincial organ procurement organization/program before withdrawing life support from patients can significantly increase in the number of potential organ donors.Read More
What is it?
Which provinces have implemented mandatory referral?
British Columbia, Alberta, Manitoba, Ontario, Quebec, New Brunswick currently has mandatory referral.
What is the success of mandatory referral policy?