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Key Policies for Donation Success in Alberta and Canada

To ensure transplant success for all Albertans and Canadians, every hospital and every organ procurement system must have the following procedures in place.

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.

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.

References:
Shemie SD, MacDonald S. Improving the process of deceased organ and tissue donation: a role for donation physicians as specialists. CMAJ : Canadian Medical Association Journal 2014; 186: 95–96.
MacDonald SI, Shemie SD. Ethical Challenges and the Donation Physician Specialist: A Scoping Review. Transplantation 2017; 101: S27.
Shemie SD, Simpson C, Blackmer J et al. Ethics Guide Recommendations for Organ-Donation–Focused Physicians: Endorsed by the Canadian Medical Association. Transplantation 2017; 101: S41–S47.
Fifty physicians to champion organ and tissue donation in Ontario hospitals. (n.d.). Retrieved October 10, 2017, from http://www.newswire.ca/news-releases/fifty-physicians-to-champion-organ-and-tissue-donation-in-ontario-hospitals-560932261.html
Jones, K. (2015, January 17). Physicians engaged to lead on organ donation in Ontario. Retrieved October 10, 2017, from http://hospitalnews.com/physicians-engaged-lead-organ-donation-ontario/
Physicians Engaged to Lead on Donation in Ontario. (n.d.). Retrieved October 10, 2017, from http://www.marketwired.com/press-release/physicians-engaged-to-lead-on-donation-in-ontario-1978155.htm

These audits help quantify potential organ donors, highlight successes in donor conversion, and identify systems gaps that led to a missed donor opportunity.

 

 

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. Current Alberta legislation does not ask for mandatory referral, but rather, mandatory consideration, which may lead to missed donor opportunities.

What is it?

  • Mandatory referral, or routine notification is the process in which all potential donors are referred to an organ procurement organization.
  • There are currently a variety of mandatory referral models used in Canada.
  • An early referral allows an organ procurement organization enough time to test the potential donor for medical suitability and to approach the family for consent to deceased organ donation
  • For example, in Ontario, the Trillium Gift of Life Network Act states that:
    • “(1) A designated facility shall notify the Network as soon as possible when a patient at the facility has died or a physician is of the opinion that the death of a patient at the facility is imminent by reason of injury or disease.”(1)

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?

References:

  1. Trillium Gift of Life Network Act, R.S.O. 1990, c. H.20 [Internet]. Ontario.ca2014; [cited 2017 Oct 9] Available from: https://www.ontario.ca/laws/view
  2. Domínguez-Gil B, Murphy P, Procaccio F. Ten changes that could improve organ donation in the intensive care unit. Intensive Care Medicine 2016; 42: 264–267.
  3. Robertson VM, George GD, Gedrich PS, Hasz RD, Kochik RA, Nathan HM. Concentrated professional education to implement routine referral legislation increases organ donation. In: Transplantation proceedings. Elsevier, 1998; 214–216

These system must be managed by dedicated full-time leadership, an effective and accountable structure, and access to dedicated infrastructure.

Ontario has the Trillium Gift of Life Network. British Columbia has BC Transplants. Both organization are responsible for delivering and coordinating organ and tissue donation and transplant services throughout their provinces.

Improving public awareness of the need and benefits of organ & tissue donation and transplantation creates a culture of donation. By having the ‘kitchen table talk’, you are asking your loved ones to honour and respect your organ donation wishes. Each organ donor can save up to eight lives and enhance the lives of up to 75 more.

When an organ donor matches with a prospective recipient, the transplant must happen. Not having an operating room to perform the transplant cannot be the reason why a transplant is missed. Having dedicated space for transplants is consistent with leading jurisdictions.