By Amy Kwon and Katarina Zorcic
Organ donations are imperative and often life-saving medical treatments for many patients worldwide. There seems to be a disconnect between the public’s knowledge of the importance of organ donating and the number of organ donors, and there is undoubtedly a supply problem compared to the demand. In Canada, there are more than 4,000 patients registered on a waitlist to receive a life-saving organ donation, and many die while waiting. Although 90% of Canadians express support for organ donations, only 32% are officially registered to be organ donors [1]. Every year, approximately 2,000 Canadians fail to receive their required organ transplantation.
From 2002 to 2012, deceased organ donations have risen steadily, from 12.9 per million population (PMP) to 15.5 PMP, while the rate of living organ donations have been relatively stable [2]. The average number of organs used from a deceased donor can range from 3.4 to 3.8 organs per donor [3]. Canada has improved organ donation outcomes through better organ maintenance to further optimize organ viability.
Organ donation rates differ by geographical location within Canada. Regions such as British Columbia, Ontario, Quebec, and Atlantic Canada have shown a gradual increase in organ donation rates, while other provinces and territories have shown no change or a decline in organ donations [2]. Organ donation rates also depend on the type of organ being donated and the method of donation (i.e., deceased vs living donor donations). For kidney donations, approximately two thirds of kidneys come from deceased donors. While the demand for kidney donations has increased, the mortality rate has relatively stayed the same. As medical technology improves over time, the mortality rate of those on the waitlist has decreased. For liver donations, living donor liver transplantations significantly outnumber deceased donors. Additionally, a large increase in demand for heart transplants was noted.
There could be several reasons why donated organs cannot be used for transplantation, including viral infections, organ damage, and poor organ function. Other reasons that should be focused on are logistical issues and failures to locate and identify recipients. The United States has a centralized, nation-wide information management system to update and inform healthcare professionals about the organ transplantation waiting lists called the United Network for Organ Sharing, but Canada currently lacks a proper framework to this extent [3].
Currently in Canada, an opt-in system is in place, meaning organ donors must formally express their wishes to be an organ donor, and in cases where the person cannot decide whether to donate their organs or not (e.g., in a coma), their family decides. However, some have suggested an opt-out system in which consent to be an organ donor is presumed for everyone unless they have indicated otherwise. This may bridge the gap between expectations and reality: only one third of the Canadian population is registered to be an organ donor despite the vast majority of the population saying they support organ donation. However, some countries with opt-out systems, such as Sweden and Poland, report lower rates of organ donors. Therefore, the opt-out method does not guarantee a significant increase in organ donors.
Since 2008, the Canadian Blood Services has been responsible for coordinating national efforts in organ donating, which has led to an increase in registered organ donors. However, more information and awareness regarding organ donations and transplantations would mitigate the supply-demand problem and ameliorate the rate of survival and quality of life for Canadians.
References
[1] Canadian Blood Services. (n.d.). Organs & Tissues. About | Organs & Tissues. Retrieved November 5, 2022, from https://organtissuedonation.ca/en/about#:~:text=Approximately%204%2C100%20Canadians%20await%20a,have%20actually%20registered%20their%20decision.
[2] Kim SJ, Fenton SS, Kappel J, et al. Organ Donation and Transplantation in Canada: Insights from the Canadian Organ Replacement Register. Canadian Journal of Kidney Health and Disease. 2014;1. doi:10.1186/s40697-014-0031-8
[3] Norris, S. (2011). Organ donation and transplantation in Canada. Library of Parliament.
Organ Advocacy Initiative 