Living Donor Paired Exchange becomes first Canada-wide organ donation registry

Yesterday, the Living Donor Paired Exchange performed the first match run to include kidney patients and donors from all across Canada. In doing so, it became the first Canada-wide organ donation registry.

The LDPE registry facilitates living kidney donations between patients with a willing but incompatible donor and another pair in the same situation. It is a partnership between Canadian Blood Services and transplant programs across the country, and was launched as a three-province pilot in January 2009. Since then, all other provinces have gradually joined the registry, and with Quebec firming up its participation in October, the initiative has become Canada-wide in scope.

"The inclusion of all provinces in the LDPE is a significant development for patients as it increases the pool of donors. And of course the larger the pool, the more likely patients are to find a match and receive the transplant they need," said Dr. Graham Sher, CEO, Canadian Blood Services. "This is a prime example of how better collaboration and integration can improve donation and transplantation rates in this country, and ultimately, save more lives. It is what sets top performing countries apart."

The LDPE has registered 185 donor/recipient pairs from across the country, and has been responsible for facilitating 57 kidney transplants since the launch with an additional 16 scheduled for surgery in the weeks ahead.

Critical to the registry's success has been the inclusion of non-directed donors - a person who is entered into the registry, unpaired and willing to donate to any one in need. "Non-directed donors are selfless heroes that have created 'domino exchanges' which are responsible for 45 of the 57 transplants to date," said Dr. Ed Cole, Chair of the National Kidney Registries Advisory Committee and University Health Network Physician-in-Chief. "Non-directed donors greatly increase the number of available matches, but best of all, since they enter as a single rather than a pair, it means that at the end of the domino chain, one patient on the deceased donor waiting list also gets a transplant."

In addition to going Canada-wide, the registry has celebrated some other important milestones of late, including:

• the first LDPE surgeries performed in the province of Nova Scotia;
• the first patients in Saskatchewan, Nova Scotia and Newfoundland and Labrador receiving transplants;
• matches and transplants for highly sensitized (difficult-to-match) patients; and
• first instance where kidneys were shipped as part of a living donor exchange from one Canadian centre to another, demonstrating that transporting the kidney rather than the donor is feasible in some circumstances.

"A transplant is generally the preferred treatment for people whose kidneys have failed but far too many patients are dying while waiting" said Paul Shay, National Executive Director of The Kidney Foundation of Canada. "Each kidney transplant saves the health care system up to $40,000 annually.  The 57 transplants that have happened as a result of this registry will save the system millions of dollars and improve the quality of life of the transplant recipients beyond any monetary value."

The concept of a national registry for LDPE was proposed by the Canadian Society for Transplantation and the Canadian Council for Donation and Transplantation (merged with Canadian Blood Services). It was developed, implemented, and is currently operated by Canadian Blood Services. Two more registries - the national organ urgent wait list and a registry for highly sensitized (difficult-to-match) kidney patients are now in development and are planned for roll-out in 2011.

Delivering these registries is part of the mandate Canadian Blood Services was given by the Federal, Provincial and Territorial Ministers of Health in 2008 to help improve Canada's performance in organ and tissue donation and transplantation (OTDT).  The mandate also included assuming the activities of the former Canadian Council for Donation and Transplantation (CCDT), as well as leading the efforts of the OTDT community to design an integrated system to improve clinical patient outcomes, increase the quality of life for patients, and improve the system's efficiency.