Organ donation up by more than half in Ontario since Canada introduced new policy

By Sally Robertson, B.Sc.Sep 25 2017

Since Canada introduced a new organ donation policy in 2006 called “circulatory determination of death” (DCD), Ontario has seen a 57% increase in donation, according to a new study.

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The policy, which was introduced to address the shortage of organs available for transplantation, permits the donation of organs once patients have lost circulatory function.

Prior to 2006, deceased organ donation was allowed after “neurologic determination of death” (NDD), commonly referred to as “brain death,” where a person is diagnosed as dead when the entire brain ceases to function.

In the case of DCD, patients with severe brain damage, but who are not brain dead, can still donate organs if they themselves or their family agree to life support being withdrawn.

A few minutes to one hour after the support is withdrawn, the heart ceases to beat, at which point the patient is observed to check the heart does not re-start and if there is no circulation after 2 to 5 minutes, the patient is pronounced dead. At that point, organ removal is allowed.

Lead author of the current study, Vivek Rao (University of Toronto), says the most significant development in efforts to widen the donor pool has involved donations taking place since the introduction of DCD.

To investigate the trends in organ donation since the policy was introduced, Rao and colleagues compared data available for the period 2002 up to 2006 (a pre-DCD period), with data available for 2011 up to 2014, a recent DCD period.

Commenting on the study findings, medical advisor for Deceased Organ Donation, Sam Shemie says the research showed that, over the 12 -year period, Ontario saw an increase in transplantation rates that is almost entirely attributable to the introduction of DCD.

The findings, says Shemie, is instructive for the rest of the country, as there is still significant variation in organ donation rates between provinces that can be accounted for by variation in adoption of DCD.

Rao and team state that donation after DCD has had a positive effect in Ontario in terms of both overall number of donors and transplant activity.

"Although there are disparities among organ groups, we foresee that an active DCD program will continue to have a positive effect for all solid-organ transplant recipients," they conclude.