My doctor told me, you'd better shop around

The state of organ donation in Canada is pretty grim
� is it time for the needy to be desperately seeking donors?

By Jason Gondziola

"You have to be careful about not being viewed as being coercive," says transplant specialist Dr John Gill. "Transplant programs, for lack of a better word, don't want to be in the business of recruiting donors."

For a patient with kidney failure, a transplant could mean the difference between a longer, healthier life and a shorter one filled with misery punctuated by weekly dialysis treatments. Unfortunately the demand for kidneys and other organs continues to exceed the available supply, according to a recent study by the Canadian Institute for Health Information (CIHI).

"We have a demand for transplantation, but we don't have sufficient donors," says Kim Badovinac, the manager of the Canadian Organ Replacement Register at the CIHI. "Basically they're stagnant."

At the end of 2003, there were 3,914 Canadians on waiting lists for organ transplants, which actually indicates a small decrease from the previous two years. But this apparent decline in demand is deceiving, according to Dr Gill, who practises at St Paul's Hospital in Vancouver and is an advisor to the Canadian Organ Replacement Register. "The waiting list appeared not to be growing," he says, "but the numbers of people on the waiting list was in fact flat. That clearly doesn't reflect real life."

DYING FOR DONORS
According to the CIHI, 250 patients � approximately five every week � died waiting for new organs last year. This included 82 patients waiting for a kidney, 100 waiting for a liver, 30 waiting for a heart, 26 waiting for a lung and 12 patients waiting for other organs or combination transplants. It doesn't provide much incentive to get on the list, notes Dr Gill, adding that the waiting time for kidneys typically runs from five to eight years. "There are people who doctors just don't refer because they know they're going to die before they get a transplant," he says. "I'm sure it happens for hearts and livers as well."

Canada's organ donor situation is also bedevilled by an aging population, which generates an increased demand for organs while limiting the options for supply. This is particularly problematic for deceased elderly donors, whose advanced age typically goes hand in hand with a host of health complications. Those who die of strokes, says Dr Gill, usually have a history of high blood pressure or vascular disease, which affects the rest of their organs.

"All of these organs are finicky," he says. "If I get a donor who's got high blood pressure, pretty much we're looking at getting a biopsy on the kidney to see if it's viable." Dr Gill is quick to add that this information isn't meant to discourage elderly donors.

STAGNATED RATES
How people die is also affecting the available organs. Head injuries and trauma were historically a strong source of organs, but this trend is showing signs of slowing down. Stricter laws enforcing seatbelt usage and punishing drunk drivers are leaving our roads safer � but are also sharply decreasing the number of donors from victims of road accidents. Canada's overall cadaveric donor rate was 13.5 per million population in 2003, a rate that has stagnated over the past 10 years.

This means that kidney patients waiting for organs should try and find live donors. But there's a troubling atmosphere of ignorance and misinformation surrounding organ donations, according to Dr Gill. He feels the solution lies in education.

"We don't really empower our patients to go out there and get a live donor," he says. "We're not very good at educating the families and friends about a few things. Yes there are risks, but the risks are small. The other part of it is that people think that you have to be a blood relative to donate. You don't have to be a blood relative to donate, you just have to be blood-group compatible."

Early action, from both patients and doctors, is key, says Dr Gill. If a kidney patient � or a liver patient looking for a partial organ donation � doesn't find a volunteer within the early stages, it's historically unlikely that they will find one. Doctors can help too, but have the added impediment of taking care to not seem too forceful when trying to convince donors to cough up a kidney.