Meeting report and recommendations
PDF copies of the following reports are available by request. Submit a request by sending an email to OTDT@blood.ca, please include the title and use the subject line: PDF Document Request.
RED blog post
Deceased donation rates in Canada lag behind leading countries. A key area of focus to improve the system for all Canadians is to ensure health care professionals are able to identify and refer potential organ donors. If they are not equipped to identify and refer potential organ donors to organ donation organizations (ODOs) in a timely manner, patients on transplant waiting lists are left waiting and the wishes of potential donors and their families remain unfulfilled.
A Potential Organ Donor Identification and System Accountability (PODISA) Workshop was held September 20-21, 2016 in Ottawa. A collaboration between Canadian Blood Services and the Canadian Donation and Transplant Research Program (CDTRP), this workshop engaged representatives from critical care, neurocritical care, emergency medicine, donation, transplantation, research, health care administration, family partners, and patient safety and quality organizations. The results have now been published in the Canadian Journal of Anesthesia.
To better understand the importance of donor identification and referral, we spent some time with lead author Dr. Samara Zavalkoff a pediatric intensivist at Montreal Children’s Hospital.
My name is Samara Zavalkoff and I am a pediatric intensive care physician at the Montreal Children’s Hospital. I look after children of all ages who are critically ill. I am an expert in patient safety and quality improvement. I have a keen interest in organ donation.
Donor identification and referral is the process of recognizing when a patient who is gravely ill, dying or brain dead, has the potential to become a deceased organ donor and should be referred to an organ donation organization for follow up.
Many reasons prevent identification and referral. They include:
Donor identification and referral is the first and most essential step in the deceased donation process. If a potential donor is not identified and referred, organ donation cannot happen. Failing to identify and refer a potential donor can have catastrophic consequences for transplant candidates awaiting an organ. A patient on the transplant list may die if a suitable donor is not found in time. Circumstances when a doctor does not identify and refer a potential organ donor, should be considered critical patient safety events.
Today, referral of potential organ donors is law in only five provinces. Currently, British Columbia, Manitoba, Ontario, Quebec and Nova Scotia require that the provincial organ donation organization must be notified when death is imminent or established.
Very much so. These guidelines are the result of a workshop hosted by Canadian Blood Services and the Canadian Donation and Transplant Research Program (CDTRP) that engaged representatives from critical care, neurocritical care, emergency medicine, donation, transplantation, research, health care administration, family partners, and patient safety and quality organizations. We gathered experts from areas across the organ donation community in Canada, including the very important perspectives of patients and donor families. They are the ones most impacted by donor identification and referral.
Ultimately, the meeting generated 37 expert consensus statements to establish best practices for healthcare professionals and the healthcare system with respect to donor identification and referral.
Donation opportunities are rare. Of 250 000 Canadians who die each year, only 2000-4000 will meet eligibility criteria for donation, and yet only 600 will become donors. In contrast, well over 4000 Canadians are waiting for an organ transplant.
This huge gap between actual donors and waiting recipients, the low-volume nature of organ donation and the high cost to patients if they do not receive a donated organ are the reasons that the healthcare system – and every professional working within it – must be highly coordinated in identification and referral of potential organ donors. Together, we must ensure that there are no missed opportunities in this complex process.
Some of the key consensus statements developed as a result of the workshop are described as follows at both the professional and the system level.
At the healthcare professional level, key statements include:
At the healthcare system level, key statements include:
When we fail to identify and refer a donor, harm is caused to another patient who is awaiting an organ transplant. This harm is disconnected, as we don’t know the name or face of this patient on the transplant list, but it is a critical patient safety issue and an example of harm that should be prevented.
Every Canadian who meets eligibility criteria has the right to be considered for organ donation. Every time a potential donor is not identified or referred, we deprive the patient and their family of fulfilling their wish to become a donor. For some families, organ donation is an important part of their grieving process and helps them attach meaning to their loved one’s death.
For transplant recipients, optimal compliance with donor identification and referral means the difference between life (receiving a transplant) and potentially death.
Making donor referral a part of end-of-life care falls into four key areas:
In February Dr. Zavalkoff presented about this topic to the Donation Physician Network via webinar. A recording of that session can be found below. Additional webinars designed for Donation Physicians can be found on Canadian Blood Services' Professional Education website.
This report provides an overview of the Potential Organ Donor Identification and System Accountability workshop and a summary of participant recommendations in response to prescribed questions. The workshop was based on the collaborative wisdom of a broad range of stakeholders, experts and key leaders representing Canadian Blood Services and the Canadian National Transplant Research Program (Refer to Appendix B: Workshop participants and affiliations). The Steering Committee would like to collectively thank Canadian Blood Services and the Canadian National Transplant Research Program for their support of this initiative, as well as all participants who helped in the creation of these recommendations. We would also like to acknowledge Ms. Debbie Neville and Mr. Emile Therien, our family representatives, who took the time to share compelling personal experiences which situated participants to the circumstances facing Canadians.
Note: This report and the published manuscript have been endorsed by the Canadian Critical Care Society