Interprovincial Organ Sharing of High Status Hearts

Building upon the success of the interprovincial sharing of kidneys for highly sensitized patients, and guided by Canada's heart transplantation community, Canadian Blood Services has developed the technology that supports the approved inter-provincial Heart sharing policies that will streamline and propel heart allocations and transplantations in Canada in to the future.  

The Interprovincial Organ Sharing of Hearts for High-Status Recipients project (referred to as the “IPOS Heart project”) is guided by the need to improve the allocation of a very rare and precious gift. The project’s focus is to match available hearts to the most medically urgent, and difficult to match heart waitlist patients. The policies are a result of a collaborative pan-Canadian approach and provides an enhanced framework for balancing competing principles; while adding a national consistency, transparency, and accountability to the heart allocation process. 

Canadian Blood Services is honoured to work with, and inspired by, the many hard-working doctors, nurses, laboratory technicians, managers, analysts and software developers from coast-to-coast who are united in working on this "Made-in-Canada" project. 

 

Project background  

The IPOS Heart project has further developed the Canadian Transplant Registry (CTR) to allocate hearts interprovincially to medically urgent (status 4) and highly sensitized (≥80% cPRA) recipients and improve the tracking of the outcomes of organ sharing in these patient populations.  

Building on foundational policy work by the Canadian Cardiac Transplant Network (CCTN), the Heart Transplant Advisory Committee (HTAC), led by Canadian Blood Services, developed policies outlining a consistent national approach that defines eligibility and prioritization requirements for listing and interprovincial sharing of high status hearts (Medically Urgent and > = 80%  cPRA). Today, heart transplant programs in Canada list all transplant candidates in Canadian Blood Services' CTR.

Interprovincial policies were approved by provincial funders for implementation within the CTR in January 2019 and CCTN have updated their eligibility and listing criteria endorsing the use of these policies. Organ Donor Organizations (ODOs) and Transplant Centres are encouraged to review the national polices and prepare for potential impact on local processes.

Virtual Crossmatch functionality was implemented on October 15, 2019 and continues to be available to use in identifying those candidates that are known to be vXM negative to the donor heart being allocated. This immediate, interim function has helped reduce the allocation time of highly sensitized hearts, resulting in a more efficient process for donor coordinators and reduced wait times for donor families.

Canadian Blood Services entered the final implementation phase of the Interprovincial Organ Sharing of Hearts for High-Status Recipients project in 2023, and implementation went live on October 12, 2023. Previously, heart transplant recipients of all statuses were listed on the National Organ Waitlist (NOW); however, once the implementation work was completed by CBS and our provincial partners, all heart allocation and offers to medically urgent and highly sensitized patients began to be conducted through the CTR.

 

Current project status 

First anniversary activity

Launched in October of 2023, the High-Status Heart program provides heart transplant patients who are in greatest need of assistance with priority access to available donors. This program is administered by Canadian Blood Services through the Canadian Transplant Registry in cooperation with provincial donation and transplant programs across Canada. 

Qualifying for the high-status heart program

  1. Patients whose need for a heart transplant is rated as having the highest level of medical urgency (medical status 4) 
  2. Patients who are estimated to be immunologically compatible with one in five available donors or fewer (highly-sensitized). 

Goals

  • Promoting interprovincial sharing and a national system
  • Ensuring organs are allocated fairly to the right recipients
  • Improving organ utilization (avoiding missed opportunities for transplant)

First year results

  • In the first year, 36 heart transplants were facilitated through the HSH program in its first year, 30 of which went to medically urgent recipients.
    • Status 4: 27
    • Highly-sensitized: 6
    • Both: 3
  • Heart transplants are typically performed in British Columbia, Alberta, Ontario, and Quebec. Within the first year of the program’s operation, 30 of the 36 transplants were performed in Ontario (14) and Quebec (16), with the remaining 6 transplants having been performed in Alberta.
  • More than 170 donors were made available to patients through the HSH program in its first year of operation
  • At any given time, there are 10 to 20 patients participating in the program who are awaiting a heart transplant.

 

“Efficiency has been greatly improved for organ matching and allocation as we are able to generate a list of potential recipients with a single click of a button.” 
– Organ Donation Organization Feedback
 

 

Support

Prior to implementation, virtual training sessions that were role based specific to ODO Coordinators, Recipient Coordinators, and Physicians were held. These sessions have been recorded and can be viewed here.

For heart coordinators or physicians who may need access to CTR , email the CTR Customer Support team at transplantregistry@blood.ca to arrange for user access and initial user training session, if possible, prior to attending IPOS HSH focused sessions.

IPOS Heart program documents, policies, and training resources in support of our provincial partners can be found by clicking here.

We will continue to work with all of our stakeholders through multiple lines of communication and various committees.

For any questions or concerns, please contact the Canadian Blood Services team at ctr.ipos@blood.ca.