Interprovincial Organ Sharing of High Status Hearts

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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 is now developing the technology that supports the approved national Heart sharing policies that will streamline and propel heart allocation and transplantation 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 aims to develop the Canadian Transplant Registry (CTR) so that it can be used to allocate hearts interprovincially for sensitized (≥80% cPRA) and/or medically urgent (status 4) patients and to improve the tracking of the outcomes of organ sharing in this patient population.  

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' Canadian Transplant Registry.

Current project status 

Canadian Blood Services has entered the final implementation phase of the Interprovincial Organ Sharing of Hearts for High-Status Recipients project. Currently, heart transplant patients of all statuses are continuing to be listed through the National Organ Waitlist (NOW); however, allocation and offers for medically urgent and highly sensitized patients will be conducted through the CTR once the implementation is completed. Implementation is currently scheduled to be completed in May 2022.

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.

The requirements were finalized in December 2019 and have been sent to all provinces to inform impact analyses. The first round of implementation impact meetings with provinces was concluded in December 2019. A second round of impact meetings are currently underway.

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 in the interim to review the national polices and prepare for potential impact on local processes.  

The next steps toward the implementation of the IPOS Heart Project will be scheduling a series of meetings with ODOs in November 2021 with the current CCTN President, Dr. Brian Clarke, and past CCTN President and current HTAC Chair, Dr. Michael McDonald to answer any questions about, clarify any confusion about the policies, and discuss impacts on local processes.

In parallel to the development of the above, training materials in support of our provincial partners are currently being developed. Training will be delivered to our users across Canada in December 2021 and January 2022 with a series of virtual training sessions.

We will continue to work toward an assessment of the overall impact of the project, maintaining multiple lines of communication with each of our stakeholders through direct communication and various committees.

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