Échange interprovincial de cœurs destinés aux receveurs à statut élevé

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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 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. 

Coeurs pour patients à statut élevé - statut médical urgent

 

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.

Current project status 

Résumé des activités de la première année

Lancé en octobre 2023, le Programme d’échange interprovincial de cœurs destinés aux patients à statut élevé (EIPO-cœurs) augmente les chances de transplantation des patients ​ les plus vulnérables en leur donnant un accès prioritaire aux organes. Ce programme est administré par la Société canadienne du sang en coopération avec les programmes de don ​et de transplantation, et fonctionne par l’entremise du Registre canadien de transplantation. 

Admissibilité au programme EIPO-cœurs

  1. Patients ayant le plus urgemment besoin d’une transplantation (patients de statut 4) 
  2. Patients immunologiquement compatibles avec 1 donneur sur 5 ou moins (patients hyperimmunisés)  

Objectifs du programme

  • Promouvoir l’échange interprovincial d’organes et l’existence d’un système à l’échelle nationale
  • S’assurer que les organes sont attribués de façon équitable aux patients appropriés
  • Optimiser l’utilisation des organes (ne pas rater d’occasions de transplantation)

36 transplantations

  • Pendant cette première année, 36 transplantations ont été réalisées, dont 30 sur des patients ayant un statut médical urgent.
    • Status 4: 27
    • Hyperimmunisés: 6
    • Les deux: 3
  • Les transplantations cardiaques sont généralement réalisées en Colombie-Britannique, en Alberta, en Ontario et au Québec. Pendant cette première année, 30 des 36 transplantations réalisées ont été effectuées en Ontario (14) et au Québec (16), et les 6 dernières, en  Alberta. 
  • Plus de 170 organes ​ont été rendus disponibles grâce au programme EIPO-cœurs.
  • À tout moment, il y a entre et 10 et 20 participants au programme en attente d’une transplantation.

 

« Les processus de jumelage et d’attribution d’organes ont été grandement améliorés, car maintenant il suffit de cliquer sur un bouton ​pour générer la liste des receveurs potentiels. » 

– Rétroaction d’un organisme de don d’organes

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.