Organ donation shortfall at large general hospitals in Ontario

Organ donation in Ontario is significantly less common at large general hospitals than at hospitals with clinical programs for transplant recipients, which points to missed opportunities to optimize organ donation, according to a study published in CMAJ by researchers at the Institute for Clinical Evaluative Sciences (ICES).

To understand whether organ donation rates differ between hospitals that treat transplant recipients and those that do not, researchers looked at all patients (adults and children) who died from catastrophic brain injury in Ontario between 1994 and 2011. After excluding small hospitals and ineligible patients, the study included 79,746 deaths at 56 hospitals and 1,898 organ donors. Transplant hospitals accounted for 22,515 deaths and 1,118 organ donors for a procurement rate of 5.0 per 100 deaths. In comparison, large general hospitals accounted for 57,231 deaths and 780 donors for a rate of 1.4 per 100 deaths.

"Our research suggests lower frequency of deceased organ donation at large general hospitals than at transplant hospitals," writes Dr. Donald Redelmeier, a senior scientist at ICES and the University of Toronto, with co-authors. The absolute reduction amounted to about 121 actual organ donors per year in large hospitals in Ontario and was accentuated among older patients. "Some of the shortfall may be explained by appropriate medical judgment, given that older organs are sometimes unsuitable for transplantation to young recipients. However, unfair age discrimination may be an additional explanation," write the authors.

Over the 17-year study period the number of actual donors increased steadily and was almost double comparing the last year to the first year. The average age of donors increased from about 40 years to 51 years  by the last year of the study. Men and women were equally represented. Patients aged 59 or younger were about 10 times more likely to become actual donors than patients aged 60 or older.  Patients with lower socioeconomic status were about 30 per cent less likely to become actual donors than patients with higher socioeconomic status. The most common condition leading to donation was brain death due to major trauma.

The authors suggest more training, education and improved policies around potential donors at large general hospitals in Ontario. Redelmeier and colleagues also stress, "Any of these approaches would require tact, are prone to misinterpretation and are rarely included in national campaigns for organ donation. The current data suggest, however, that prevailing practices lead to missed potential opportunities for solid organ donation in large general hospitals."

The study “Organ donation after death in Ontario: a population-based cohort study” was published today in CMAJ.

Authors: Donald A. Redelmeier, Frank Markel, Damon C. Scales.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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