We have two interrelated priorities: to increase donations and transplants, and to expedite the sharing of leading practices and professional education.

Canadian Blood Services has played a national leadership role in organ and tissue donation and transplantation (OTDT) since 2008. Our work in OTDT reflects our 20-year evolution from a blood system operator to a broader strategic partner in various dimensions of health-care delivery.

The needs of OTDT patients transcend geographical boundaries, and so too must the services that support them. By coordinating our collective efforts nationally, we’re helping to ensure a more accountable and transparent system that operates safely, equitably, efficiently and effectively. In some cases, we lead the development of specific programs; more often, we help to leverage existing provincial capabilities and make them accessible to others nationally.

We deliver value to Canadians in two fundamental ways: by working to improve donation rates and access to organ and tissue transplants and by creating opportunities for OTDT professionals to share best practices and educate one another.

Connecting donors to patients

In 2017–2018, Canada’s OTDT community marked a milestone: the 1,000th kidney transplant made possible through interprovincial organ sharing. The donor and patient registries maintained by Canadian Blood Services have played an important role in this success:

• The Kidney Paired Donation program links living donors to compatible patients across the country, often helping to create “domino chains” of multiple paired-exchange transplant surgeries. With a total of 578 transplants since its launch in 2009, the Kidney Paired Donation program is a great example of what can be achieved when provincial health systems work together to improve patient outcomes across the country.

• The Highly Sensitized Patient Kidney program, also a collaborative effort with our provincial OTDT partners, finds matches for immune-sensitive patients with a higher risk of rejecting new organs. Before this program was launched in 2013, these patients made up about 20 per cent of provincial transplant wait lists but received less than one per cent of available kidneys. As of March 2018, thanks to our collective efforts to simplify the necessary research, modelling and organ-sharing protocols, the program — the only one of its kind worldwide — has facilitated 422 kidney transplants.

Underpinning these two programs, as well as our National Organ Waitlist, is a web-based repository of donation and transplantation data developed and managed by Canadian Blood Services: the Canadian Transplant Registry. Since bringing the next-generation version online in 2017, we’ve been able to support better information-sharing among provincial programs, as well as sophisticated data analytics and reporting. Health systems across the country now have faster, easier access to information linking both living and deceased organ donors with potential recipients. They can gain deeper insights into how the system is performing as all stakeholders work to achieve better transplant outcomes for patients.

Our OTDT registry work has helped to save and improve hundreds of patients’ lives — our number one priority. It is also cost-effective. To take just one metric, we estimate that the kidney transplants facilitated by our programs avoided more than $16 million in cumulative dialysis costs to Canada’s health systems in 2017–2018.

Sharing advice and insights

It takes years of rigorous research to develop leading clinical practices in OTDT, with an investment that’s beyond what most provincial health budgets can afford. This is another key area where Canadian Blood Services supports health-care providers across the country: we serve as a hub for collaborative OTDT research and an engine for knowledge dissemination. As a result, we’re able to develop clinical guidelines for bedside practitioners that translate into operating policies for institutions.

Our work to develop leading practices includes:

• Internationally recognized guidelines for the determination of death.
• Canadian guidelines for pediatric donation after circulatory determination of death.
• Guidance for initiating end-of-life conversations with the families of potential donors.
• New strategies in multiple-organ transplantation.
• Methods to control and reduce microbial bioburden in tissue banking.

Our regular professional forums on clinical practice contribute to better patient outcomes, equity of access to care, greater interprovincial sharing of organs, and overall transparency and trust in the OTDT system. Our work informs national policies and processes designed to address regional variations in practice. We also provide tools and resources for jurisdictions that have not yet implemented proven practices.

Complementing our leading-practice work is a wide-ranging professional education program for clinical practitioners, delivered by Canadian and international experts. We also play a national role in boosting public awareness and education around OTDT issues, developing system-wide messaging with our network of provincial partners, clinicians and other stakeholders.

These interconnected efforts are all aimed at the same outcome: increasing donation rates and access to transplants — and minimizing missed opportunities.

Health Canada evaluation and renewed funding for OTDT

In 2017–2018, Health Canada evaluated the OTDT program managed by Canadian Blood Services. A standard requirement of the contribution agreement between the two parties, this evaluation is conducted to assess the performance of the program, its continued relevance and, ultimately, its impact on patients across the country. The evaluation included document and data reviews and interviews with key participants. It concluded that the program continues to be relevant, aligned with government priorities and federal roles, and effective in advancing OTDT system objectives.

The evaluation noted that some aspects of the program overlap with other stakeholders’ activities. At the same time, it recognized these are complementary and essential to support smaller jurisdictions with limited capacity to expand their own programs and services. The evaluation also observed that the program’s performance has been affected by certain operational barriers, and that continued effort is needed to improve awareness and uptake of programs and services across all jurisdictions.

To help address barriers and support the federal health minister’s mandate to strengthen and improve the OTDT system in Canada, Health Canada is coordinating with Canadian Blood Services and the provinces and territories to identify the challenges and opportunities for improved collaboration.

Federal funding has been renewed for three years to support Canadian Blood Services’ ongoing work in this important field and to complement funds received from provincial and territorial ministries of health.