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Ivey International Centre for Health Innovation

One problem, many solutions: How to improve Canadian organ donation

  • Zoha Khan
  • |
  • Jan 26, 2018
One problem, many solutions: How to improve Canadian organ donation

Photo by Piron Guillaume on Unsplash

Canada has one of the most disorganized and fragmented organ donation systems amongst industrialized countries. As seen in its donation rate of only 18 donors per million people, Canada ranks as one of the world’s worst, behind the United States, at 26 donors per million people. As a result, Canadians waiting for an organ transplant are placed on extremely lengthy waiting lists that span several years, depending on the province, and a fraction of these individuals die while waiting. In 2013, 246 Canadians died while waiting for an organ transplant – deaths which could have been prevented.

While waiting on these lists for kidneys, lungs, livers, or other organs, individuals rely on various machines and medications to survive and keep their organs working. This not only adds to health care costs but can greatly deteriorate an individual’s quality of life. According to a report by the Canadian Institute for Health Information (CIHI), the cost for hemodialysis treatment is approximately $60,000 per patient, per year. On the contrary, the one-time cost for a kidney transplant is approximately $23,000, plus any additional expenses for medication necessary to maintain the transplant. Thus, over a five-year period, a transplant translates to almost $250,000 in cost savings for the health care system, while also significantly improving quality of life.

Currently, organ donation in Canada is managed by the Canadian Blood Services, who are responsible for overseeing the entire process. However, because health care falls under provincial jurisdiction, each province operates its own organ donation registry, rather than using a centralized system to help identify individuals who have consented to donate. As a result, this has created a system that is fragmented and inconsistent in health care delivery as certain regions, such as Ontario, result in a higher number of consented donors in comparison to others, but still nowhere near the benchmark.

Furthermore, Canada also operates under an opt-in system, otherwise referred to as required consent, whereby individuals must express the intention to become a donor by filling out their donation card or signing up online. Despite these initiatives, the percentage of the population registered to become donors still remains extremely low. Although about 90 percent of Canadians have indicated that they support organ donation, surveys and polls reveal that only about 20 percent have actually consented to donate. It can be deduced that the low registration rates are primarily due to a lack of awareness surrounding this topic and easily accessible information regarding what steps to take to register.

Therefore, convincing Canadians to register as donors is not the solution to increasing national rates – they are already interested. The solution lies in systematic changes, which include updating methods that are currently used to register donors and developing a centralized and nationwide organ registry.

Lessons must be learned from leading countries, such as Spain and Croatia that have some of the highest organ donation rates in the world. Both countries have established national registries and developed educational policies to increase awareness about organ donation and donor registration processes, resulting in their high performance. For example, in 1989, Spain created its Organizacion Nacional de Trasplantes (ONT) to oversee the donation and transplantation process within the country, including a national registry for individuals to register as donors and a public-education campaign. As a result of this initiative, Spain has been able to maintain a steady growth rate and its position as a world leader in organ donation for over 20 years. Croatia has also been able to establish a successful model for organ donation by implementing similar programs. Over the past decade, the country’s Ministry of Health, along with non-governmental organizations have successfully launched a variety of national public awareness campaigns to educate the public about this topic and has significantly improved the lines of communication to allow individuals to easily access information.

As evidenced by these countries, developing a national registry and implementing new registration methods are two solutions that present great opportunities for Canada to significantly improve its organ donation rates and progress in this field is already under way. Bill C-316 was introduced as a private member’s Bill in October 2016 to amend the current Canadian Revenue Agency Act. The Bill recommends that the annual tax return document should serve as a method through which Canadians can register as donors and have their names added to the registry. The program would not only be a cost-effective method to keep an up-to-date registry but would allow individuals to easily register as donors.

None of these initiatives alone will raise national rates of organ donation. This issue requires a concerted effort and a mixture of initiatives to drive change, just as was done in Spain and other leading countries. It is imperative that national organizations, such as the Canadian Blood Services, work together with Health Canada to streamline processes to improve performance rates, ultimately leading to a better quality of life for many individuals, cost savings for the health care system, and more lives saved each year.

Zoha Khan is a Student Research Analyst at the Ivey International Centre for Health Innovation. She is currently an HBA1 student at the Ivey Business School at Western University.