Dr. Les Lilly
Dr. Les Lilly, Medical Director, Gastrointestinal Transplantation, points out that Ontario and UHN are leaders in championing donation after cardiac death, which has helped to increase the numbers of transplants that can be performed. (Photo: UHN)

For the second year in a row, UHN set a record for the numbers of transplants performed.

In 2016, the Multi-Organ Transplant (MOT) Program performed 616 transplants, with large increases in kidney, liver and lung transplants. A year earlier was another record-breaker, with 535 transplants.

"There has been a tremendous growth in the program in the last five years due to our talented team, research which impacts clinical care, improvements in deceased organ donation rates, and the huge team effort of everyone at UHN to accommodate the surge in transplants for which we are very grateful," says Dr. Atul Humar, Medical Director of the MOT Program at UHN.

In 2016, the program performed 184 adult kidney transplants, 202 adult liver transplants and 142 lung transplants – all three organ programs surpassing their own records.

Living organ donation in the liver and kidney programs is also strong, averaging more than 30 such donations in the liver transplant program, with more than 50 in the kidney transplant program for the last two years.

Canadian data shows that for organs other than kidney, from 15 per cent to 30 per cent of patients die while waiting for an organ. Living donation is one way UHN tries to bridge the gap between need and availability of organs.   

In addition, the Ontario organ donor rate increased by 30 per cent in 2016. That's due to efforts by Trillium Gift of Life, which has resulted in an increase in the numbers of people registering online as potential donors, and the work of Ontario's hospitals in referring all potential donation cases to Trillium Gift of Life.

From 2015 to 2017, UHN has increased organ donation by 60 per cent, and, in one year, UHN has had a 10 per cent increase in tissue donation with 87 tissue donors.

"We acknowledge Trillium's leadership in tirelessly working to increase awareness about organ donation, and actual deceased donor rates," Dr. Humar says. "We could not accomplish what we do, without the strong partnership of Trillium Gift of Life."

Dr. Humar credits technologies such as ex vivo organ perfusion – pioneered at Toronto General Hospital – which helps assess, repair and transplant organs which previously could not be used.

Since 2012, the program has been able to offer lung transplants to 28 per cent more patients every year due to the Toronto Ex Vivo Lung Perfusion System. It is now being refined for use with other organs, such as the liver, kidney and heart.  

'Pushing boundaries' with technologies

Dr. Humar also notes that the criteria for accepting organs, such as kidneys, for transplantation have been expanded to include organs from "extended criteria" donors, typically those who are older than 60, or who have hypertension or diabetes.

"We're pushing the boundaries, using organs from donors that 10 years ago we would not have used," says Dr. Humar. "And yet our results are excellent, better than international benchmarks."

Dr. Les Lilly, Medical Director, Gastrointestinal Transplantation, also points out that Ontario and UHN are leaders in championing donation after cardiac death (DCD). That's a death declared on the basis of cardiopulmonary criteria (irreversible cessation of circulatory and respiratory function) rather than the neurologic criteria used to declare "brain death" (irreversible loss of all functions of the entire brain, including the brain stem). Such donations usually involve patients who are on a ventilator as the result of irreversible brain or spinal cord injuries or end-stage musculoskeletal disease.

DCD is practiced in the U.S. and Europe, including the United Kingdom where DCD donors comprise about 40 per cent of all deceased donations. This approach was first followed until about 1968, when a brain-based definition of death was adopted.

"This resource has always been there," notes Dr. Lilly, "but for years and years the organs of these patients have been buried with them. And although there is minimal activity in their brain stem, you can't live with just a brain stem. These are patients who don't wake up."

The impact on increasing donation is huge, says Dr. Lilly, noting that brain death accounts for about 1.5 per cent of hospital deaths. For most patients, death occurs due to cardiac death after life support is removed.  

In Ontario, at any point in time, there are 1,500 patients waiting for an organ transplant, and someone dies every three days while waiting. Currently, about 30 per cent of Ontarians have registered consent to donate.

You can register online at www.BeADonor.ca, the provincial site administered by the Trillium Gift of Life Network. ​

In 2016, Ontario performed a record number of organ transplants. Trillium Gift of Life Network, the provincial agency that co-ordinates organ and tissue donations in Ontario, reported that 1,302 people received organ transplants in 2016. These came from 351 deceased donors — a 30 per cent increase over the previous year — and from 256 living donors.

Although Ontario has one of the highest organ transplant rates in Canada, family members still override the wishes of about one in five registered organ donors. For a discussion about organ donation and transplant in Ontario, featuring Dr. Les Lilly of UHN, click here to watch TVO's The Agenda. 

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