Greg Knoll and John Mahoney1 correctly point out that the use of NHBDs could increase the number of cadaver organs available for transplantation in Canada. This possibility is under consideration in Quebec, and the Canadian Council for Donation and Transplantation will discuss the topic in an upcoming forum.
However, the use of NHBDs is fraught with ethical and logistic problems, and the addition of this type of donor to the existing pool will not be sufficient to meet the increasing need. In contrast, there is definitely room for better identification of brain-dead donors, as underlined in a recent study by the Collège des médecins du Québec.2 In response to that study, the Quebec government is now funding a network of in-house organ donor coordinators, whose role is to help identify potential donors and to support both families and medical personnel throughout the organ donation process.
Living related and unrelated kidney donors are also underused in Canada. Only 391 such transplants were performed in Canada in 2002, representing 30% of all kidney transplants.3 In contrast, the United Network for Organ Sharing in the United States reported 6236 live-donor kidney transplants in 2002, which accounted for 42% of all US kidney transplants in that year.4
In a climate where health care resources are scarce, NHBDs should certainly be considered, but there are clearly other areas that require attention and investment if we are to meet the needs of patients with end-stage organ failure.
Dana Baran Associate Professor Faculty of Medicine McGill University Montréal, Que. Medical Director, Québec-Transplant
References
- 1.Knoll GA, Mahoney JE. Non-heart-beating organ donation in Canada: Time to proceed? [editorial]. CMAJ 2003;169(4):302-3. [PMC free article] [PubMed]
- 2.Morin JE, Baran D, Dandavino R, Marleau D, Naud A, Cloutier R. Les donneurs potentiels d'organes dans les hôpitaux du Québec année 2000. Rapport du Comité de transplantation. Montréal: Collège des médecins du Québec; 2003. Available: www.cmq.org/uploadedfiles/transplantation%20FINAL.pdf (accessed 2004 Jan 5).
- 3.Canadian Organ Replacement Register [quarterly statistics]. Ottawa: Canadian Institute for Health Information; 2003. Available: secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=services_corr_e (accessed 2003 Oct 2).
- 4.Transplants by donor type [table]. In: National data, Organ Procurement and Transportation Network [online]. Richmond (VA): Organ Procurement and Transportation Network; 2003. Available: www.optn.org/latestData/rptData.asp (accessed 2003 Oct 2).