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 (Canadian Medical Association Journal).
To understand whether organ donation rates differed 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 physician at the Institute for Clinical Evaluative
Sciences and the University of Toronto, with coauthors. 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 to 51 years of
age by the last year of the study. Men and women were equally
represented. Patients aged 59 years or younger were about 10 times more
likely to become actual donors than patients aged 60 years or older.
Patients with lower socioeconomic status were about 30% 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
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, is prone to misinterpretation and is 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."