Improving organ donation in Canada
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* David Hollomby
* Marc Germain
* Sam Shemie
* Leah Hollins
* Kimberly Young

*   © 2007 Canadian Medical Association or its licensors

The Canadian Council for Donation and Transplantation (CCDT) agrees with some of the issues raised by Wayne Kondro.1 There is indeed fragmentation in the organization of the organ and tissue donation and transplantation system in Canada, and Canadian donation rates are a concern.

We know that the Canadian organ and tissue donation and transplantation system is complex and the optimal made-in-Canada solution to improving patient outcomes and quality of life needs to be found through collaboration, consensus and coordination. As a national nonprofit organization with a mandate to provide advice to the Conference of Deputy Ministers of Health on improving the organ and tissue donation and transplantation system, the CCDT is a catalyst for change in this system.

Measures such as donation rates can be informative. We have learned, though, that international donation rates are not measured in the same way. Thus, comparing Canadian donation rates to those in other countries may not be a useful way to mark Canadian progress.

Kondro cites the United Network for Organ Sharing in the United States as a model to solve the current problems in the Canadian system. There are some things that we can learn from this model, but it may be significantly less applicable in our country because of the different health care context in Canada. The United Network for Organ Sharing is a regulatory body that specializes in organ allocation, but, according to our stakeholders, efficiency in allocation is not the only issue that needs to be addressed to improve patient outcomes.

The CCDT, physicians and other health care providers involved in donation and transplantation seek to ensure that people requiring transplantation have access to the care they need at the earliest opportunity. The creation of a made-in-Canada system is already evolving through national dialogue and deliberation about best practices in donation and transplantation.2–4 We look forward to further consensus recommendations from experts in the field and trust that regional authorities will implement them, as they have done in the past.

Canada has centres of excellence with high donation rates, and the role of the CCDT is to support the transfer of this excellence throughout our country. All stakeholders in the organ and tissue donation and transplantation system want to move more quickly because lives are being lost.

## REFERENCES

1.  1. Kondro W. Fragmented organ donation programs hinder progress. CMAJ 2006;175(9):1043.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMDoiMTc1LzkvMTA0MyI7czo0OiJhdG9tIjtzOjIzOiIvY21hai8xNzYvOC8xMTI1LjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. Shemie SD, Doig C, Dickens B, et al. Brain arrest: the neurological determination of death and organ donor management in Canada: Severe brain injury to neurological determination of death: Canadian forum recommendations. *CMAJ* 2006;174(6 Suppl):S1-S12.
    
    

3.  3. Shemie SD, Ross H, Pagliarello J, et al. Brain arrest: the neurological determination of death and organ donor management in Canada: Organ donor management in Canada: recommendations of the forum on Medical Management to Optimize Donor Organ Potential. *CMAJ* 2006;174(6 Suppl):S13-S30.
    
    

4.  4. Shemie SD, Baker AJ, Knoll G, et al. National recommendations for donation after cardiocirculatory death in Canada. *CMAJ* 2006;175(8 Suppl):S1-S24.