overview of organ donation and transplantation activity in ...€¦ · unadjusted 3-month, 1-, 3-...

Canadian Institute for Health Information

cihi.ca @cihi_icis

Landscape of organ donation and transplantation activity in Canada

September 25, 2017

Jagbir Gill MD MPH FRCPC

Associate Professor of Medicine, UBC

Vice President, CORR Board

2017 CST Fellows Symposium, September 25, 2017

Overview

• Delivery of donation and transplantation services in Canada

• Wait-list statistics

• Organ donation

• Transplant activity

• Outcomes

25 adult and pediatric programs perform transplantation10 Organ donation organizations

ProvincialdeliveryofODandTrelatedcare

Source: Organ Donation and Transplantation Services Report, CBS 2016

5

Waiting List Statistics

6

Number of Wait-Listed Transplant Candidates by Organ Type, 2007–2016, Canada (preliminary)

0

500

1000

1500

2000

2500

3000

3500

4000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Kidney Kidney-Pancreas Liver Heart LungNote: Excludes Quebec because of under-reporting between 2011 and 2016Source: Canadian Organ Replacement Register, 2017, CIHI

7

Number of Kidney Transplant Candidates and Death Rates on the Waiting List, 2007–2016 (preliminary)

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Kidney 2,159 2,026 1,981 2,399 2,431 2,505 2,629 2,665 2,766 2,840

Deaths 2% 2% 2% 3% 2% 2% 3% 2% 2% 3%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

0

500

1,000

1,500

2,000

2,500

3,000

Note: Excludes Quebec because of under-reporting between 2011 and 2016

Source: Canadian Organ Replacement Register, 2017, CIHI

8

Duration of Dialysis prior to first kidney transplant, Adults (18+) by Blood type, 2014 to 2016 (preliminary)



Type A Type AB Type B Type O Total

Duration on

Dialysis (Median

Days), Deceased

Donor

1,093 842 1,943 1,739 1,448

Duration on

Dialysis (Median

Days), Deceased

Donor, No Pre-

Emptive

1,112 961 1,967 1,744 1,468

Duration on

Dialysis (Median

Days), Living

Donor

269 380 341 297 300

Duration on

Dialysis (Median

Days), Living

Donor, No Pre-

Emptive

525 548 642 553 551

9

Duration of Dialysis Prior to First Kidney Transplant, Adults (18+), by Province, 2014 to 2016 (preliminary)



B.C. Alta. Sask. Man. Ont. N.S. Canada

Duration on

Dialysis (Median

Days), Deceased

Donor

1,420 1,281 1,851 2,114 1,476 1,089 1,448

Duration on

Dialysis (Median

Days), Deceased

Donor, No Pre-

Emptive

1,430 1,396 1,883 2,114 1,497 1,231 1,469

Duration on

Dialysis (Median

Days), Living

Donor

202 331 621 562 273 490 297

Duration on

Dialysis (Median

Days), Living

Donor, No Pre-

Emptive

576 611 828 775 495 636 544

Number of Liver Transplant Candidates and Death Rates on

the Waiting List, 2007–2016, Canada (preliminary)

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Liver 512 464 431 397 402 374 395 399 382 329

Death Rate 12.7 16.6 17.6 14.9 19.2 11.5 20.0 26.1 15.4 23.7

0.0

5.0

10.0

15.0

20.0

25.0

30.0

0

100

200

300

400

500

600

Note: Excludes Quebec because of under-reporting between 2011 and 2016Source: Canadian Organ Replacement Register, 2017, CIHI

11

Donor Activity

12

Number of Canadian Organ Donors by Donor Source, 2007–2016, Canada (preliminary)


2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Living 554 546 516 557 521 538 585 553 563 544

Deceased 485 481 487 466 515 541 553 591 649 758

0

100

200

300

400

500

600

700

800

13

Deceased Donor Rate (PMP) by Year, 2007–2016, Canada (preliminary)


14.7 14.5 14.5 13.715.0 15.6 15.7

16.618.1

21.1

0.0

5.0

10.0

15.0

20.0

25.0

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rate

pe

r m

illi

on

po

pu

lati

on

14

Deceased Donor Rate (PMP) by country


15

Deceased Donor Rate (PMP) by Region, 2007–2016, Canada (preliminary)

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

BC/YK 8.8 12.3 7.2 10.9 12.3 15.3 14.5 14.8 20.1 20.5

AB/NT/NU 13.5 11.3 10.5 8.7 10.2 9.9 11.8 13.7 12.5 16.5

MB/SK 13.2 12.2 12.0 14.5 9.6 7.7 7.2 6.2 10.7 11.9

ON 15.5 13.7 16.8 15.2 16.5 18.8 16.6 19.3 19.4 25.5

QC 18.2 19.5 17.6 15.0 17.1 14.8 20.2 18.7 20.8 20.6

Atl. 13.8 13.7 14.1 13.6 17.7 17.7 13.1 13.5 15.2 16.9

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Rat

e p

er m

illio

n p

op

ula

tio

n


16

Proportion of deceased donors, by age, 2007-2016, Canada



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 2 3 4 5 6 7 8 9 10

60+

55-59

50-54

40-49

18-39

0-17

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

17

Proportion of DCD among all deceased donors, 2007-2016, Canada

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

NDD 471 446 444 423 446 456 486 473 514 585

DCD 22 40 43 45 67 86 66 125 138 173

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Source: Canadian Organ Replacement Register, 2017, CIHI.

18

Donor Rate (PMP) by Donor Source (Deceased vs. Living), 2007–2016, Canada (preliminary)


2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Deceased Donor 14.7 14.5 14.5 13.7 15.0 15.6 15.7 16.6 18.1 21.1

Living Donor 16.8 16.4 15.3 16.4 15.2 15.5 16.6 15.6 15.7 15.2

10.0

12.0

14.0

16.0

18.0

20.0

22.0

Ra

te p

er

mil

lio

n p

op

ula

tio

n

19

Living Donor Rate (PMP), by country


20

Living Donor Rate (PMP) by Region, 2007–2016, Canada (preliminary)

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

BC/YT 25.9 18.5 20.5 23.1 23.2 19.7 28.1 22.9 23.7 20.1

AB/NT/NU 20.8 17.3 14.2 21.7 17.5 20.1 20.7 16.6 18.6 20.3

MB/SK 13.2 15.8 9.8 10.1 9.6 13.3 11.8 13.7 7.4 13.6

ON 20.7 21.3 21.2 20.1 19.1 19.0 19.0 20.3 20.3 18.6

QC 6.0 7.0 5.2 6.9 6.0 6.6 6.4 5.7 6.7 6.8

Atl. 12.5 16.7 14.1 12.3 11.0 12.6 13.9 8.4 8.0 7.6

0.0

5.0

10.0

15.0

20.0

25.0

30.0


Rat

e p

er

mill

ion

po

pu

lati

on

22

Proportion of living donors by relation, 2007-2016, Canada



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 2 3 4 5 6 7 8 9 10

Unrelated

Spouse

Other related

Offspring

Sibling

Parent

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

24

Transplant Activity

25

Number of Organ Transplantsby Donor Source, 2007–2016, Canada (preliminary)


2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Deceased 1588 1530 1577 1559 1609 1698 1778 1805 1955 2291

Living 554 546 516 557 522 537 585 553 563 544

0

500

1000

1500

2000

2500

26

Transplant Rate (PMP), by organ


27

Number of Kidney Transplants by Donor Type, Adult (18+), 2006 to 2017 (preliminary)

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Deceased 523 496 524 553 552 635 563 642 708 885

Living 414 406 402 415 395 391 441 401 411 395

0

100

200

300

400

500

600

700

800

900

1,000



28

Number of Kidney Transplants by Centre, All Ages, 2016 (preliminary)

Nu

mb

er

of

kid

ne

y t

ran

sp

lan

ts

A B C D E F G H I J K L M N O P Q R

Number of transplants 2 4 7 7 10 14 25 50 73 78 86 112 115 115 137 144 156 190

0

20

40

60

80

100

120

140

160

180

200



29

Proportion of Kidney Transplants from Deceased vs. Living Donors, by Centre, All Ages, 2016 (preliminary)



A B C D E F G H I J K L M N O P Q R

Living donor 0 2 4 0 5 6 8 21 33 18 31 31 28 48 25 62 38 57

Deceased donor 2 2 3 7 5 8 17 29 40 60 55 81 87 67 112 82 118 133

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

30

Kidney Transplant Rate (PMP), 2015, by country


31

Liver Transplant Rate (PMP), 2015, by country


32

Heart Transplant Rate (PMP), 2015, by country


33

Lung Transplant Rates (PMP), 2015, by country


34

Outcomes

35

Unadjusted 3-month, 1-, 3- and 5-Year Graft Survival in Kidney

Transplant Patients, All ages, by Donor type, Canada, 2007 to 2016



Donortype

TimePoint

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Living

N 392 384 384 390 382 367 427 386 398 379

At start 100.0 100.0 99.7 99.7 99.7 100.0 99.8 100.0 100.0 100.0

3 Months 98.7 98.2 99.0 97.7 98.4 98.9 99.1 99.5 99.0 98.0

1 Year 96.4 96.9 97.9 95.6 97.6 98.1 97.2 98.4 97.2 .

3 Years 92.6 93.7 95.0 93.3 94.5 94.8 93.0 . . .

5 Years 88.0 89.0 90.6 89.0 89.8 . . . . .

Deceased

N 482 460 505 520 526 592 523 596 624 818

At start 99.8 99.8 100.0 99.8 99.6 100.0 99.2 100.0 99.8 99.8

3 Months 96.7 96.5 96.2 98.3 97.1 97.3 96.0 95.3 97.3 96.9

1 Year 93.2 92.8 92.9 95.4 93.2 94.6 93.9 92.6 94.2 .

3 Years 86.5 86.5 88.1 91.1 88.2 88.3 89.3 . . .

5 Years 79.9 81.5 81.6 83.4 82.5 . . . . .

36

Unadjusted 1-, 5-Year Graft Survival in Kidney Transplant Patients,

All ages, by Donor type and Centre (blinded), Canada, 2007 to 2016



Centre A B C D E F G H I J K L M N O P Q R

Total N 20 25 34 59 72 162 190 390 475 718 723 730 766 785 8421,00

21,15

21,39

0

Living

1 YearSurvival

80.0100.

0100.

0. 97.6 94.3 96.1 97.2 96.3 97.7 97.1 94.6 99.3 96.5 95.1 98.9 98.4 97.1

5 YearSurvival

80.0100.

091.7 . 90.8 88.6 93.7 90.5 91.4 90.6 93.6 85.8 95.4 87.6 86.1 87.3 90.6 88.6

Deceased

1 YearSurvival

93.3 93.3100.

094.5 93.3 91.5 97.4 91.9 95.3 92.6 93.1 94.3 96.9 94.6 93.8 92.2 91.6 93.8

5 YearSurvival

93.3 84.8 90.9 81.8 73.8 75.7 82.4 77.1 80.7 79.0 80.3 83.5 86.2 84.4 83.4 81.7 80.7 83.1

37

Kidney Transplant Survival, by country


Unadjusted Three-Month and One-, Three- and Five-Year Patient Survival Rates

for Deceased-Donor Liver Transplant Recipients, First Graft, 2007 to 2016, Canada

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

3 months 97.4 97.9 94.5 96.6 94.2 96.1 94.7 96.9 94.4 97.5

1 year 92.8 93.7 91.9 92.8 91.1 93.7 90.1 91.8 90.2

3 years 87.4 89.9 85 88.2 85.5 90.2 86.3

5 years 82.7 87.3 81.5 82.4 83

70

75

80

85

90

95

100

Pe

rce

nt

Note: Excludes Quebec because of under-reporting between 2011 and 2016Source: Canadian Organ Replacement Register, 2017, CIHI

39

Summary

• The number of wait-listed patients outnumber the number transplant recipients

• Significant rise in deceased donation in Canada in recent years increased transplantation rates in Canada

• Living donor (kidney) transplantation is declining despite new initiatives

• Canadian rates of donation and transplantation are lower than the US, but outcomes are better

• Regional variability in deceased and living donor transplantation indicate room for growth

40

Areas in Development

• National collaboration and oversight

• Ongoing need for more granular and standardized provincial and national data

• Minimizing regional variability in practice

• Innovation in policy and research to expand access to and outcomes after transplantation

overview of organ donation and transplantation activity in ...€¦ · unadjusted 3-month, 1-, 3-...

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