COMPOSICIÓN DE LA AVIFAUNA PRESENTE EN LAS CERCAS VIVAS Y USO DE

tissue donors identified and referred to recovery programs. Although there are examples of success- ful initiatives in some regions of the country, Canada’s overall tissue donation rate has not changed significantly, and the gap between tissue demand and supply continues to grow. The number of potential tissue donors in acute care settings, and outside of hospitals, far exceeds the number needed to meet patient demand for the types of allografts currently produced in Canada. It is recom- mended that Canadian Blood Services collaborate with medical examiners, coroners, allied health professionals, hospital donation physicians and OPO staff to develop more effective mechanisms to identify and refer potential tissue donors.

Value to canadians

Donor-identification initiatives will help increase the supply of tissues available to Canadian patients. An inter-provincial approach will leverage the support of professionals and professional groups—such as medical examiners, coroners and donation physicians—to increase the number of tissue donation opportunities and improve the availability of tissue for all Canadian patients. Increasing the number of tissue donations will improve the availability of some tissue allografts that are currently in short supply, such as paediatric heart valves.

Compared with the current TDT environment, an inter- provincial approach offers a number of benefits. For example, it will significantly increase the number of families that are offered the option of donation. It will align donor identification and referral activity with tissue recovery and processing activities, ensuring that increased donation translates into improved availability of tissues for patients across the country. Finally—led by Canadian Blood Services, an inter-provincial organization that has demonstrated experience and expertise in the health care sector—it will also ensure a consistent approach to quality and safety, standardizing donor criteria inter-provincially and applying best practices.

mary gatien Director, New Brunswick Eye and Tissue Bank, and Tissue Expert Committee member

t i S S u e D o n a t i o n a n D t r a n S P l a n t a t i o n i n C a n a D a | TDT System Recommendations

description

The Canadian supply of tissue does not meet demand. More than 2,000 Canadians are waiting for cornea transplants to restore their vision. In half of the paediatric cardiac valve procedures performed in Canada, surgeons are required to use alternate implants due to the shortage of the preferred allograft heart valve. Plastic surgeons have indicated that the shortage of skin allografts means they are used in only the most critical cases, even when other patients would benefit as well. The need for an emergency stock of skin to deal with sudden demand for treatment of a large number of burn patients has also been identified. Fresh joint allografts are considered the ideal graft for a number of surgical procedures, but the timing and logistics are a challenge to manage, making the supply of these allografts very limited. An inter-provincial approach would improve the likelihood of identifying a donor allograft best-suited to a specific patient by enlarging the base of potential donors and facilitating the transfer of the allograft to the patient’s location. In 2008, Canadian tissue banks recovered tissue from 278 multi- tissue and 2,679 ocular donors for a total of 2,957 cadaveric donors. Recent analysis indicates that the potential exists to recover tissue from 44 per cent of patient deaths that occur within the acute care

environment. This figure is conservatively estimated to be approximately 4,000 potential multi-tissue donors and 8,000 potential ocular donors. Also in 2008, tissue was recovered from 135 (or 40 per cent) of the 335 organ donors in the acute care environment. This last figure can be compared with programs in Spain, where more than 90 per cent of organ donors are also tissue donors. The gap between potential and realized tissue donors in Canada’s acute care environment is attributed to a lack of awareness and focus on tissue donation, as well as to a lack of capacity to recover tissue from donors.

It is estimated that half of the otherwise healthy individuals who die outside the acute care environment are potential tissue donors. Medical examiners and coroners are responsible to investigate these unexpected deaths, and can therefore play a major role in identifying and referring these potential tissue donors. Currently only a small number of referrals are received from medical examiners and coroners offices, indicating there is a significant opportunity to collaborate with this professional community to increase tissue donation. The strategy to increase tissue donation will leverage existing structures to optimize the identification and referral of potential donors both within and outside acute care. Emphasis will be placed on collaboration with medical examiners and coroners and the existing support from this professional community. Funeral home professionals are also very influential in the tissue donation process. This community will therefore be encouraged to foster and increase support for donation. A small team of tissue donation specialists will be established by Canadian Blood Services to support the medical examiner and coroner communities and to provide subject matter expertise and support to hospital donation physicians, funeral home professionals and organ procurement organization communities.

Professor of Orthopaedic Surgery at Dalhousie University, Dr . michael gross was also a member of the Tissue Expert Committee .

t i S S u e D o n a t i o n a n D t r a n S P l a n t a t i o n i n C a n a D a | TDT System Recommendations

A number of recommendations for improving organ donation and transplantation in Canada also apply to tissue donation and transplantation. Recommendations that pertain to donation physicians, public awareness, intent-to-donate registries, required referral and professional education (detailed in the organ donation and transplantation recommendations) are designed to increase the number of organ and tissue donors. Implementation of these recommendations is fundamental to improving the number of tissue donors and the system’s ability to optimize donation in acute and non-acute care settings. Existing referral centres or systems that support current donor identification and referral activities may require incremental resources to support increased activity.

As outlined, donation of organs and tissues will be encouraged in public awareness and marketing campaigns to ensure consistent messaging. However, only those donors whose tissues can be used in a timely manner and in a cost-effective fashion will be recovered. This is an acknowledgement of the reality that Canada’s tissue requirements can likely be met with recovery focused in some, but not all geographic areas, and that it is not always cost-effective to send recovery teams to all outlying or remote areas.