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CMAJ • February 3, 2004; 170 (3)
© 2004 Canadian Medical Association or its licensors

Letters
Correspondance

How to improve organ donation rates

Greg Knoll* and John Mahoney{dagger}

*Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont.; {dagger}Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont.

We agree with both Sam Shemie and colleagues and Dana Baran that there is a need to improve the rate of brain-dead organ donation in Canada through better identification and management of potential donors. We therefore encourage physicians, organizers of local organ donation programs and provincial agencies to participate in reviewing and improving guidelines on the management of severely brain-injured patients developed by the Canadian Council for Donation and Transplantation.

However, even if every potential brain-dead donor were identified and became an actual donor, the supply would be insufficient to meet demand.1 Yet it has been estimated that if the number of living and brain-dead donors were increased and NHBDs were used, the waiting list could be eliminated within 5 to 10 years.1,2

Baran states that the "use of NHBDs is fraught with ethical and logistic problems." However, similar difficulties were overcome when heart-beating, brain-dead donors were first used in transplantation.3 Despite the challenges, the concept of brain death has now become accepted both clinically and legally,4,5 allowing transplantation to occur today. The Canadian medical community cannot ignore a real opportunity to improve organ donation just because of ethical and logistic problems. We6 and others7 have identified the important issues surrounding non-heart-beating donation. It is now time to move forward. We hope that all Canadians, not just those who experience brain death, can have the option of organ donation as a part of standard end-of-life care.

Greg Knoll Department of Medicine John Mahoney Department of Surgery University of Ottawa and The Ottawa Hospital Ottawa, Ont.

References

  1. Sheehy E, Conrad SL, Brigham LE, Luskin R, Weber P, Eakin M, et al. Estimating the number of potential organ donors in the United States. N Engl J Med 2003;349:667-74.[Abstract/Free Full Text]
  2. Terasaki PI, Cho YW, Cecka JM. Strategy for eliminating the kidney shortage. In: Cecka JM, Terasaki PI, editors. Clinical transplants 1997. Los Angeles: UCLA Tissue Typing Laboratory; 1998. p. 265-7.
  3. Cecka JM. Donors without a heartbeat. N Engl J Med 2002;347(4):281-3.[Free Full Text]
  4. Lazar NM, Shemie S, Webster GC, Dickens BM. Bioethics for clinicians: 24. Brain death. CMAJ 2001;164(6):833-6.[Abstract/Free Full Text]
  5. Dossetor JB. Death provides renewed life for some, but ethical hazards for transplant teams [editorial]. CMAJ 1999;160(11):1590-1.[Medline]
  6. Knoll GA, Mahoney JE. Non-heart-beating organ donation in Canada: Time to proceed? [editorial]. CMAJ 2003;169(4):302-3.[Free Full Text]
  7. Non-heart-beating organ transplantation: medical and ethical issues in procurement. Washington: Institute of Medicine, National Academy Press; 1997.




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