How to improve organ donation rates

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.