The Canadian Organ Replacement Register.
The analyses presented in this chapter are a subset of the yearly audit of organ donation and transplantation in Canada published in the CORR Annual Report. They represent the collaborative efforts and the voluntary contributions of many of the transplant physicians, surgeons, nurses and coordinators in Canada. In Canada, organ donation has remained static at approximately 14 per million population. Despite many local and provincial as well as corporate initiatives, this rate is approximately half the current rate in many regions of the U.S.A. and Spain. The modest increases in transplant activity represent an increase in the use of living donors, reassessment of the traditional donor risk factors (including age) and expansion of the potential donors for each organ. Analysis of the renal transplant activity has determined that the likelihood of being transplanted during the first year on the list was less than 40%. A graft loss rate of 4% per year after the first year was observed for a cadaveric kidney, compared with graft loss rates of 3% and 2% per year for living-related and living-unrelated donor kidneys, respectively. Cox regressional analysis identified that the major determinants of patient survival were the transplant year, the region where the transplant was performed, the presence of diabetes, the recipient's age, and whether the kidney was from a living donor. Liver transplantation has increased each year at the transplant centers in Vancouver, Edmonton, London, Toronto, Montreal, and Halifax. Patient and graft survival rates have improved since 1985 and the most significant determinant of patient survival following transplantation was the patient's medical status at the time of transplantation. Living-related liver donor transplant programs have begun in London and Toronto. Pancreas transplantation remains limited across Canada, but with the development of new pancreas programs in Toronto and Halifax, an increase in the availability of this therapy for Type 1 diabetics is anticipated. Heart transplantation has recovered from a decline in 1991-1992 to approximately 6 hearts per million population. There has been a trend towards better one- and 3-year patient survival rates since 1985. With the development of a lung transplantation program in Winnipeg, lung transplantation has increased. This likely reflects increased utilization of the available donor lungs. A particular increase in double-lung transplants was noted.
Walker
S R
SR
Canadian Institute for Health Don Mills, Ontario, Canada.
Parsons
D A
DA
Coplestons
P
P
Fenton
S S
SS
Greig
P D
PD
D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002170:Canada; D002648:Child; D002675:Child, Preschool; D005190:Family; D005260:Female; D005843:Geography; D006085:Graft Survival; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000706:statistics & numerical data; D019520:Living Donors; D016040:Lung Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000706:statistics & numerical data; D012042:Registries; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000706:statistics & numerical data; D014180:Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D014850:Waiting Lists