 BY ADELLE LARMOUR
The transplant process is complex and delicate, but like any valued commodity, the availability of healthy transplantable organs can be simply a case of supply and demand.
Although Ontarians are donating more organs, the transplant waiting lists are also growing, according to Trillium Gift of Life Network (TGLN) statistics that track organ transplants and donations within the province.
Ontario’s waiting list consists of approximately 1,700 people, but every three days, someone on that list dies waiting, said Sandra Petzel, Trillium’s co-ordinator for northwestern Ontario.
Petzel has seen an increase in the demand for kidney organs during her 32 years as a nurse in the hemodialysis unit at the Thunder Bay Regional Health Sciences Centre.
“When I first started working in the unit, it took between a year to a year-and-a-half before the patient was transplanted. When I left five years ago, it was up to eight years.”
Petzel attributes the rising numbers to better diagnosis, an aging population and an increased number of people with diabetes. She estimates that 30 per cent of the people in Thunder Bay receiving dialysis are diabetic.
Prior to 2000, each hospital had its own waiting list for transplant recipients, said Petzel. In order to make it more equitable and to deal with rising numbers on the transplant lists, the Ontario government created the Trillium Gift of Life Network to assume the role of a central organ and tissue donation agency with a mandate to increase organ donations. Now, one central list exists in the province.
Pam Andlar, Trillium’s Sudbury co-ordinator for northeastern Ontario, said the donation program aims to achieve a 75 per cent conversion rate, meaning 75 per cent of potential donors will go on to donate organs. For the last two years, Sudbury’s TGLN won the Hospital Achievement award for attaining that rate.
Despite recent bad press about low organ donations and long waiting lists, Brian Kellow, Trillium’s spokesman, said in the past three years, TGLN has had an organ donation increase of 35 per cent.
Twenty-two co-ordinators in Ontario deliver the message to emergency room and intensive care staff, and promote general public awareness campaigns about organ and tissue donation.
The process of organ procurement and transplant is a complex one. Out of every 100 deaths, only one to two progress to brain death and qualify for organ donation. This strict criterion heightens the importance of appealing to potential donors and their families about signing a donor card.
Petzel said one of the public’s misconceptions is that once brain death occurs, hospital staff won’t try hard to resuscitate a patient. However, the declaration of brain death is very thorough and requires testing performed by two physicians.
“The best practice is that we don’t approach a family until the person has been declared brain dead,” said Andlar, who has a call team of eight critical care nurses at her disposal. “It is important that the family understands we’ve done everything we can to save their loved one. It is about helping them make a decision, understanding the benefits of that decision, and letting them know there are others in the province whose loved one may not survive.”
All deaths are reported to Trillium’s Provincial Resource Centre in Toronto, where the calls are triaged for potential tissue and organ donations. The local co-ordinator is contacted, goes to the hospital and starts the referral process.
Once a patient is declared brain dead and consent has been given for organ donation, the co-ordinator will work with the donor family. A social and medical history of the patient is taken to ensure the organs transplanted are as healthy as possible. The co-ordinator remains with the donor family to answer questions, provide support or just be a presence throughout the donation process.
Petzel said the process of maintaining a deceased body is intensive because, without the brain, the body naturally wants to shut down. Blood pressure and temperature must be maintained. Blood samples are sent off to a lab in Toronto or London for matching with potential recipients. Once matches are found, the physician of the potential recipient at the top of the transplant list is called to check on his or her patient’s health. If that person gets the green light, the process of transporting the organ retrieval team from the transplant centre to the donor’s city is started, while the potential recipient is prepped for surgery.
Even though the organs are a blood and tissue match, the operation doesn’t proceed until the transplant team views them and determines whether they are healthy for donation.
Among the many organs that can be retrieved, the heart is the first to be removed. This takes about four hours. The kidneys are the last organs out.
Petzel emphasized that the process is performed in a very respectful, dignified manner, and can take from 13 to 40 hours.
“We do our very best to stay with the family because, next to birth, death is probably the most intimate process people can go through. Our role doesn’t stop until the whole process finishes.”
In the post-surgery hours, the co-ordinator contacts the donor family and, if requested, lets them know which organs were successfully retrieved. Within a month, a note is written to them informing them generally about placement of the organ(s). Down the road, they can make a request for updates about the recipients and vice versa, if so desired.
Transplantable organs include the heart, liver, lungs, kidneys, stomach, pancreas, and small bowel, as well as tissue organs such as eyes, bones, skin, heart valves and ligaments.
“People forget the importance of tissue donation,” Petzel said. “Eighty per cent of (people who die) could go on and donate (their) eyes.”
Both Petzel and Andlar have seen first hand the comfort organ donation brings to grieving families. “It helps them through their darkest hour,” Andlar said.
Petzel, too, is astounded at people’s selflessness.
“When I sit down and make a request to a family, it always takes my breath away that people who are in so much pain, suffering such a devastating loss, can stop thinking about themselves and say: ‘Yes, this would be a good thing to do.’”
Recipients
In 2007, 926 transplants were performed in Ontario, according to TGLN statistics. This year 533 transplants were performed as of early September. Since 2001, those numbers have been rising steadily, with kidney transplants accounting for the lion’s share.
Steffany Bourque and Leslie Laporte, two front-line nurses in the nephrology unit at Sudbury Regional Hospital, have a total of 270 chronic renal failure patients, a consistent increase over the 104 patients treated in 1991.
When people experience kidney failure, they eventually end up on dialysis. Extra fluids and toxins are removed through either a four- or five-hour treatment, usually three times a week.
Bourque, who is an 11-year veteran in nephrology, said dialysis is hard on a body and its organs. The body goes through extreme highs and lows, pushing the organs, especially the heart, to work harder. People on dialysis are on a restricted diet and liquid intake.
An average transplanted kidney lasts about 10 years, although some have lasted up to 20 to 25 years. The longest living person on dialysis at Sudbury Regional lasted 36 years, Bourque said.
The process to go on a waiting list requires a patient request, followed by extensive testing to assess overall health. The patient meets the transplant team consisting of a cardiologist, nephrologist, surgeon, anesthetist, and social worker at one of the major hospitals in Toronto, London, Hamilton or Ottawa.
Once they get a clean bill of health, they are listed. If the organ is to be sourced from a deceased person, the patient gets a pager; if it is a living donor, a date will be set for the transplant.
Forty-four-year-old Ronald Ross has a tentative date this fall for kidney transplant surgery from a living donor. His assessment process started 11 months ago, ensuring he will be in optimal health for a successful operation.
Ross, who is a 14-year diabetic, has been on dialysis for five-and-a-half years. He said the transplant team thoroughly educates the patient about the pros and cons of a transplant and is fastidious about making sure the tests are in order.
Bourque stressed the importance of “doing your homework” about transplants. “People need to be well-versed before getting a transplant because it is not the be all and end all. It is a modality change.”
Positive Outcome
Although not every transplant is successful, many are. Fourteen-year-old Ian Smyth received a double lung transplant on May 19 at Toronto’s Hospital for Sick Children.
Smyth was afflicted at five-years-of-age with a virus called bronchiolitis obliterans organizing pneumonia, a flu-like illness that created a lot of scar tissue in his lungs. By age 13, his lungs were down to 20 per cent capacity.
Patients awaiting lung transplants are required to live within two hours travel time of the transplant hospital. Therefore, in November 2007, Ian and his mother, Susan, moved to Toronto while he waited on the transplant list. Six months later, he received his transplant. After three months of recovery he is now back in Sudbury going to school with his friends.
Susan described the move, the waiting, the operation and the three-month recovery as a journey.
“In that journey, you have to take every day as it comes,” she said. “In this case, we are fortunate, because our journey has a happy ending.”
She was very pleased with the medical care and treatment her son received and continues to receive. With only a six-month waiting time from when his name was placed on the list, she was very grateful for the gift of life. A thank you card has been written and sent to Trillium, which will be forwarded to the donor family.
www.giftoflife.on.ca
www.tbrhsc.net
www.hrsrh.on.ca |
