Landscape of organ donation and transplantation activity in Canada

Transcription

1 Landscape of organ donation and transplantation activity in Canada Jagbir Gill MD MPH FRCPC Associate Professor of Medicine, UBC Vice President, CORR Board 2017 CST Fellows Symposium, September 25, 2017 Canadian Institute for Health Information September 25, 2017

2 Overview Delivery of donation and transplantation services in Canada Wait-list statistics Organ donation Transplant activity Outcomes

3 Provincial delivery of OD and T related care 25 adult and pediatric programs perform transplantation 10 Organ donation organizations

4 Source: Organ Donation and Transplantation Services Report, CBS 2016

5 Waiting List Statistics 5

6 Number of Wait-Listed Transplant Candidates by Organ Type, , Canada (preliminary) Kidney Kidney-Pancreas Liver Heart Lung Note: Excludes Quebec because of under-reporting between 2011 and

7 Number of Kidney Transplant Candidates and Death Rates on the Waiting List, (preliminary) 3,000 50% 45% 2,500 40% 2,000 35% 30% 1,500 25% 20% 1,000 15% % 5% Kidney 2,159 2,026 1,981 2,399 2,431 2,505 2,629 2,665 2,766 2,840 Deaths 2% 2% 2% 3% 2% 2% 3% 2% 2% 3% 0% Note: Excludes Quebec because of under-reporting between 2011 and

8 Duration of Dialysis prior to first kidney transplant, Adults (18+) by Blood type, 2014 to 2016 (preliminary) Type A Type AB Type B Type O Total Duration on Dialysis (Median Days), Deceased Donor Duration on Dialysis (Median Days), Deceased Donor, No Pre- Emptive Duration on Dialysis (Median Days), Living Donor Duration on Dialysis (Median Days), Living Donor, No Pre- Emptive Note: Excludes Quebec because of under-reporting between 2011 and , ,943 1,739 1,448 1, ,967 1,744 1,

9 Duration of Dialysis Prior to First Kidney Transplant, Adults (18+), by Province, 2014 to 2016 (preliminary) B.C. Alta. Sask. Man. Ont. N.S. Canada Duration on Dialysis (Median Days), Deceased Donor Duration on Dialysis (Median Days), Deceased Donor, No Pre- Emptive Duration on Dialysis (Median Days), Living Donor Duration on Dialysis (Median Days), Living Donor, No Pre- Emptive Note: Excludes Quebec because of under-reporting between 2011 and ,420 1,281 1,851 2,114 1,476 1,089 1,448 1,430 1,396 1,883 2,114 1,497 1,231 1,

10 Number of Liver Transplant Candidates and Death Rates on the Waiting List, , Canada (preliminary) Liver Death Rate Note: Excludes Quebec because of under-reporting between 2011 and 2016

11 Donor Activity 11

12 Number of Canadian Organ Donors by Donor Source, , Canada (preliminary) Living Deceased

13 Rate per million population Deceased Donor Rate (PMP) by Year, , Canada (preliminary)

14 Deceased Donor Rate (PMP) by country Source: Organ Donation and Transplantation Services Report, CBS

15 Rate per million population Deceased Donor Rate (PMP) by Region, , Canada (preliminary) BC/YK AB/NT/NU MB/SK ON QC Atl

16 Proportion of deceased donors, by age, , Canada 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Note: Excludes Quebec because of under-reporting between 2011 and

17 Proportion of DCD among all deceased donors, , Canada 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% NDD DCD

18 Rate per million population Donor Rate (PMP) by Donor Source (Deceased vs. Living), , Canada (preliminary) Deceased Donor Living Donor

19 Living Donor Rate (PMP), by country Source: Organ Donation and Transplantation Services Report, CBS

20 Rate per million population Living Donor Rate (PMP) by Region, , Canada (preliminary) BC/YT AB/NT/NU MB/SK ON QC Atl

21 Proportion of living donors by relation, , Canada 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Unrelated Spouse Other related Offspring Sibling Parent Note: Excludes Quebec because of under-reporting between 2011 and

22 Transplant Activity 24

23 Number of Organ Transplants by Donor Source, , Canada (preliminary) Deceased Living

24 Transplant Rate (PMP), by organ Source: Organ Donation and Transplantation Services Report, CBS

25 Number of Kidney Transplants by Donor Type, Adult (18+), 2006 to 2017 (preliminary) 1, Deceased Living Note: Excludes Quebec because of under-reporting between 2011 and

26 Number of kidney transplants Number of Kidney Transplants by Centre, All Ages, 2016 (preliminary) A B C D E F G H I J K L M N O P Q R Number of transplants Note: Excludes Quebec because of under-reporting between 2011 and

27 Proportion of Kidney Transplants from Deceased vs. Living Donors, by Centre, All Ages, 2016 (preliminary) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% A B C D E F G H I J K L M N O P Q R Living donor Deceased donor Note: Excludes Quebec because of under-reporting between 2011 and

28 Kidney Transplant Rate (PMP), 2015, by country Source: Organ Donation and Transplantation Services Report, CBS

29 Liver Transplant Rate (PMP), 2015, by country Source: Organ Donation and Transplantation Services Report, CBS

30 Heart Transplant Rate (PMP), 2015, by country Source: Organ Donation and Transplantation Services Report, CBS

31 Lung Transplant Rates (PMP), 2015, by country Source: Organ Donation and Transplantation Services Report, CBS

32 Outcomes 34

33 Unadjusted 3-month, 1-, 3- and 5-Year Graft Survival in Kidney Transplant Patients, All ages, by Donor type, Canada, 2007 to 2016 Donor type Living Deceased Time Point N At start Months Year Years Years N At start Months Year Years Years Note: Excludes Quebec because of under-reporting between 2011 and

34 Unadjusted 1-, 5-Year Graft Survival in Kidney Transplant Patients, All ages, by Donor type and Centre (blinded), Canada, 2007 to 2016 Centre A B C D E F G H I J K L M N O P Q R Total N ,00 2 1,15 2 1,39 0 Living 1 Year Survival 5 Year Survival Deceased 1 Year Survival 5 Year Survival Note: Excludes Quebec because of under-reporting between 2011 and

35 Kidney Transplant Survival, by country Source: Organ Donation and Transplantation Services Report, CBS

36 Percent Unadjusted Three-Month and One-, Three- and Five-Year Patient Survival Rates for Deceased-Donor Liver Transplant Recipients, First Graft, 2007 to 2016, Canada months year years years Note: Excludes Quebec because of under-reporting between 2011 and 2016

37 Summary The number of wait-listed patients outnumber the number transplant recipients Significant rise in deceased donation in Canada in recent years increased transplantation rates in Canada Living donor (kidney) transplantation is declining despite new initiatives Canadian rates of donation and transplantation are lower than the US, but outcomes are better Regional variability in deceased and living donor transplantation indicate room for growth 39

38 Areas in Development National collaboration and oversight Ongoing need for more granular and standardized provincial and national data Minimizing regional variability in practice Innovation in policy and research to expand access to and outcomes after transplantation 40