Archived reports and publications

Archives / Document Library – Organ and Tissue Donation and Transplantation

A catalogue of reports and documents available upon request can be found listed below. This archive includes documents and reports from Canadian Blood Services’ Organ and Tissue Donation and Transplantation program from 2008- 2020. This archive also includes historical records from 2001-2008 that are outputs from the Canadian Council for Donation and Transplantation. A PDF copy of any of the reports listed here is available by request. Submit requests by email to OTDT@blood.ca. Please include the title and use the subject line: PDF Document Request.

Report Title Date Author(s) Summary
       
2020 Canadian Eye and Tissue Banking Statistics  2020 Canadian Blood Services

System Performance Data

Beginning in 2012, Canadian Blood Services with coordination through the Eye and Tissue Data Committee (ETDC), has received data submissions from all Canadian eye and tissue programs. Data definitions were established, and data training delivered to the Canadian eye and tissue community prior to recite of data metrics.

Canadian Blood Services maintains and collates data for review by the ETDC. Each year a summary report is generated. The purpose of this report is to provide information and insights into the Canadian recovery, processing and distribution of ocular and tissue allografts across Canada.

Prospective data collection was initiated in 2012. In 2020, data was submitted from 16 eye and tissue banks and one recovery program representing a census of all Canadian eye and tissue banking activity (results were not available for select metrics for certain programs, as indicated). Data on allografts imported by Canadian tissue banks from the United States was available for the first time in 2016; however, data on allografts imported directly by Canadian hospitals from the United States is not readily available. 

Kidney Paired Donation Program: Living Donation Network Meeting March 6, 2020 2020-03-06 Canadian Blood Services Canadian Blood Services thanks the members of the Living Donation Advisory Committee (LDAC) and the Kidney Transplant Advisory Committee (KTAC), as well as the planning committee for their support of this initiative. Additionally, we thank all of the meeting participants for taking the time to attend, for freely contributing ideas, and for participating with energy and enthusiasm. Your commitment to living donation is inspiring!
Cornea Donation and Transplantation: A National Consensus Forum for Improving Access in Canada 2020-02-09
2020-02-10
Canadian Blood Services,
Ocular Leading Practice Forum Planning Committee and Executive Committee, the Canadian Ophthalmological Society, and the Eye and Tissue Data Committee
The guidance stemming from this national consultation is transformational and acting on the recommendations will improve access to cornea donation and transplantation in Canada.

For the last decade the increasingly long waiting lists for cornea transplantation have consistently gained media and government attention. Wait times are often measured in years as opposed to months, meaning the rates of access to cornea transplantation in Canada are on par with, or lower than, the rates seen in some developing countries. Yet, despite all the attention the number of corneas transplanted in Canada has remained unchanged for the last six years and no focused and coordinated efforts have been expended to improve this system.

On Feb. 9 and 10, 2020, eye and tissue bank representatives, health authority and hospital leadership, transplant ophthalmologists, organ donation organizations, transplant recipients, donor families and several national organizations – including the Canadian Ophthalmological Society, the Canadian National Institute for the Blind, the Canadian Donation and Transplantation Research Program, the Canadian Standards Association – Ocular Technical Committee, Canadian Blood Services, and the Donation Physician Network, came together to identify opportunities and solutions and in doing so, put forth the ultimate recommendation:
• To create a Canadian cornea donation and transplantation system that is self-sufficient and eliminates corneal transplant waiting lists within five years.
• The community of experts assembled understood the challenges that undertaking system-level improvement presents; however, they believe the recommendations identified in this guidance are specific, realistic, time-based, and largely attainable and that implementation of the recommendations will lead to transformative change. Respecting the resource limitations of the current system, there are opportunities to optimize existing programs and infrastructure and execute strategies at the provincial level that will ultimately demonstrate national system improvement.
• The engagement, excitement and momentum generated from this consultation is palpable. The energy and recommendations from the community will provide guidance to the provinces, governments, health-care organizations, health-care professionals, researchers, transplant recipients, and donor families who want to work together to achieve this bold vision.
Canadian Eye and Tissue Banking Statistics 2019 2019 Canadian Blood Services System Performance Data
Beginning in 2012, Canadian Blood Services, on behalf of the Eye and Tissue Data Committee (ETDC), has received data submissions from all Canadian eye and tissue programs. Data definitions have been established and data training delivered to the Canadian eye and tissue community.

Canadian Blood Services maintains and collates data for review by the ETDC. Each year a summary report is generated. The purpose of this report is to provide information and insights into the Canadian recovery, processing and distribution of ocular and tissue allografts across Canada.

Prospective data collection was initiated in 2012. In 2019, data was submitted from 16 eye and tissue banks and one recovery program representing a census of all Canadian eye and tissue banking activity (results were not available for select metrics for certain programs, as indicated). Data on allografts imported by Canadian tissue banks from the United States was available for the first time in 2016; however, data on allografts imported directly by Canadian hospitals from the United States is not readily available.
Measuring Quality in Kidney Transplantation:  Canadian Consensus Workshop November 27-28, 2019 Toronto, Ontario, Canada 2019-11-27
2019-11-28
Ottawa Hospital Research Institute, Canadian Blood Services, Canadian Donation and Transplantation Research Program Canada requires more than the traditional one-year survival indicator for measuring quality in kidney transplantation. Potential additional quality indicators include domains of: accessibility, effectiveness, safety, patient-centred care, equity and efficiency. Existing data gaps include sharing of data, reporting of centre-specific data to patients or the public, information on living donors after they donate, and what transplant groups do/could do with this information. Although Canada has multiple standards dedicated to quality measurement in transplantation and living kidney donation, there are no specific requirements for what indicators to collect, how to define the indicators, how to collect the data or how to establish benchmarks. While countries like the United States and Germany may offer examples of measurement with formal and mandatory reporting structures, they come with inherent challenges, including that data used for regulatory purposes has the potential to lead to risk avoidance, limitations on data regarding access to transplant and or population.
Interprovincial Organ Sharing Report: National Organ Waitlist - 2012-2018  2018 Canadian Blood Services Canadian Blood Services manages and operates clinical programs that support interprovincial sharing of organs and operates the national technology platforms essential to the success of these programs.

The National Organ Waitlist (NOW) is a web-based program maintained and operated by Canadian Blood Services and used by provincial donation and transplantation programs to identify patients in urgent need of an organ transplant across Canada. The NOW is accessible 24/7, meaning transplant programs are able to list and update the status of patients in need in real-time. Provincial Organ Donation Organizations (ODOs) use the NOW as a first step in the organ allocation process to identify patients in most critical need of an organ anywhere in Canada. 
National Data Report: Kidney Paired Donation Program 2018 Canadian Blood Services Working in collaboration with the provincial living donation programs, the Kidney Paired Donation program serves patients who have a willing living donor with whom they are not medically compatible by finding another pair with whom they can swap donors so both patients receive a transplant.

The registry contains medical information about incompatible pairs of donors and transplant candidates from across Canada and identifies pairs that might be able to exchange kidneys. From there, it’s a matter of finding a suitable exchange and creating “chains” of matching donors and recipients.

The KPD program runs its match cycle algorithm three times a year to compare the medical information on all the pairs and nondirected donors in the Registry and identifies kidney transplant opportunities. Typically, between 140 and 150 pairs and eight NDADs participate in each Match Cycle, and it is expected that results for upcoming Match Cycles will be consistent with this level of participation. The matches proposed in a Match Cycle result in 27 transplants on average, with chains being completed approximately four months from the date they are initially proposed. Just over half (51%) of the transplant candidates who have participated in at least one Match Cycle received a transplant. Many of those who withdrew from the KPD program did so because they received a transplant from another source, including those who received a deceased donor transplant through the HSP program.
National Data Report: Kidney Paired Donation Program 2009-2018 2018 Canadian Blood Services Canadian Blood Services manages and operates national programs that support interprovincial sharing of organs and the national technology platform essential to the success of these programs.

The Kidney Paired Donation (KPD) program, established in 2009 (as the Living Donor Paired Exchange Program) by Canadian Blood Services in collaboration with transplant programs across the country, is a living donation program that finds and facilitates medically compatible kidney transplants through chains of donor exchanges from medically incompatible pairs. The program serves patients who have a willing living donor with whom they are not medically compatible by finding another pair with whom they can swap donors so both patients receive a transplant. The KPD program significantly expands access to potential donors for all Canadians with an incompatible donor; every patient who receives a living donor transplant comes off the deceased donor waitlist and thereby decreases the demand on the waitlist for others.
National Data Report: Highly Sensitized Patient Program - 2013-2018 2018 Canadian Blood Services Canadian Blood Services currently operates three interprovincial organ sharing programs that serve to maximize transplant access for patients most in need. These include the National Organ Waitlist (NOW), the Kidney Paired Donation (KPD) program and the Highly Sensitized Patients (HSP) program. These programs are operated on the Canadian Transplant Registry (CTR) web-platform, which is maintained by Canadian Blood Services.

The HSP program was initiated in the Fall of 2013 and has become a cornerstone of Canadian Blood Services’ contribution to the organ donation and transplantation system in Canada. It provides access to deceased donors on a national scale for kidney transplant candidates who have significantly reduced access to compatible donors due to their immunological profile.

The data in the following report has been extracted from the CTR and covers the period of 2013–2018, from the initiation of the HSP program (started in November of 2013) until December of 2018. 
2018 OTDT System Progress Report Update 2018 Canadian Blood Services Each year we are reminded of the remarkable collaborative effort that underpins the organ and tissue donation and transplantation (OTDT) system in Canada. On behalf of that collaborative network, I am pleased to introduce this 2018 update on OTDT system progress.
Canadian Eye and Tissue Banking Statistics  2018 Canadian Blood Services The Canadian Eye and Tissue Data Committee (ETDC) works diligently to assemble and provide annual national reports on eye and tissue data in Canada. The 2018 ETDC report provides information that supports assessment and improvement of Canadian eye and
tissue banking. The value of the information captured has been recognized regionally, nationally, and internationally. 
Key elements of a high-performing deceased donation system
Key definitions
2018 Canadian Blood Services Definitions
Pathway to deceased donation 2018 Canadian Blood Services Definitions
Heart donation and transplantation after circulatory determination of death: expert guidance from a Canadian consensus building process 2018-10-15
2018-10-16
Canadian Blood Services, Dorothy Strachan, Mr. Sylvain Bédard, Ms. Heather Berrigan, Ms. Diana Brodrecht, Mr. Thomas Shing, Mr. Everad Tilokee, and Mr. Jonathan Towers, Trillium Gift of Life Network Controlled donation after circulatory determination of death (DCD) implementation in Canada has been responsible for the largest quantitative increase in deceased donation and transplantation for all organs, except the heart. Two innovative recovery methods have been developed to allow for recovery of hearts after cardiac death from DCD donors: normothermic regional perfusion (NRP) and direct procurement and perfusion (DPP). These procedures have been used successfully in the United Kingdom (UK) (NRP and DPP) and in Australia (DPP) to increase the number of hearts available for transplant.

Interest in DPP and NRP has been expressed by several Canadian heart transplant programs, including those with ongoing research programs in DCD heart transplantation. In response to a request from Trillium Gift of Life Network (TGLN), Canadian Blood Services and TGLN collaborated to organize a two-day forum, as a step in the process to develop expert guidance for the implementation of DCD heart donation in Canada. 
Management of the neurologically deceased organ donor: A Canadian clinical practice guideline 2018-05-01 Canadian Blood Services

Demand for organs continues to exceed their availability, both in Canada, and around the world. Optimizing the medical management of potential organ donors is an important strategy for enhancing organ supply. The explicit goals for management of deceased organ donors in the intensive care unit (ICU) are to stabilize the potential donor, and to optimize the number and quality of organs for transplantation.


In 2006, the Canadian Council for Donation and Transplantation (CCDT) published the first Canadian recommendations for organ donor management. This guideline was the product of a February 2004 forum entitled, “Medical Management to Optimize Donor Organ Potential” and was produced in collaboration with the Canadian Critical Care Society and the Canadian Society of Transplantation. This forum was the first structured, cooperative assembly of health care professionals in the fields of critical care medicine and transplantation and was a landmark event in Canadian organ donation practice. The 2006 guideline had an influence on organ donation recommendations internationally; however, it had not been updated to incorporate emerging evidence in organ donor management and general critical care medicine and the many advances in guideline development methodology.


The objective of this guideline is to update recommendations for the medical management of neurologically deceased (“brain dead”) adult and pediatric potential donors for the purposes of single or multi organ recovery for transplantation.

2017 OTDT System Progress Report Update 2017 Canadian Blood Services The results reflected within this report represent the individual and collective work of both the provincial programs and the national efforts led by Canadian Blood Services. Most importantly, through this report we sincerely acknowledge the generosity of the 1,335 organ donors and 4,969 tissue donors and their families who gave so selflessly in 2017. We also recognize the heartfelt appreciation of the recipients whose lives were saved or changed through the act of donation. 
Donation and Transplantation Canadian Eye and Tissue Banking Statistics: 2017 2017 Canadian Blood Services Beginning in 2012, Canadian Blood Services, on behalf of the Eye and Tissue Data Committee (ETDC), has received data submissions from all Canadian eye and tissue programs. Data definitions have been established and data training delivered to the Canadian eye and tissue community. 
ECPR for OHCA in Canada: Planning the Research 2017 Canadian Blood Services In order to consider ECPR for OHCA in the Canadian context, a meeting was held in Ottawa on April 25-26, 2017, subsequent to an initial meeting held in 20161. The objective was to develop a collaborative multidisciplinary research consortium and a coordinated national research agenda, with participation of experts from pre-hospital care, emergency medicine, critical care, resuscitation science, neuroscience, cardiology, cardiac surgery, ECMO, bioethics, end-of-life care, patient and public engagement, and organ donation and transplantation. 
Environmental Scan of Professional Education for Donation 2017 Canadian Blood Services Currently, professional education programs for deceased donation in Canada are developed and delivered by provincial or regional organ donation organizations (ODOs),  professional societies, donation champions, tissue banks, and transplant programs. This structure results in inconsistency with respect to program content, depth at which the material is covered, and health care disciplines that receive training. Though some sources of content are developed nationally and leveraged by individual ODOs, the fragmented delivery may result in greater costs and resource use than a single national strategy would. Furthermore, a lack of consistent assessment, evaluation, or learner certification presents a barrier to ensuring nation-wide competency.
Canadian Guidelines for Controlled Pediatric Donation after Circulatory Determination of Death  2017-09-20 Canadian Blood Services Since the publication of the 2006 consensus national recommendations, donation after circulatory determination of death (DCD) has become an increasingly frequent pathway to deceased organ donation for adults in Canada. The implementation of DCD in children (pDCD), however, has lagged behind. According to 2014 data from Canadian Blood Services, DCD represented 21% (123/592) of national deceased donation, but pDCD made up only 8% (3/37) of pediatric deceased donation. This practice remains concentrated in a limited number of centres with active pDCD protocols and programs. In an effort to enhance the uptake and implementation of pDCD in Canada, the purpose of this document is to provide rigorously developed, evidence-based guidelines that centres can adapt to their own practices.
National OTDT data sets 2017-08-03
2016-06-30
2015-09-29
Canadian Blood Services

Deceased Donation Data Set (June 2016)National OTDT Data Working Groups have been created to establish standardized data sets that will allow alignment of information collected and reported across the country. These reports represent the first step in building a comprehensive national data set for organ and tissue donation and transplantation.

Heart Data Set  (September 2015)
Liver Data Set (September 2015)
Kidney Data Set (September 2015)
Lung Data Set (September 2015)
Deceased Donation Data Set (June 2016)
Pancreas data set (August 2017)
Living Donation Kidney Data Set (September 2015)

Withdrawal of Life-Sustaining Measures Canadian Critical Care Society Guideline Implementation and Quality Assurance Workshop: Meeting Report 2017-06-07
2017-06-08
Canadian Blood Services, Mr. Michael Kampen, Mr. Francis Moran and Ms. Alison Morsley As Canadian experience with controlled donation after circulatory determination of death (cDCDD) matured, it became evident varying practices of the withdrawal of life-sustaining measures (WLSM) have emerged. Without standardization of practice, there could be perceptions of undue influence on consent and donation with WLSM. In response, the Canadian Critical Care Society (CCCS) undertook a review of the published literature and developed an evidence-based leading practice, Guidelines for the Withdrawal of Life-Sustaining Measures, published in 2016, to improve the quality of end-of-life (EOL) care provided in intensive care units (ICUs).

Recognizing a need for broader implementation and uptake of these guidelines, Canadian Blood Services and the CCCS partnered to develop tools and a quality assurance process to support the implementation of the CCCS WLSM guidelines in critical care programs across Canada - an important step in translating these guidelines into clinical practice at the bedside and ensuring the consistent application of WLSM practices independent of the opportunity for donation.

This initiative focused on actions from the decision to WLSM until death. The decision process related to prognostication and the decision to WLSM were out of scope.

A collaborative workshop brought together family partners and Canadian leaders in donation, critical care and palliative care to meet the following objectives:
• develop a set of guiding principles for the application of the CCCS WLSM guidelines;
• develop tools to support the implementation of the CCCS WLSM guidelines;
• develop tools to support quality assurance in WLSM;
• develop a WLSM organizational policy template;
• identify potential implementation challenges relating to WLSM; and
• identify research opportunities and priorities to advance improvements in WLSM and organ and tissue donation in EOL care.
Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy  2017-05-15
2017-05-16
Canadian Blood Services,
Canadian Critical Care Society,
the Canadian Society of Transplantation, and
the Canadian Association of Critical Care Nurses
In Canada, organ donation from deceased donors is a common practice that saves or improves the lives of more than 2,000 Canadians every year, accounting for more than 3 out of 4 transplanted organs.1 Deceased donation is permitted following either neurological or circulatory determination of death. Donation following neurological determination of death (DNDD) is more common in Canada, but rates of DNDD have remained largely stable over the past decade. Donation following circulatory determination of death (DCDD) was historically considered more controversial than DNDD, but DCDD has become increasingly common, accounting for 23 per cent of all organs donated in Canada in 2016.

The practice of DCDD is also evolving; the DCDD guidelines developed in 2005 addressed the conventional scenario of an unconscious, incapable, critically ill patient who was not expected to survive after the
withdrawal of life-sustaining measures (WLSM).
2016 OTDT System Progress Report Update 2016 Canadian Blood Services The results reflected within this report represent the individual and collective work of both the provincial programs and the national efforts led by Canadian Blood Services.
Opportunities and Barriers for ECPR in Canada 2016 Canadian Blood Services Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging therapy for patients with cardiac arrest refractory to conventional resuscitation. ECPR entails the use of extracorporeal membrane oxygenation (ECMO) to sustain perfusion in patients with cardiac arrest. Best available evidence from around the world is of low quality but observational studies have suggested that ECPR is associated with increased survival in subgroups of out-of-hospital cardiac arrest patients and provides organ donation opportunities in non-survivors. Organized by Canadian Blood Services in collaboration with the Canadian Resuscitation Outcomes Consortium, we assembled an interdisciplinary group of clinicians and researchers from across Canada, with support from international experts, to discuss opportunities and barriers for ECPR in the Canadian context. Representatives included experts from prehospital care and paramedics, emergency medicine, resuscitation, cardiac surgery, ECMO specialists, neurology and neurointensive care, critical care, organ donation, transplantation, health policy, health economics and bioethics. 
Bioburden Leading Practice Guidelines Final Report 2016-11-01 Canadian Blood Services This report presents evidence-based bioburden reduction leading practice guidelines including 16 recommendations, 21 good tissue practices, and identification of 39 research priorities. In response to public and professional concern for preventing transmission of infectious disease by transplantation, these guidelines aim to support the provision of safe tissue for transplantation by standardizing practice using evidence-based scientific information.
Potential Organ Donor Identification and System Accountability  2016-09-20
2016-09-21
Canadian Blood Services,
Canadian National Transplant Research Program
This report provides an overview of the Potential Organ Donor Identification and System Accountability workshop and a summary of participant recommendations in response to prescribed questions. The workshop was based on the collaborative wisdom of a broad range of stakeholders, experts and key leaders representing Canadian Blood Services and the Canadian National Transplant Research Program (Refer to Appendix B: Workshop participants and affiliations). The Steering Committee would like to collectively thank Canadian Blood Services and the Canadian National Transplant Research Program for their support of this initiative, as well as all participants who helped in the creation of these recommendations. We would also like to acknowledge Ms. Debbie Neville and Mr. Emile Therien, our family representatives, who took the time to share compelling personal experiences which situated participants to the circumstances facing Canadians. 
Liver Listing and Allocation Forum 2016-05-26
2016-05-27
Canadian Blood Services, in collaboration with the Canadian Liver Transplant Network and the Canadian Society for Transplantation

The Forum process began with comprehensive planning, including scoping and initial development of challenge questions, and then moved to knowledge assembly that culminated in an on-site expert meeting focused on building consensus. Background documents on liver transplant were provided to Forum participants beforehand including:


• Two draft policies developed by the MELD-PELD Liver Forum Working Group: (a) MELDNa for liver transplant allocation, and (b) allocation of livers to pediatric recipients according to the Canadian Pediatric Allocation of Livers System (CPALS).
• Three literature reviews on (a) MELD-Na and 5vMELD versus MELD, (b) pediatric scoring models, and (c) scoring systems for hepatocellular carcinoma (HCC), based on reviews of the international literature.
• An environmental scan of HCC practices in Canada and internationally, including within it a list of selected publications from Canadian universities that were related to HCC and liver transplant. 

2006-2015 OTDT System Progress Report   2015 Canadian Blood Services Canada has seen incremental progress in its organ donation and transplantation system since 2006. Our deceased donation rate has increased from 14.1 donors per million population (DPMP) to 18.2 DPMP in 10 years. While this is encouraging, organ donation and transplantation in our country is simply not improving fast enough to help the thousands of Canadians waiting for lifesaving or life-improving transplants.

Drawing on data obtained from the Canadian Transplant Registry, the Canadian Organ Replacement Register, and the various transplant programs and provincial organ donation organizations (ODOs) across the country, this report presents an overview of the state of Canada’s organ donation and transplantation system today. It charts the areas in which the system has performed well over the past 10 years, and those in which further focus and investments may yield the greatest outcomes for patients. 
An Environmental Scan of Bioburden Reduction and Control Practices in Tissue Banking 2015 Canadian Blood Services The purpose of this environmental scan is to identify current practices relating to bioburden reduction and control in bone, connective tissue, cardiovascular and skin allograft tissue banks in Canada, the United States (U.S.) and Europe.

The goal of Canadian Blood Services’ Bioburden Reduction and Control Leading Practices initiative is to create national agreement on recommendations for bioburden reduction and control practices in tissue banking in Canada. Key representatives from the Canadian bone, connective tissue, cardiovascular and skin banking community as well as recognized experts outside of the tissue community will be convened to a consensus forum to review and evaluate evidence and current practices in bioburden reduction and control, and to identify and recommend leading practices to improve the safety of tissue allografts produced in Canada.
Estimating potential tissue donors in Canada from 2005-2008 An update based on acute care hospital admissions data (January 2014) 2014 Canadian Blood Services In 2004, the Canadian Council for Donation and Transplantation (CCDT) contracted the Canadian Institute for Health Information (CIHI) to develop the report, Estimating potential tissue donors in Canada from 1995-2000: An exploratory analysis based on acute care hospital admissions data. This report estimates the number of potential tissue donors in Canada, given a series of set parameters and demographics. Estimated potential tissue donor rates provide targets by which system performance can be evaluated. Using new discharge data from 2005 to 2008, the 2004 CIHI report has been updated to reflect more recent information from the CIHI Hospital Morbidity Database (HMDB) and changes in tissue donor criteria.
End-of-Life Conversations with Families of Potential Donors: Leading Practices in Offering the Opportunity for Donation  2014-08-01 Canadian Blood Services Canadian public and health care professionals strongly support the idea of organ and tissue donation. However, Canada’s deceased donation rate is less than half that of the best performing countries, with variable family consent rates across the country. It is recognized that presenting the opportunity for donation to families who are in a stressful, traumatic situation is difficult and must be done with sensitivity to their unique situations, values and beliefs. At the same time, international, national, and local leaders in this area have demonstrated that conversations with families can be done in a way that leads to improved and well informed decision making and support, and can have a positive impact on donation rates.  
Advancing organ and tissue donation: A collaboration of the Canadian Conference of Chief Coroners and Chief Medical Examiners, the Canadian tissue community and Canadian Blood Services (June 2013) 2013 Canadian Blood Services The manual is focused on improving the donation rates in Canada in order to reduce the unmet need for tissue and organ transplants. To achieve this purpose, we emphasize partnerships between the tissue and organ donation community and the provincial and territorial medicolegal death investigation community. 
Canadian imported surgical musculoskeletal allograft and acellular dermal matrix study (April 2013) 2013 Canadian Blood Services The Canadian surgical imported allograft market comprises nonproprietary allografts (including bone and soft tissue grafts), proprietary allografts (including demineralized bone matrices [DBMs] and cancellous/corticocancellous chips, powders, etc.), machined bone grafts, bone morphogenetic proteins (BMPs), other allografts (i.e., allograft dura), while the acellular dermal matrix (ADM) market comprises allograft-based ADMs and reinforcement grafts.

For a more in-depth discussion on these materials and the procedures they are used in, please refer to the introduction chapter. This chapter focuses primarily on imported products that are used across the country and does not include materials utilized in cardiovascular or ocular procedures.
Data, analytics and reporting system workshop 2013-06-27 Canadian Blood Services Data analysis and reporting play a pivotal role in improving donation and transplant practices and patient care, informing health care policy and supporting planning and research. To build on previous collaborative efforts with the Canadian organ donation and transplantation (ODT) community to develop a pan‐Canadian system for data, analytics and reporting, Canadian Blood Services organized a one‐day workshop to explore ways to move this work forward.  
International Guidelines for the Determination of Death – Phase I  2012-05-30
2012-05-31
Canadian Blood Services,
World Health Organization
Depending on the country and related professional societies, guidelines may or may not exist for the determination of death by neurological and/or circulatory criteria. If in place, these guidelines have not always been implemented or proven effective in alleviating concerns about legitimacy and conflicts of interest with deceased organ donation. The World Health Organization (WHO) and The Transplantation Society have had requests from various countries to provide guidance to inform leading practices and health policy in this area. Guidelines that are applicable in a wide range of global health care settings could provide many benefits, including promoting safe practices and assuring there are no diagnostic errors in the determination of death; protecting patients and health care professionals; improving public and professional confidence in the deceased donation process and; increasing the availability of organs obtained by ethically legitimate donation and procurement practices. In response, the WHO held an initial meeting in Geneva in December 2010 in an effort to generate interest in this global challenge in support of the Istanbul Declaration (May, 2008), the WHO Madrid Resolution (March 2010), and the World Health Assembly Resolution (May, 2010). 
International Guidelines for the Determination of Death - Definition of Death Literature Review 2012-05-30
2012-05-31
Canadian Blood Services,
World Health Organization
The shortage of transplantable organs is a global problem that is in urgent need of a coordinated, international response. The World Health Organization has charged nations to begin to address this serious medical health issue by, among other objectives, improving their national systems for both living and deceased donation. The ethical foundation for deceased donation is the dead donor rule, which states that “vital organs should only be taken from dead patients and, correlatively, living patients must not be killed by organ retrieval.” 1 Adhering to this rule necessitates establishing clear evidence and consensus-based medical criteria for determining death. 
Leading Practices for the Allocation of Organs for Combined Transplantation 2012-03-22
2012-03-23
Canadian Blood Services The purpose of this initiative was to develop eligibility (including listing) criteria and a decision-making model which could be applied to the allocation of organs for combined transplants that is acceptable, useful and adaptable within unique regions across the country. The consensus forum was the first step of a consultative process which is intended to aid programs with their task standardizing policies for combined transplant and interprovincial sharing. In in this report, the term “combined transplants” is defined as kidney/non-kidney combined transplant pairs and excluding kidney/pancreas as well as all other pairs.
Eye and tissue banking in Canada: A leading practices workshop 2012-02-08
2012-02-09
Canadian Blood Services

On February 8 and 9, 2012 representatives from the Canadian eye and tissue banking community joined Canadian Blood Services and international colleagues for a workshop focused on the development of leading practices in four areas: data collection and sharing, donor identification and referral, donor tissue specifications, and optimal recovery and storage processes. Objectives were to:


1. Provide an overview of current practices in Canada and a sample of international practices as a basis for informed discussion by workshop participants;
2. Consult with participants before and after the workshop regarding the workshop objectives and projected outcomes;
3. Discuss and come to agreement on the data metrics required to enable collection, sharing and reporting of information that describes the Canadian tissue donation and transplantation system‟s activities and trends;
4. Introduce and review proposed guidelines for tissue donor identification and referral by medical examiners and coroners;
5. Initiate discussions relating to the development of leading practices among eye and tissue banks; and
6. Contribute to the development of a strengthened and inter-provincial tissue community.

Eye and Tissue Banking in Canada: A Leading Practices Workshop
Survey summary for Part 3 Donor ID and referral
2012-02-08
2012-02-09
Canadian Blood Services The Planning Committee recommended the development of two surveys to inform the workshop, one for Canadian banks and one for international programs. Both surveys focused on identifying variance in practices among tissue and eye banks. This summary focuses on the areas of variation which will be discussed during this session; a full report of survey responses will be distributed after the workshop. The survey information will allow delegates to better understand Canadian and international practices, and will help shape future workshops facilitated by Canadian Blood Services.
Eye and Tissue Banking in Canada: A Leading Practices Workshop
Canadian and International Survey Responses: Part 4 – Specifications and Methodologies
2012-02-08
2012-02-09
Canadian Blood Services The Planning Committee recommended the development of two surveys to inform the workshop, one for Canadian banks and one for international programs. Both surveys focused on identifying variance in practices among tissue and eye banks. This summary focuses on the areas of variation which will be discussed during this session; a full report of survey responses will be distributed after the workshop. The survey information will allow delegates to better understand Canadian and international practices, and will help shape future workshops facilitated by Canadian Blood Services.
Call to Action 2012 Canadian Blood Services Where OTDT is concerned, we are at a tipping point in this country. This strategic plan marks a monumental effort on the part of the OTDT communities. It is an effort that has brought together dozens of agencies, groups and organizations with the sole purpose of realizing the potential of donation and transplantation to improve patient outcomes. The planning process has seen disparate groups and individuals strive and achieve remarkable consensus for the transformation of a vital component in Canada’s health care system. Yet this effort to reform OTDT is the latest of many and so stretches back more than a decade. As a result, it is an effort that may be the last for many of our country’s leading OTDT experts.
Report on the ethics consultation 2011 Canadian Blood Services In August 2008, Canadian Blood Services was given a mandate by the Conference of Deputy Ministers of Health to lead the development of an inter‐provincial /territorial strategy for organ and tissue donation and transplantation (OTDT) in Canada. As a result, Canadian Blood Services has been working in collaboration with the OTDT community to build an integrated strategy to deliver consistency, improve performance, and, most importantly, ensure more Canadians receive the organs and tissues they urgently need.

As an initial step in the development of this strategy, a national stakeholder consultation was held in September 2008 to determine how best to establish national, integrated services that would meet the needs of patients and the OTDT community. After a comprehensive and inclusive consultation process, one of the final steps was the hosting of an OTDT Ethics Consultation on January 20‐21, 2011.  
Report on the consultation: “Donation Physicians in a Coordinated OTDT System" 2011 Canadian Blood Services

The purpose of this meeting was to consult with international experts and key stakeholders regarding the proposed OTDT system design recommendation to formalize the donation physician role in health care centres in Canada. Objectives were to:


• Provide an overview of work to date on OTDT system design, ethical principles and strategy as a basis for informed discussions by consultation participants;
• Provide an overview of current policies and practices with respect to the role of donation physicians in Canada and internationally;
• Review and advise on the preliminary OTDT system design recommendation to formalize the role of donation physicians in clinical service, education, and research and innovation;
• Review the implications of Intensive Care Unit (ICU) bed and physician capacity with respect to the emerging recommendations;
• Provide information on current partners and explore potential partnerships in support of the development of the donation physician role;
• Explore sources of potential, real and perceived conflicts of interest in Canada and internationally, resulting from implementation of a donation physician role, and advise on mechanisms to explore strategies to mitigate conflicts that may arise.

Report on the ethics consultation 2011 Canadian Blood Services

The purpose of this meeting was to consult with key experts regarding ethical principles and related system design requirements to support the implementation and ongoing development of Canada’s proposed OTDT system. Objectives were: 


• To provide an overview of work to date on OTDT system design, ethical principles and strategy as a basis for informed discussions by consultation participants;
• To review and advise on proposed OTDT ethical principles for an integrated OTDT system for Canada;
• To discuss three key ethical issues identified in the proposed OTDT system design and make recommendations for accommodation in system design; and 
• To enable the continued development of a community of experts (stakeholders) with a commitment to ongoing dialogue about ethics in OTDT. 

OTDT Professional Survey 2011 Canadian Blood Services In the fall of 2010, Canadian Blood Services (CBS) proposed that a comprehensive opinion survey be undertaken to build on previous reports and information on healthcare professional’s awareness and attitudes toward organ and tissue donation and transplantation (OTDT).

The objective of this research was to establish timely information on professional opinion, attitudes and actions with regard to organ and tissue donation and transplantation.
Cost Benefit Analysis: Cornea Transplantation 2011 Canadian Blood Services

This document analyzes the costs and benefits associated with corneal transplantation.


Corneal damage and disease adversely impacts quality of life. According to the CNIB, those waiting for a corneal
transplant are generally suffering from vision loss or pain that “interferes with daily activities such as driving,
reading or working at a computer.”

• Pseudophakic bullous keratopathy, a complication of cataract surgery, which accounted for 28.5% of cases;
•  Deterioration of a previous graft necessitating a regraft (22.3%);
• Keratoconus;
• Fuchs’ dystrophy;
• Viral infection; and
• Trauma.

Cornea transplantation surgery is generally performed on an outpatient basis. Two types of transplant procedures can be performed:

• A penetrating keratoplasty (PK), where a damaged or diseased cornea is replaced in entirety with a donor graft; or
•  Lamellar (or non‐penetrating) keratoplasty, where the outer two‐thirds of the cornea is removed and replaced with donor cornea.

The technique of posterior lamellar keratoplasty (PLK) has been introduced relatively recently. Beauchemin et al (2010) showed that while success rates with PK were high and resulted in better visual acuity relative to PLK, transplant rates were limited by a shortage of corneal tissue and therefore, lengthy wait times from diagnosis to surgery. PLK, on the other hand, could be used only to treat epithelial corneal disease, but led to substantially lower rates of graft rejection, less astigmatism, fewer suture‐related complications and more rapid visual recovery (although not to the visual acuity level afforded by PK). In addition, tissue that was often not suitable for PK (i.e. tissue with anterior corneal damage) could be used for PLK. According to Beauchemin et al, PLK was less expensive ‘over a lifetime horizon’ compared to PK and also more effective, providing more quality‐adjusted life years (QALYs). The difference in QALYs was attributed to several different factors: lower wait times, shorter recovery times, substantially lower graft rejection rates and fewer suture‐related complications.

Intent to Donate - Environmental Scan 2011 Canadian Blood Services

Recognizing the need to improve the organ and tissue donation and transplantation (OTDT) system in Canada, the federal, provincial (except Quebec) and territorial governments in April 2008 asked Canadian Blood Services to take on new responsibilities related to OTDT.  This included the development of a strategic plan for an integrated OTDT system, in collaboration with the OTDT community.  As part of this work, three committees were formed – the Steering Committee, Organ Expert Committee and Tissue expert Committee – to help develop the recommendations through a formal, structured planning process.

This document is one of a series of background documents developed to help the committees in their discussions. These documents focused on the critical issues within the system, describing the current state and examining potential options and solutions. Conclusions from the committee discussions were consolidated and incorporated in the final recommendations of the final report.  The full report, Call to Action: A strategic plan to improve organ and tissue donation and transplantation performance for Canadians, can be found at organsandtissues.ca, along with the other background documents in this series. 

How can tissue donation be increased in Canada? 2011 Canadian Blood Services

Recognizing the need to improve the organ and tissue donation and transplantation (OTDT) system in Canada, the federal, provincial (except Quebec) and territorial governments in April 2008 asked Canadian Blood Services to take on new responsibilities related to OTDT.  This included the development of a strategic plan for an integrated OTDT system, in collaboration with the OTDT community.  As part of this work, three committees were formed – the Steering Committee, Organ Expert Committee and Tissue expert Committee – to help develop the recommendations through a formal, structured planning process.

This document is one of a series of background documents developed to help the committees in their discussions. These documents focused on the critical issues within the system, describing the current state and examining potential options and solutions. Conclusions from the committee discussions were consolidated and incorporated in the final recommendations of the final report.  The full report, Call to Action: A strategic plan to improve organ and tissue donation and transplantation performance for Canadians, can be found at organsandtissues.ca, along with the other background documents in this series. 

What role should surgical bone play in the Canadian tissue donation and transplantation system? 2011 Canadian Blood Services

Recognizing the need to improve the organ and tissue donation and transplantation (OTDT) system in Canada, the federal, provincial (except Quebec) and territorial governments in April 2008 asked Canadian Blood Services to take on new responsibilities related to OTDT.  This included the development of a strategic plan for an integrated OTDT system, in collaboration with the OTDT community.  As part of this work, three committees were formed – the Steering Committee, Organ Expert Committee and Tissue expert Committee – to help develop the recommendations through a formal, structured planning process.

This document is one of a series of background documents developed to help the committees in their discussions. These documents focused on the critical issues within the system, describing the current state and examining potential options and solutions. Conclusions from the committee discussions were consolidated and incorporated in the final recommendations of the final report.  The full report, Call to Action: A strategic plan to improve organ and tissue donation and transplantation performance for Canadians, can be found at organsandtissues.ca, along with the other background documents in this series. 

Organ and Tissue Donation and Transplantation (OTDT) Listing of Key Government Reports 2011 Canadian Blood Services

Recognizing the need to improve the organ and tissue donation and transplantation (OTDT) system in Canada, the federal, provincial (except Quebec) and territorial governments in April 2008 asked Canadian Blood Services to take on new responsibilities related to OTDT.  This included the development of a strategic plan for an integrated OTDT system, in collaboration with the OTDT community.  As part of this work, three committees were formed – the Steering Committee, Organ Expert Committee and Tissue expert Committee – to help develop the recommendations through a formal, structured planning process.

This document is one of a series of background documents developed to help the committees in their discussions. These documents focused on the critical issues within the system, describing the current state and examining potential options and solutions. Conclusions from the committee discussions were consolidated and incorporated in the final recommendations of the final report.  The full report, Call to Action: A strategic plan to improve organ and tissue donation and transplantation performance for Canadians, can be found at organsandtissues.ca, along with the other background documents in this series. 

How can the Canadian tissue donation and transplantation system best ensure consistent safety and quality? 2011 Canadian Blood Services

Recognizing the need to improve the organ and tissue donation and transplantation (OTDT) system in Canada, the federal, provincial (except Quebec) and territorial governments in April 2008 asked Canadian Blood Services to take on new responsibilities related to OTDT.  This included the development of a strategic plan for an integrated OTDT system, in collaboration with the OTDT community.  As part of this work, three committees were formed – the Steering Committee, Organ Expert Committee and Tissue expert Committee – to help develop the recommendations through a formal, structured planning process.

This document is one of a series of background documents developed to help the committees in their discussions. These documents focused on the critical issues within the system, describing the current state and examining potential options and solutions. Conclusions from the committee discussions were consolidated and incorporated in the final recommendations of the final report.  The full report, Call to Action: A strategic plan to improve organ and tissue donation and transplantation performance for Canadians, can be found at organsandtissues.ca, along with the other background documents in this series. 

For recovery and processing,  what is the best balance between domestic and imported tissue? 2011 Canadian Blood Services

Recognizing the need to improve the organ and tissue donation and transplantation (OTDT) system in Canada, the federal, provincial (except Quebec) and territorial governments in April 2008 asked Canadian Blood Services to take on new responsibilities related to OTDT.  This included the development of a strategic plan for an integrated OTDT system, in collaboration with the OTDT community.  As part of this work, three committees were formed – the Steering Committee, Organ Expert Committee and Tissue expert Committee – to help develop the recommendations through a formal, structured planning process.

This document is one of a series of background documents developed to help the committees in their discussions. These documents focused on the critical issues within the system, describing the current state and examining potential options and solutions. Conclusions from the committee discussions were consolidated and incorporated in the final recommendations of the final report.  The full report, Call to Action: A strategic plan to improve organ and tissue donation and transplantation performance for Canadians, can be found at organsandtissues.ca, along with the other background documents in this series. 

How can the tissue donation and transplantation system best ensure that supply aligns with demand? 2011 Canadian Blood Services

Recognizing the need to improve the organ and tissue donation and transplantation (OTDT) system in Canada, the federal, provincial (except Quebec) and territorial governments in April 2008 asked Canadian Blood Services to take on new responsibilities related to OTDT.  This included the development of a strategic plan for an integrated OTDT system, in collaboration with the OTDT community.  As part of this work, three committees were formed – the Steering Committee, Organ Expert Committee and Tissue expert Committee – to help develop the recommendations through a formal, structured planning process.

This document is one of a series of background documents developed to help the committees in their discussions. These documents focused on the critical issues within the system, describing the current state and examining potential options and solutions. Conclusions from the committee discussions were consolidated and incorporated in the final recommendations of the final report.  The full report, Call to Action: A strategic plan to improve organ and tissue donation and transplantation performance for Canadians, can be found at organsandtissues.ca, along with the other background documents in this series. 

How can the proposed system ensure the traceability of tissue products? 2011 Canadian Blood Services

Recognizing the need to improve the organ and tissue donation and transplantation (OTDT) system in Canada, the federal, provincial (except Quebec) and territorial governments in April 2008 asked Canadian Blood Services to take on new responsibilities related to OTDT.  This included the development of a strategic plan for an integrated OTDT system, in collaboration with the OTDT community.  As part of this work, three committees were formed – the Steering Committee, Organ Expert Committee and Tissue expert Committee – to help develop the recommendations through a formal, structured planning process.

This document is one of a series of background documents developed to help the committees in their discussions. These documents focused on the critical issues within the system, describing the current state and examining potential options and solutions. Conclusions from the committee discussions were consolidated and incorporated in the final recommendations of the final report.  The full report, Call to Action: A strategic plan to improve organ and tissue donation and transplantation performance for Canadians, can be found at organsandtissues.ca, along with the other background documents in this series. 

Organ and Tissue Donation and Transplantation Legislative and Legal Framework 2011 Canadian Blood Services

Recognizing the need to improve the organ and tissue donation and transplantation (OTDT) system in Canada, the federal, provincial (except Quebec) and territorial governments in April 2008 asked Canadian Blood Services to take on new responsibilities related to OTDT.  This included the development of a strategic plan for an integrated OTDT system, in collaboration with the OTDT community.  As part of this work, three committees were formed – the Steering Committee, Organ Expert Committee and Tissue expert Committee – to help develop the recommendations through a formal, structured planning process.

This document is one of a series of background documents developed to help the committees in their discussions. These documents focused on the critical issues within the system, describing the current state and examining potential options and solutions. Conclusions from the committee discussions were consolidated and incorporated in the final recommendations of the final report.  The full report, Call to Action: A strategic plan to improve organ and tissue donation and transplantation performance for Canadians, can be found at organsandtissues.ca, along with the other background documents in this series. 

Utilization and cost of procurement of skin, cardiac and vascular allografts and allograft products (June 2010) 2010 Canadian Blood Services The following report provides a detailing of the utilization and allograft costs for burn treatment, paediatric cardiac surgery, and adult cardiac and vascular surgery in Canada with the exception of Québec. Hospitals in Québec were not included in this project because Québec has an independent tissue system managed by Héma-Québec. The purpose of this project was to determine utilization and cost of procurement within the remaining Canadian jurisdictions. 
Supply of human allograft tissue 2010 Canadian Blood Services The purpose of the National Survey for Supply of Human Allograft Tissue in Canada was to quantify the current supply of allograft tissue from Canadian tissue banks and to collect information on the characteristics and capabilities of these banks. Information was requested on tissue bank functions, donor activity, tissue recovery, processing and distribution activity, staffing, transmissible-disease testing, ancillary support and funding. The scope of this survey included human allograft bone, soft tissue, cardiovascular, skin, and ocular tissues. In addition to the supply survey work, interviews were conducted with representatives from Canadian tissue programs to obtain information on the programs’ governance structure, roles and responsibilities, partnerships, strategic priorities, and funding models, as well as their end-user interactions. Quebec tissue banks, which are managed by Héma-Québec, were not included in the scope of the survey or in the interview
process.
Canadian imported surgical & dental allograft, allograft substitute, & acellular dermal matrix study 2010 Canadian Blood Services The following report uses a number of methodologies to gather and present data and analysis. At the outset, a large survey of secondary sources is conducted. These sources act as the basis for the primary research stage, which builds and enhances the quantitative and qualitative attributes of the early research.
Demand for ocular tissue in Canada 2010 Canadian Blood Services In 2009, Canadian Blood Services prepared and distributed the National Survey for Demand of Ocular Tissue. The goal of the survey was to obtain information on the demand for ocular tissue allografts and on importation practices in Canada. A total of seven programs involved with recovery, processing and distribution of ocular tissue completed the survey. The findings from the survey capture the demand and usage of ocular tissue in all Canadian provinces with the exception of Quebec.   
Views Toward Organ and Tissue Donation and Transplantation (Public Survey) 2010 Canadian Blood Services The study consisted of a quantitative telephone survey with an average length of 13.5 minutes, administered to provide a nationally representative sample of n=1,500 randomly selected Canadians, 18 years and older. The margin of error for a sample this size is ± 2.5 percentage points, 19 times out of 20. The margins of error for regional, demographic, and attitudinal subsamples are higher. The study was conducted in English and French between March 24 and March 30, 2010.

This study references tracking from three previous surveys conducted by another research supplier, where appropriate. Each of the previous surveys was conducted nationally by phone, including a survey of: 1,505 Canadians between August 17 and September 7, 2005; 1,514 Canadians between April 29 and May 6, 2002; 1,516 Canadians between October 10 and 15, 2001.
Improvement through collaboration: A reference guide for teams In organ and tissue donation 2007 Canadian Council for Donation and Transplantation A reference guide for teams In organ and tissue donation.
Enhancing tissue banking in Canada. Phase II: Surveillance and traceability in tissue transplantation (June 2007) 2007 Canadian Council for Donation and Transplantation The purpose of this workshop was to consult with stakeholders in the transplant community regarding possible future options for surveillance and traceability in tissue transplantation in Canada.
Human tissue importation practices in Canada 2006 Canadian Council for Donation and Transplantation Through previous work with the Canadian Institute for Health Information in 2003, the Canadian Council for Donation and Transplantation (CCDT) identified a supply-demand gap in Canada for certain types of human allograft tissues.

In January 2006, the CCDT chose to investigate and analyze current human tissue importation practices in Canada in order to gain a better understanding of the “unknown supply” required to meet tissue demand. 
Market evaluation of demineralized bone matrix products in Canada 2006 Canadian Council for Donation and Transplantation The Canadian Council for Donation and Transplantation (CCDT) initiated a study to characterize the use of DBM products in Canada through quantitative market research.

The study methodology consisted of two main components: 

1) An end user survey of dentists, periodontists, oral and maxillofacial surgeons and hospital or operating room managers at hospitals with orthopaedic surgeons and neurosurgeons to obtain primary data on DBM utilization and purchasing; and
2) An industry analysis to characterize the types of organizations producing DBM products, the range of product types, how DBM products are entering the Canadian market, utilization of DBM products by end users, and a Canadian market size estimate.
Tissue banking innovation practices 2006 Canadian Council for Donation and Transplantation

The Canadian Council for Donation and Transplantation (CCDT) initiated the following evaluation of current innovations in technology and surgical practice that utilize human tissue substitutes for their potential impact on tissue supply and demand in Canada. This study is also intended to assist the CCDT in the development of a framework for systematic and sustainable tissue banking services. 


A literature review of current innovations and the development of innovation assessments were performed for the following areas:

• Artificial Cartilage,
• Corneal Tissue,
• Gene Therapy and Stem Cells in Orthopaedics,
• Hip Resurfacing,
• Artificial Skin and Wound Healing,
• Artificial Tendons, and
• Vascular and Pericardial Tissue: Bovine and Synthetic Options.

Enhancing tissue banking in Canada. Phase 1: Sustainability 2007 Canadian Council for Donation and Transplantation The purpose of the Task Force on Enhancing Tissue Banking (ETB) in Canada is to engage stakeholders in a collaborative process that will result in an issues-based approach to strategic action aimed at enhancing tissue-banking sustainability. This will improve access to and quality of tissue for patients as well as instill greater public confidence in the tissue system. 
Kidney allocation survey of the informed public 2007 Canadian Council for Donation and Transplantation The Canadian Council for Donation and Transplantation (CCDT), through its Kidney Allocation Steering Committee, is working to develop recommendations for an allocation model that is acceptable, useful and adaptable within unique regions across Canada.  The CCDT is a national, not-for-profit organization mandated to provide the Federal/Provincial/Territorial Conference of Deputy Ministers of Health (CDM) with advice on organ and tissue donation and transplantation in Canada.  
The allocation of organs: Emerging legal issues 2006 Canadian Council for Donation and Transplantation In this paper, we discuss important legal and ethical issues that arise in the context of organ allocation. First, we provide an overview of ethical principles of justice and equity and describe how these goals may conflict in transplantation decisions. Next, we discuss legal issues in health care resource allocation, focusing on potential legal challenges that may arise in efforts to prioritize organ recipients. We summarize various potential grounds for legal challenges, including violation of anti-discrimination laws and malpractice lawsuits. Finally, we comment on public engagement and education in developing allocation criteria and emerging strategies to increase the supply of available organs. 
Deceased donor kidney allocation in the US, Europe, Australia, and New Zealand 2006 Canadian Council for Donation and Transplantation Fueled by the growing patient waiting lists and relative lack of donors, the allocation of deceased donor kidneys is a subject of much current debate.  In the early years of kidney transplantation, the prevailing opinion in the transplantation community was that HLA matching was of prime importance, and most allocation schemes were heavily weighted toward close matching.  With the passage of time and the introduction of better immunosuppression, other factors are being considered and given greater importance.  All the recipient and donor characteristics relevant for kidney allocation are listed in Table 1.  Other issues that may be considered include logistic factors such as cold ischemia time and the balance between organ supply and demand in a given area.  
Extended criteria kidney donors: Benefits, risks, and optimal use 2006 Canadian Council for Donation and Transplantation It has been clear for many years that kidney transplantation offers an improved quality of life as compared to dialysis for selected patients with end stage renal disease. However, in 1999, Wolfe and others circumvented this problem by comparing survival in transplanted patients with those on dialysis who were selected for the waiting list.  They showed that while survival in the immediate post transplant period was worse for transplant recipients, by about 3 months post transplantation, survival was equal, and over the long term, survival was significantly better for those individuals receiving transplants.  Subsequently, Fenton et al, using a large Canadian database confirmed these findings and emphasized that they were true for older patients as well as diabetics and also for patients with one or two significant comorbidities, providing they were selected for the transplant list.  While a potential problem with these analyses was the failure to censor patients if they were placed on hold on the waiting list, and the potential bias, since selection of the recipient was up to the physician or surgeon, Vandewoude and colleagues utilized a European database with computer allocation of organs and censoring of patients when placed on hold and were once again able to demonstrate a very significant survival benefit associated with transplantation.  As a result of these studies, and continually improving outcomes in transplantation, very appropriately, more patients are being referred for consideration of transplantation, waiting lists are increasing while the number of deceased donor organs is static, and as a result, waiting time for transplantation is increasing significantly.  The negative impact of this increase in waiting time is emphasized by the data of Meier-Kriesche et al showing that longer waiting times on dialysis are associated with significant reductions in post transplantation survival. 
HLA matching and sensitization in kidney transplantation 2006 Canadian Council for Donation and Transplantation

In recent years the growing shortage of donor organs coupled with improvements in immunosuppressive therapy and recognition of the effect of prolonged cold ischemic time on graft survival, has led to a call for re-evaluation of the benefits derived from HLA matching. The first part of this paper will focus on a review of the evidence for or against the continued practice of prioritizing allocation of deceased donor kidneys on the basis of HLA matching.


While the benefits of HLA matching have been recognized over the years, the negative impact of HLA sensitization has also been noted. Indeed, the fact that most programs, up until lately, have considered a positive cross-match a contraindication to transplantation is evidence of the community’s limited ability to overcome this barrier. Recognition that sensitized individuals have a more restricted pool of acceptable donors has resulted in kidney allocation protocols assigning additional points to patients who are highly sensitized. In the second part of this paper, the impact of this approach will be reviewed to determine if there is evidence for ongoing support of this practice or whether the practice goes far enough in creating equity of access for this disadvantaged group. 

Donor and recipient age and the allocation of deceased donor kidneys for transplantation 2006 Canadian Council for Donation and Transplantation The most pressing problem facing kidney transplantation today is the donor organ shortage. Since mortality is reduced by transplantation, death on the waitlist can be viewed as a direct consequence of the shortage of kidney donors. Socioeconomic and ethnic inequities in the allocation of kidneys for transplantation are also unfortunate consequences of the growing donor organ shortage. Many transplant programs have addressed the donor shortage by increasing the use of living donors. However, another strategy has been to expand the criteria for accepting deceased donor kidneys for transplantation.  
Kidney pancreas allocation 2006 Canadian Council for Donation and Transplantation

Aim: To provide an evidence-based rationale to pancreas allocation that will increase overall outcomes without disadvantaging other patients needing an organ transplant.  


In order to provide a framework for a discussion on allocation a review of candidate eligibility, transplant options, current activity status and current allocation practice is presented below.   

Prioritization for kidney transplantation due to medical urgency 2006 Canadian Council for Donation and Transplantation Policies guiding the allocation of deceased donor kidneys for transplantation were developed in the context of available alternative therapy for end-stage renal disease (ESRD), namely dialysis. For decades, there was no evidence demonstrating a clear survival benefit between dialysis or kidney transplantation. Rather the major benefits of transplantation were improved quality of life, avoidance of dialysis-related complications, and cost-effectiveness. Priority allocation of kidneys based on medical urgency has historically been limited to those patients developing severe uremic complications despite optimal dialysis or where dialysis could no longer be reliably performed.  
Waiting time for transplantation 2006 Canadian Council for Donation and Transplantation

Ensuring equitable access to solid organ transplantation while maintaining utility is the goal of organ allocation.


Equity can be defined as fairness in access to transplants for all those in need. Equity is difficult to achieve and some patients will always be disadvantaged (i.e., those with uncommon blood types or who are broadly sensitized). In the current era, in which the demand for transplantation far exceeds the supply of transplantable organs, equity is maximized when organs are allocating according to waiting time. 

Summative evaluation – Executive summary and management response 2007 Canadian Council for Donation and Transplantation In 2006, an external summative evaluation was conducted. The purpose of the evaluation, conducted by Barrington Research Group Inc., was to determine the impact and outcomes of the CCDT during its initial mandate.
CCDT summative evaluation final report 2006 Canadian Council for Donation and Transplantation The purpose of this evaluation was to explore the development and implementation processes of the CCDT during its first mandate and to evaluate the outcomes resulting from these processes.
Appendixes for CCDT summative evaluation final report 2006 Canadian Council for Donation and Transplantation Appendixes (December 2006) for CCDT summative evaluation final report.
Evaluation of surgical bone banking and utilization in Canada 2006 Canadian Council for Donation and Transplantation The Canadian Council for Donation Transplantation (CCDT) commissioned an evaluation of surgical bone banking in Canada in order to:

1. Attempt to determine the number of surgical bone banks and their tissue volumes not identified in previous CCDT work,
2. Obtain a sense of surgical bone potential,
3. Obtain a sense of the actual donation rates of surgical bone,
4. Identify and analyze key issues in surgical bone banking, and
5. Provide a high level cost benefit analysis of surgical bone banking.
Appendixes for Evaluation of surgical bone banking and utilization in Canada 2006 Canadian Council for Donation and Transplantation Appendixes (September 2006) for Evaluation of surgical bone banking and utilization in Canada.
Health professional awareness and attitudes on organ and tissue donation and transplantation 2006 Canadian Council for Donation and Transplantation The goal of the survey was to understand health professional’s personal beliefs and attitudes regarding organ and tissue donation and transplantation and, in particular, DCD. The results will be used to formulate advice to the CDM regarding the potential implementation of DCD in Canada.
Summary report 2006 Canadian Council for Donation and Transplantation The Canadian Council for Donation and Transplantation (CCDT) with the use of a web-based survey tool, surveyed healthcare professionals who were members of ten specific health professional organizations on awareness, attitudes and behaviours related to organ and tissue donation, including the issue of donation after cardiocirculatory death. Healthcare professionals were able to access the survey online from November 28, 2005 until February 1, 2006 and upon completion there were a total of 720 completed (624) and partially (96) completed surveys. 
Tissue donation potential beyond acute care 2006 Canadian Council for Donation and Transplantation As a preliminary step, the DPBAC Steering Committee assessed the current potential for donation beyond acute care in Canada and found such potential to be viable.  The Steering Committee then desired an environmental scan be conducted to determine strategies for realizing this potential in the “pre-hospital/in the field” environment, such as the home, scene of a motor vehicle accident, or in the emergency department prior to admission.  The focus of the scan was on the following professional groups:  paramedics, emergency department staff, coroners/medical examiners, and funeral home directors.   A targeted literature search and interviews with stakeholders in these professional groups was undertaken to collect information on current practices, issues and barriers, and possible solutions that would facilitate donation.
This document is the final report of the DPBAC environmental scan. 
Faith perspectives on organ and tissue donation and transplantation 2006 Canadian Council for Donation and Transplantation The forum brought together an unprecedented array of religions, a gathering which was a first in Canada for this topic. The forum was an opportunity for the faith representatives to learn more about the topic, and to look at the challenges that they face in promoting organ and tissue donation within their faith communities. 
Brain blood flow in the neurological determination of death 2006-11-16 Canadian Council for Donation and Transplantation

The Expert Consens Meeting on Brain Blood Flow (BBF) in the Neurological Determination of Death was held in Montréal, Québec, on Thursday, November 16, 2006. Sponsored by the CCDTR, it brought together 17 participants and speakers from across Canada. The meeting had the following objectives:


• To determine the distinction between tests of intracerebral blood flow, brain blood flow, intracranial blood flow, and brain perfusion;
• To determine which tests of blood flow and perfusion are acceptable for NDD and to provide recommendations on preferred tests;
• To establish minimal standards for technology, technologist, and interpreter expertise;
• To address issues of clinical critiria and ancillary testing that were not fully articulated by the 2003 CCDT NDD recommendations; and
• To identify important areas of research in ancillary testing for the NDD.

Kidney allocation in Canada: A Canadian forum 2006-10-25
2006-10-26
2006-10-27
The Canadian Council for Donation and Transplantation The Canadian forum, Kidney Allocation in Canada, brought together stakeholders responsible for kidney allocation in their jurisdictions to discuss and develop consensus recommendations for allocation. The aim of the forum was to develop a step-by-step decision-making model that is acceptable, useful, and adaptable within unique regions across the country. This aim was successfully achieved by interactive group work at the forum. The participants acknowledged that acceptance and implementation of a kidney allocation model would require thoughtful implementation strategies and must recognize the unique needs of regions, programs and health-care professionals. 
Potential Ancillary Tests in the Evaluation of Brain Death: The Value of Cerebral Blood Flow Assessment 2006-10-10 Manraj Kanwal Singh Heran,
Navraj Singh Heran
Brain death. The very concept has stirred much debate for decades. Referred to as "coma depasse" (beyond coma) by Mollaret and Goulon in 1959, the first formalized definition of brain death was by the Ad Hoc Committee of the Harvard Medical School in 1968. Since then, there has been a greater understanding of neuronal function and mechanisms of brain cell injury, with the emergence of a concept of "death of the person rather than the body", as described by Bonetti. Brain death is now considered as complete and irreversible loss of brain function, or as the Canadian Neurocritical Care Group defined it in 1999, "the irreversible loss of the capacity for consciousness combined with the irreversible loss of all brainstem functions including the capacity to breathe". Article, such as those by Baron and Bernat, nicely review the concept of brain death, as well as discuss continuing areas of controversy, such as whole-brain death versus death of the brain stem. As modern medicine can now allow survival of an individual in situations once considered hopeless, knowing the evolution of the concept of brain death is important in order to keep perspective on the person, rather than the body.
Enhancing Living Donation: A Canadian Forum 2006-02-09
2006-02-10
2006-02-11
2006-02-12
Canadian Council for Donation and Transplantation The CCDT has hosted five forums to consult with health professionals and other stakeholders on best practices that can inform recommendations to the Conference of Deputy Ministers of Health (a list of these forums can be found in Appendix 8). This sixth forum, Enhancing Living Donation, was an exciting opportunity to bring together stakeholders in living donation to develop recommendations related to this area. A variety of factors (such as the increase in organ wait-lists and the “plateauing” of the number of both deceased and living donors) means a significant number of people are dying while waiting for an organ. We hope that initiatives such as this forum will make a vital contribution to finding new ways to help potential organ recipients. 
A Review of the Economic Implications of Living Organ Donor Donation: Donor Perspectives and Policy Considerations 2006-01-16 Canadian Council for Donation and Transplantation A Review of the Economic Implications of Living Organ Donor Donation: Donor Perspectives and Policy Considerations.
Environmental Scan of Live Organ Donation Programs 2006-01-01 Canadian Council for Donation and Transplantation Environmental Scan of Live Organ Donation Programs.
Living Donor Liver Transplantation Overview 2006-01-01 Canadian Council for Donation and Transplantation Living Donor Liver Transplantation Overview.
Living Organ Donation: Consent Challenges 2006-01-01 Canadian Council for Donation and Transplantation Living Organ Donation: Consent Challenges.
Medical Risks of Becoming a Living Kidney Donor – What is known and what needs to be known 2006-01-01 Canadian Council for Donation and Transplantation Medical Risks of Becoming a Living Kidney Donor – What is known and what needs to be known.
Psychosocial Aspects of Living Organ Donation 2006-01-01 Canadian Council for Donation and Transplantation Psychosocial Aspects of Living Organ Donation.
The Risks of Living Lung Donation 2006-01-01 Canadian Council for Donation and Transplantation The Risks of Living Lung Donation.
Public awareness and attitudes on organ and tissue donation and transplantation 2005 Canadian Council for Donation and Transplantation To augment the recommendations of this forum, the CCDT also sought to understand the views of the public and health professionals in relationship to DCD. Environics Research Group Limited was retained to conduct survey research among the Canadian public to examine current awareness, knowledge, and attitudes towards organ and tissue donation, including donation after a cardiac death.

The goals of the public opinion survey were:
• To provide insight into the awareness, knowledge and attitudes in general toward organ and tissue donation among Canadians;
• To provide insight into possible strategies to increase awareness of donation among the Canadian public;
• To explore Canadians’ awareness, knowledge and attitudes toward donation after cardiac death.
Data tables – Supplement report 2005 Canadian Council for Donation and Transplantation CCDT Public Opinion Survey.
Summary report 2005 Canadian Council for Donation and Transplantation Environics Research Group Limited was retained by Canadian Council for Donation and Transplantation to survey the general public on awareness, attitudes and behaviours related to organ and tissue donation, including the issue of donation after cardiac death. Environics surveyed 1,505 Canadian adults by telephone from August 17 to September 7, 2005. The margin of error for samples of this size is plus or minus 2.5 percentage points, 19 times in 20. 
Canadian highly sensitized patient and living donor paired exchange registries 2005 Canadian Council for Donation and Transplantation The CCDT “Highly Sensitized Patient and Living Donor Paired Exchange Registries” Task Force examined current practices, literature and new technologies for the establishment of Canadian Registries for (a) the highly sensitized patient awaiting a kidney transplant on the deceased donor wait-list; and (b) those patients who, due to human leukocyte antigen (HLA) or ABO incompatibilities, are unable to accept a kidney from a living donor who is otherwise willing and able to donate. This is Phase I of a two phase process. 
Section I: Full report of consultation 2005 Canadian Council for Donation and Transplantation In May 2004, the CCDT hired a consultant to undertake the development of a Diverse Communities Consultation to identify and discuss issues affecting organ and tissue donation and the development of key considerations and related recommendations. The purpose of the consultation was to identify and understand the unique perspectives on organ and tissue donation of people from three diverse backgrounds.

The objectives for the consultation were to:
• Develop methods for government, donor programs and stakeholders to work together for the support of communities in:
• Understanding and learning about donation and transplantation;
• Determining changes that would assist communities in receiving information in a culturally appropriate way; and
• Assessing what can be done to augment the existing systems to ensure that communities are supported from within.
• Establish a set of principles (key considerations) or a model for use in each Federal/Provincial/Territorial (FPT) jurisdiction in Canada as they develop specific strategies for communicating information relative to organ and tissue donation.
• Consider current values and beliefs about organ and tissue donation in selected diverse communities.
• Assist people in considering organ and tissue donation and signifying their intent by providing them with information that is appropriate for their community.
Section II: Chinese-Canadian community 2005 Canadian Council for Donation and Transplantation

The Toronto consultation focused on the Chinese-Canadian community.  Toronto was chosen as the place for consultations with the Chinese Community because of the extremely diverse nature of the place for consultations with the Chinese Community because of the extremely diverse nature of the city and the large Chinese population. This diversity in itself presents many challenges in terms of organ and tissue donation.  There is a real need to understand the variety of perspectives on organ and tissue donation and transplantation and identify both opportunities and barriers to increasing donation rates. The Chinese community is considered a priority for the consultations because there are a large number of people waiting for transplants, while the rate of donation is low.  The typical waiting time for a kidney transplant within the Chinese community in Toronto is eight years.


The overall objectives for the Toronto consultations were:
1. Identify stated beliefs and views about organ and tissue donation in the Chinese-Canadian community.
2. Identify processes that work for engaging Chinese-Canadians on the topic of donation and transplantation.
3. Consider partnerships between local Chinese cultural groups and the local donation and/or transplant program.

Section III: South-Asian community 2005 Canadian Council for Donation and Transplantation

The Vancouver and Lower Mainland consultation is part of a national Diverse Communities Consultation of the Canadian Council on Donation and Transplantation (CCDT). A total of four consultations took place during the fall and winter of 2004/2005, including the Chinese community in Toronto, Aboriginal communities in Winnipeg and Saskatoon and this consultation in BC. Each consultation was guided by three objectives:


1. To identify beliefs and views about organ and tissue donation
2. To identify processes for engaging ethnocultural groups on the topic of donation and transplantation
3. To consider partnerships between the ethnocultural groups and the local donation and transplantation program.

Section IV: Indigenous Peoples’ dialogue 2005 Canadian Council for Donation and Transplantation To understand the views and beliefs of Indigenous Peoples, we asked them, in a respectful way, to share their views about organ and tissue donation and transplantation.  On the advice of several First Nations people about what the most respectful way would be, The CCDT Ethnocultural Steering Committee convened two Elders’ and Traditional Knowledge Keepers’ Circles; one in Winnipeg and one in Saskatoon.  The aims of the Circles were to identify the range of beliefs and attitudes that may influence Indigenous Peoples when considering donation; to advise on a successful model for respectful dialogue with Indigenous Peoples; and to start or support a partnership between the Indigenous Peoples and the local donation and transplant programs. 
Planning public awareness and education initiatives to promote organ and tissue donation (August 2005) 2005 Canadian Council for Donation and Transplantation

The need to engage individual Canadians, through public awareness and education initiatives, is one of the keys to improving consent levels and donation rates in Canada. However, public opinion polls have consistently demonstrated that high support for organ and tissue donation does not translate to an increase in donors. 


Canadians can adopt the following actions to improve the “supply” side of the donation equation:
• As a potential donor, confirm the individual’s decision to donate (intent) by adopting one or both of the following behaviours:
– Signing or registering.
– Letting family members know of the decision to donate.
• As a family member, be prepared to receive a request and respect the decision of the deceased person when the request is made (consent).
• Living donation.

The Guide for Planning Public Awareness and Education Initiatives to Promote Organ and Tissue Donation is a practical resource for donation stakeholders working at all levels. The guide was developed with the knowledge that most Canadian donation stake-holders have limited financial resources dedicated to public awareness.  

Assessment and management of immunologic risk in transplantation 2005 Canadian Council for Donation and Transplantation The CCDT Forum, Assessment and Management of Immunologic Risk in Transplantation, was conceived as a vehicle to examine current practices, literature and new technologies for the assessment of HLA antibodies pre-transplant with the goal of being able to develop recommendations on best practices. The improved measurement of the immunologic risk profile of potential transplant recipients is the first step towards improving organ allocation, addressing the needs of sensitized individuals, optimizing the use of new drugs and generally working towards improved graft survival rates.
Donation after cardiocirculatory death: A Canadian forum 2005-02-17
2005-02-18
2005-02-19
2005-02-20
Canadian Council for Donation and Transplantation There are two fundamental but not mutually exclusive perspectives on organ donation:
• As an important part of end-of-life care, patients who die should be provided the opportunity to donate organs and tissues.
• Potential transplant recipients, who would otherwise die or be substantially compromised, can benefit from initiatives that address the current shortage of organs for transplantation.

Current Canadian practice supports organ donation after death as determined by neurological criteria and tissue donation after death determined by cardiocirculatory criteria. However, contrary to international practice and historical practice in Canada prior to brain death criteria, organ donation after cardiocirculatory death has not been offered to dying patients in Canada and is not available to families who request it. Reflecting these perspectives, the Canadian transplant and donation communities have called for the establishment of this form of donation.
Estimating potential tissue donors in Canada from 1995-2000; An exploratory analysis based on acute care hospital admissions data 2004 Canadian Council for Donation and Transplantation The purpose of this report is to provide a current estimation of tissue donor potential for Canada for the period of 2005-2008. It is an update of the original 2004 study, Estimating potential tissue donors in Canada from 1995-2000: An exploratory analysis based on acute care hospital admissions data, commissioned by the Canadian Council for Donation and Transplantation (CCDT) and conducted by the Canadian Institute for Health Information (CIHI). 
Medical management to optimize donor organ potential: A Canadian forum 2004-02-23
2004-02-24
2004-02-25
The Canadian Council for Donation and Transplantation The mandate of the Canadian Council for Donation and Transplantation (CCDT) is to strengthen Canada’s donation and transplantation system through advice to the Federal, Provincial and Territorial (FPT) Conference of Deputy Ministers of Health. The CCDT Donation Committee took an initial step in this strategy by holding the Forum Severe Brain Injury to Neurological Determination of Death in April 2003. This Forum developed recommendations for a national agreement on the processes of care, commencing with severe brain injury and culminating with neurological determination of death, including standard diagnostic criteria and procedures across all age groups. The final report on this initiative was released in December 2003. 
Demand for human allograft tissue in Canada: Integrating dental industry demand 2003 Canadian Council for Donation and Transplantation The purpose of this study:
• To estimate Current Demand for human allograft tissue (cancellous, demineralized and mineralized bone, structural bone, skin, soft tissue) in Canada by the Dental Industry;
• To predict demand for allograft tissue in Canada by the Dental Industry;
• To investigate common dental procedures using allograft tissue, factors affecting Dental Industry demand; and,
• To evaluate demand by the Canadian Dental Industry in relation to non-dental demand and Known Supply.
Human tissue banking in Canada: Costing and economic analysis final report 2003 Canadian Council for Donation and Transplantation The overall purpose of this study is to develop for the Canadian Council for Donation and Transplantation, a more comprehensive understanding of the costs and economics of operating tissue banks in Canada. To achieve this objective, it is necessary to convey an accurate picture of the types and magnitudes of all costs that Canadian tissue banks incur, as many costs are hidden in global hospital budgets, and many services are provided free of charge by the hospitals in which the tissue banks reside. It is also important to understand how Canadian tissue bank cost structures compare with those of American tissue banks, as many Canadian tissue banks and hospital operating rooms rely on purchasing imported tissue to meet demand. Fees for US tissue fees are often sharply higher than those paid to other Canadian tissue banks. Many tissue banks in Canada are only now beginning to develop fee structures.  
Demand for human allograft tissue in Canada 2003 Canadian Council for Donation and Transplantation This document represents the CCDT Project 4.1 deliverable of “Demand for Human Allograft Tissue in Canada—Final Report”. The Demand study has focused on a range of key users of allograft tissue in Canada (primarily surgical specialists), their product preferences, and predicted use of tissue in the future.

The purpose of this study is:
• to estimate the Current Demand for human allograft tissue (bone, tendons, soft tissue, cardiovascular, ocular and skin) in Canada;
• to estimate predicted demand for allograft tissue in Canada;
• to investigate common procedures using allograft tissue, factors affecting demand; and
• to consider demand in context with Known Supply.
Supply of human allograft tissue in Canada 2003 Canadian Council for Donation and Transplantation The CCDT Project 4.1 is considered a foundation phase to document the “lay of the land” with regard to Canadian tissue banking and related activities, as they exist today. These initiatives will position the CCDT Tissue Committee to identify areas of focus for future initiatives deemed necessary to gather the additional data and information required to recommend an appropriate Canadian model.

This report, Supply of Human Allograft Tissue in Canada, is a deliverable for the CCDT Project 4.1. The findings of the Supply study are presented in this report in three major sections:
• Supply Survey of Known Tissue Banks,
• Key Informant Interviews, and
• Estimation Methods of Canadian Tissue Supply from Unknown Sources.
Severe brain injury to neurological determination of death: A Canadian forum  2003-04-09
2003-04-10
2003-04-11
Canadian Council for Donation and Transplantation The purpose of the Forum "Severe Brain Injury to Neurological Determination of Death" (SBINDD) was to initiate the development of a national agreement on the processes of care, commencing with severe brain injury and culminating with neurological determination of death (NDD). A priori, the Forum accepted brain death as a medical and legal concept of death in Canadian society and restricted the discussion to optimal practice in the field. Objectives were:
1. To review global and Canadian legislation, polices and practices related to NDD.
2. To create a made-in-Canada definition of NDD for children and adults to ensure consistency and reliability in its diagnosis, declaration, documentation and reporting.
3. To discuss and agree on policies and practices in relation to Emergency Department (ED), Neurological/Neurosurgical and Intensive Care Unit (ICU) management of critically injured patients with poor neurological prognoses.
4. To develop recommendations to the Canadian Council for Donation and Transplantation (CCDT) and other interested organizations and groups on the dissemination of these definitions, policies and practices across Canada.
Legal Foundations for the Neurological Determination of Death 2003-04-09
2003-04-10
2003-04-11
Canadian Council for Donation and Transplantation Overview of the status of legislation in Canada and selected jurisdictions on the determination of death. It does not investigate the advantages and disadvantages of embodying in law a definition of death and neurological determination of death. This paper examines the status of legislation on the definition of death and its determination in Canada, select Commonwealth nations and the United States. This paper is predicated upon the assumption that the definition of death is irreversible cessation of all functions of the entire brain including the brainstem and that the validity of this definition is incontrovertible.
Factors Affecting Referral of Severely Brain Injured Patients to Critical Care for Prognostication and Treatment 2003-04-09
2003-04-10
2003-04-11
Canadian Council for Donation and Transplantation, Paul Tomlinson Donation is the critical antecedent to providing life-saving transplantation for individuals with end-stage organ failure. Strategies to increase donation rates are numerous and reflect, in part, the complex nature of the health care system combined with societal factors in which the system operates. Several factors, including formal policies by professional societies, may affect the course of treatment for the severely brain-injured. These factors include the following:
• the potential desire of family members to avoid highly intensive intervention for a loved one who has life-threatening injuries in order to facilitate the best quality of death
• the ethical imperatives of physicians that entail acting in the best interests of the patient. Such imperatives may result in the reduction of withdrawal of life-support technology in intensive care, followed by patient death as determined by cardiopulmonary criteria
• policies and guidelines for admission to the intensive care unit (ICU) that reify the goals of critical care as the prevention of unnecessary suffering and premature death through treatment of reversible illnesses or injury for an appropriate period of time
• failure to refer patients to intensive care for prognostication and treatment because they are perceived to be too seriously ill to benefit from treatment
• triage of admission to the ICU because of scarcity of resources such as beds or staff
A Review of the Literature on the Determination of Brain Death: Full version 2003-04-09
2003-04-10
2003-04-11
Leonard B. Baron The Planning Committee for the Forum on Severe Brain Injury to Neurological Determination of Death (April 9-11, 2003) commissioned this paper, a working draft, as a background information piece for Forum participants. This review of literature considers issues surrounding existing clinical practices in Canada. This paper represents a detailed summary of more recent medical literature on brain death and a summary description of the evolution of the brain death concept from the 1950s until the early 1990s. 
The Dissemination-Implementation Challenge 2003-06-23 Canadian Council for Donation and Transplantation Implementation of the agreements developed at the Forum on Severe Injury to Neurological Determination of Death (BINDD) is planned in two phases:
• Phase I: reporting to the Canadian Council on Donation and Transplantation (CCDT), which reports to the Conference of Deputy Ministers of Health (CDM).
• Phase II:
A) Dissemination of knowledge and Forum agreements through publication of the Forum proceedings in the Canadian Medical Association Journal, and
B) Dissemination and implementation of agreements via Forum participants, Members of the Forum Recommendations Group (FRG) and Pediatric Reference Group (PRG) and stakeholder organizations and groups represented at he Forum.

The purpose of this document is to suggest strategies for "b" above, i.e., enabling change in the practice of health care professionals through dissemination and implementation of Forum agreements.
Organ and tissue donations: Awareness, knowledge and advertising recall 2002 Canadian Council for Donation and Transplantation Health Canada launched an advertising and communications initiative to raise awareness of the need for organs and tissues and to encourage a positive response. This multimedia campaign ended on April 28, 2022.

The goals of the current survey were:

• To measure awareness and knowledge of, and attitudes toward, organ and tissue donations among Canadians;
• To measure any changes in these over the six-month period since October 2001;
• To measure public awareness, recall and assessment of this television, newspaper and website advertising campaign on the topic of organ donation.
Organ and tissue donor awareness: Canadian public awareness, knowledge and attitudes 2001 Canadian Council for Donation and Transplantation In this context, it is important to understand how public awareness and beliefs might be contributing to Canada's low rate of organ and tissue donation, as well as how donation might be increased. Thus, the goals of the survey were:
• To provide insights into awareness, knowledge and attitudes of organ and tissue do-nations among Canadians;
• To provide insights into possible strategies to increase awareness of donations among the Canadian public;
• To identify target segments.

The topics addressed in this survey included:
• Awareness of organ and tissue donations
• Approval of organ and tissue donations
• Personal views and behaviour
• Importance of specific motivations and beliefs for donating and for not donating
• Knowledge issues about donation
• Family and legal issues
• Information sources and needs
• Policy options
• Demographics