This interactive online platform reports national performance data for organ donation and transplantation in Canada. The dashboard consists of nine primary sections presenting data on key aspects of donation and transplantation across the system. The data presented here are results as of Dec. 31, 2021.
If you require documentation in an accessible format not available here, please submit a request by sending an email to OTDT@blood.ca.
2782 organ transplants were performed, made possible thanks to the generous act of organ donation from 734 deceased donors and 595 living donors.
250 patients died waiting for an organ transplant.
4043 patients were waiting for a lifesaving or life-enhancing organ transplant by the end of the year
For living donation, 2021 was a particularly strong year thanks in part to the Kidney Paired Donation (KPD) program operated by Canadian Blood Services on behalf of the country. The KPD program is an organ allocation program run through the Canadian Transplant Registry. The KPD program provides opportunities for transplant candidates in need of a kidney transplant who have an incompatible living donor available to potentially receive a transplant through an exchange with other incompatible pairs across the country. In 2021, 104 transplants were facilitated through the KPD program, representing an all-time high since the program began in 2009.
Deceased Donation - 2021
Overall, deceased donation activity levels remained relatively unchanged in 2021 from the previous year, with the same count of 734 utilized deceased donors in both years and 19.2 donors per million population (DPMP). In 2020, on average 2.9 transplants were completed per deceased donor. This number increased modestly in 2021 to 2.97 complete organ transplants on average from each deceased donor. Interestingly, utilization has been on a steady decline since the introduction of donation after circulatory death (DCD) because while DCD introduces more donors, DCD donors produce fewer viable organs for donation.
Despite the lack of change in total deceased donation compared to 2020, 2021 did see a drop in the proportion of neurological determination of death (NDD) donors at 502, a 16 per cent decrease from the 601 NDD donors reported in 2017 (the peak year for NDD donors). This represents a continuing shift in the ratio of NDD donors versus DCD donors that has continually shifted over the past five years.
The Parliament of Canada passed federal legislation in June 2016 which permitted eligible Canadian adults to request medical assistance in dying (MAID). In March 2021 Parliament passed revised legislation that made important changes to who can access MAID. A total of 232 donors proceeded to DCD in 2021, and notably of adult DCD donors (228) nationally, one quarter were cases involving MAID.
Organ transplantation - 2021
In total, 2782 organ transplants were performed in 2021, representing a six per cent increase relative to the previous year, with overall transplantation activity remaining nine per cent lower than the total reported in 2019. Transplantation rates in 2020 were significantly impacted by COVID-19. Transplantation programs across the country experienced a wide variety of impacts including restricted availability of ORs, decreased ICU capacity, human resource challenges and in some cases complete suspension of transplant programs. Compared to 2020, several organ groups including kidney, liver and lung, saw six to 10 per cent increases in the number of transplants completed in 2021. However, transplantation activity for these organ groups has yet to return to the levels observed in 2019 (pre-pandemic levels).
Heart transplantation has been particularly limited in 2021, with only 142 heart transplants performed across Canada in 2021, a 34 per cent decrease from the 215 reported in 2019. A review is currently underway to assess factors impacting performance.
Patients waiting and deaths on waitlist - 2021
There were nine per cent fewer patients placed on transplant waitlists across Canada at the end of 2021 relative to the end of 2019. For the 10-year period from 2010 to 2019, annual results have consistently shown more than 4,300 patients on waitlists in Canada, yet only 4043 patients were reported at the end of 2021. Two-hundred-and-fifty patients died while on Canadian organ transplant waitlists in 2021, which is consistent with the average of the preceding 10 years.
This data report acknowledges the generous gift made by organ and tissue donors, both living and deceased, and the families of those who have donated. The report further acknowledges the hopes of patients with end-stage organ failure and the dedication of healthcare teams and practitioners throughout the health care system who make it possible to fulfill and increase opportunities for organ and tissue donation and transplantation. This report was made possible through the collective effort and input from members of Canadian Blood Services’ Organ and Tissue Donation and Transplantation Committees, the Canadian Institute for Health Information, and the Information Management team with Canadian Blood Services’ Organ and Tissue Donation and Transplantation department.
In 2020, as the COVID-19 pandemic affected all aspects of healthcare around the world, Canada’s performance in terms of deceased organ donation and transplantation experienced a reduction when compared to the previous year’s results. At 19.3 donors per million population (dpmp), we remain close to reaching our target of 22 dpmp. Similarly, national living donation rates decreased over last year. In 2020, a total of 276 Canadians died while waiting for a suitable organ transplant opportunity.
The results reflected within this data represent the individual and collective work of both the provincial programs and the national efforts led by Canadian Blood Services. Most importantly, we sincerely acknowledge the generosity of the 1,221 organ donors and their families who gave so selflessly in 2020. We also recognize the heartfelt appreciation of the recipients whose lives were saved or changed through the generous act of donation. For data related to eye and tissue donation and transplantation in Canada, click here.
It goes without saying that the COVID-19 pandemic affected almost all aspects of the Canadian health system, as well as those of other countries around the world. Organ donation and transplantation was no exception, as the network of healthcare professionals involved in this field attempted to rapidly develop strategies to balance patients’ need for lifesaving and life-improving transplants with the potential risks posed by a novel respiratory illness.
When COVID-19 cases began emerging in Canada in early 2020, organ transplantation activity was generally curtailed at a national level, with almost all programs implementing precautionary measures to address this new potential threat to patient health during the first wave. This culminated in most organ transplant programs suspending or modifying their operations, including living donor transplant procedures being essentially suspended nation-wide for more than a month in the spring of 2020.
Further research emerged about the nature and extent of the risks posed by COVID-19 and the measures required to manage that risk in order to perform organ transplantation procedures in a safe and effective manner. This enabled organ donation and transplantation activity to generally resume in the summer of 2020 at a level that approximated historical performance, with subsequent waves of COVID-19 case prevalence having less of an impact on system activity at a national level.
The impact of the changes in program activity in response to the pandemic is evident in the results for the 2020 calendar year, including an 11 per cent reduction in deceased donation and a 21 per cent reduction in living donation relative to the previous year, as well as a consequent 14 per cent reduction in transplants performed. Nevertheless, it would be inaccurate to interpret these results as reflecting negatively on system performance; on the contrary, our ability as a nation to adapt to uncertain conditions in a manner that ensured the health and well-being of Canadian patients, as well as healthcare personnel, to safely perform at the observed level despite these conditions is a testament to the effectiveness of the donation and transplantation system in Canada, and represents something we can take great pride in as a nation.
The success that this represents can be contextualized when looking at the equivalent reductions in donation and transplantation activity internationally; for example, while the rate of deceased donors per million population in Canada decreased by 11.7 per cent in 2020 relative to the previous year, this is on par with Australia which saw a 10.4 per cent decrease in its deceased donation rate, and reflects a considerably smaller decrease than was seen in the UK (24.9%) and in the world-leader in deceased donation, Spain, which experienced a 23.5 per cent decrease in its deceased donation rate. Moreover, many donation and transplantation programs within Canada were able to achieve results that were consistent with, or even exceeded, previous years, with Alberta, Saskatchewan, Manitoba, and the Atlantic region seeing the same number or more utilized organ donors in 2020 than the previous year, and living donor liver transplantation activity in 2020 exceeding 2019 results at a national level.
Canadian Blood Services played a meaningful role in achieving these successes by serving as a national conduit for information sharing throughout 2020 and into the following year. These contributions included systematic scans of international best-practice guidelines and emerging research, national consensus guidance, as well as near-real-time data collection and reporting on program operational statuses and activity. Canadian Blood Services provided visibility to critical national and international information that informed the decisions made by the organ donation and transplantation community and functioned as the hub for disseminating this information, as well as providing opportunities for peer-to-peer information exchanges to share research results and expertise from across Canada and around the world.
This interactive online platform reports national performance data for organ donation and transplantation in Canada. The dashboard consists of nine primary sections presenting data on key aspects of the donation and transplantation across the system. The data presented are results as of Dec. 31, 2019. This format replaces our previous annual System Progress Report publication.
For data related to eye and tissue donation and transplantation in Canada, click here.
Past OTDT system progress reports are available in PDF format upon request, submit request to OTDT@blood.ca)
Key elements of a high-performing deceased donation system Through experience gained provincially, nationally and internationally it is generally accepted that fundamental key components to a high performing deceased donation system exist, and when implemented, lead to improved performance. These foundational elements include adequate resources and infrastructure, availability of highly trained front-line specialists, leading practice guidelines and professional education, data and analytics to inform system and performance improvement including death audits and the identification of missed donation opportunities, adequate legislation (including mandatory referral), and the presence of appropriate accountability tools and structures.
Another fundamental component of a high-performing system is adequate public education and awareness. Organ donation and transplantation is complex and not well understood. There are many misconceptions that contribute to barriers to registering intent to donate. Increasing awareness for organ and tissue donation and transplantation, and increasing the number of registered organ donors, is part of a comprehensive system-wide approach to increasing donation rates.