Organ donation in Ontario increased 57% since 2006 when the province introduced a Canadian policy that allows donation of organs after circulatory functions cease, called circulatory determination of death (DCD), according to a new study published in CMAJ (Canadian Medical Association Journal) http://www. cmaj. ca/ lookup/ doi/ 10. 1503/ cmaj. 161043

Before 2006, deceased organ donation traditionally occurred after neurologic determination of death (NDD), commonly known as brain death, when a person was declared dead after the complete and irreversible loss of all brain functions.

Because of a lack of organ donors and other factors, waiting lists for donations of lungs, kidneys, livers and hearts are long and recipients often die while waiting, depending on the type of organ.

"The most important development in efforts to expand the donor pool has involved donation after [DCD]," writes Dr. Vivek Rao, Multiorgan Transplant Unit, Toronto General Hospital and the University of Toronto, Toronto, Ontario, with coauthors.

Researchers compared data from the pre-DCD period (2002/03 to 2005/06), early DCD period (2006/07 to 2009/10) and recent DCD period (2010/11 to 2013/14) to understand trends in organ donation after introducing the policy.

"Donation after circulatory determination of death has had a positive effect in Ontario in terms of both overall number of donors and transplant activity," state the authors. "Donation after NDD does not appear to have been adversely affected. Although there are disparities among organ groups, we foresee that an active DCD program will continue to have a positive effect for all solid-organ transplant recipients," they conclude.

In a related commentary http://www. cmaj. ca/ lookup/ doi/ 10. 1503/ cmaj. 170988 , Dr. Sam Shemie of Montreal Children's Hospital and McGill University Health Centre & Research Institute, and medical advisor for Deceased Organ Donation, Canadian Blood Services, says that the research paper shows Ontario has seen a rise in numbers of transplants in the province over a 12-year period that is almost entirely attributable to DCD. This important finding is instructive for the rest of the country. Substantial variation in organ donation rates between provinces still exists and can be explained largely by variable degree of DCD implementation.

However, according to Dr. Shemie, the 2015 rate of 18.2 donors per million people falls far below the number of potential donors, estimated at 40-89 donors per million. Canada must continue to focus on increasing organ donation and preventing death and disability for potential transplant candidates.

The research study was conducted by researchers from Toronto General Hospital, University Health Network, St. Michael's Hospital, the University of Toronto, Trillium Gift of Life Network, Toronto, Ontario; and Children's Hospital of Eastern Ontario, Ottawa, Ontario;

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