Transplantation in Canada: review of the last decade from the Canadian Organ Replacement Register.

The descriptive analyses presented in this chapter provide a brief overview of transplant activity in Canada. While Canada's cadaveric organ donation rate has remained static, between 13-14 per million population, transplant rates increased from 1992-2001. This growth was due to more organs being retrieved per cadaveric donor and increased rates of living donor transplants for kidney, most notably, but also liver. The steady climb of the transplant waiting list continued to outstrip the number of patients transplanted on an annual basis. In 2002, 237 people died will waiting for an organ transplant. Canada is a net importer of organs from the US, particularly hearts and lungs. Heart transplantation activity has varied least of all organ transplant types from 1992-2001, reflecting in large part the stagnant cadaveric donation rate and the fact that fewer than 40% of hearts were retrieved and transplanted from the available cadaveric donors. Liver, lung, most notably double lung, and pancreas/kidney-pancreas transplant activity all grew significantly from 1992-2001. Accumulated expertise in the surgical realm combined with improved donor management and organ preservation techniques have facilitated this growth. Patient and graft survival continue to increase in Canada both for patients who are very ill at the time of their transplant, and those not as ill. Future growth areas for transplantation in Canada will likely be in the area of living kidney and liver donation, continued kidney-pancreas transplantation and islet cell transplantation. Without significant improvements in cadaveric organ donation rates in Canada, exploration of expanded donation criteria like non-heartbeating donors as well as continued improvements in donor management for the purposes of increased organ retrieval, the transplantation rates for hearts, livers, and lungs are not expected to increase, and the gap between the number of patients waiting for a transplant and the number of patients transplanted will widen.