According to the United Network for Organ Sharing (UNOS), there are 268 hospitals in the U.S. that have performed at least one kidney transplant in the past 10 years. Canada has about one-tenth the population of the U.S. and has about 25 transplant centers. A list of the centers is available from the Canadian Blood Services and the Canadian Association of Transplantation.
Transplant statistics for Canada are available from the Canadian Organ Replacement Register (CORR), which collects and summarizes patient and treatment center data in a manner similar to the United States Renal Data System (USRDS) and UNOS in the U.S. (U.S. live transplant data is described in a Jun 2010 blog post. The nuances of the U.S.wait list data is explored in an Apr 2010 blog post.)
A cursory comparison of Canadian and U.S. data shows very similar trends. In 2009, 1,181 kidney transplants were performed in Canada of which 725 were from deceased donors. About 120 were pre-emptive. The transplant rate is lower in Canada than in the U.S., but the live donor rates are similar.
There were 5,431 new cases of ESRD reported in 2008, the latest year data is available. There were an estimated 36,638 people living with end-stage renal disease (ESRD) at the end of 2008, an increase of 57% since 1999. Of these, 21,754 were on dialysis and 14,884 were living with a functioning kidney transplant. However, as a proportion of the population, the transplant waiting list is much smaller in Canada than in the U.S. There were 2,383 patients on the active list in Canada at the end of 2008 and 753 “on hold” (which I presume is similar to “inactive” in the U.S.).
Like the U.S., diabetes is the leading cause of ESRD in Canada, identified in 35% of new cases in 2008, followed by renal vascular disease at 18%. Also like the U.S., the proportion of older patients is growing, with 53% of those who initiated renal replacement therapy being age 65 and older in 2008, compared to 49% in 1999.
Living donor paired exchange
Recently, Canadian Blood Services has created a Living Donor Paired Exchange (LDPE). (For an explanation of paired exchanges, see this Mar 2010 blog post.) It began operating as a pilot program covering three provinces in January 2009. The other provinces joined afterwards and it became a nationwide program in October of this year. So far 185 donor/recipient pairs have been registered and 57 kidney transplants have been facilitated. However, very few matches have been made through the exchange. Of the 57 transplants facilitated so far, 45 have been from nondirected donors and only 12 have been swaps or chains.
The LDPE conducted its first nationwide match run on November 30, resulting in 16 matches (I don’t know how many are nondirected donations and how many are swaps or chains). The surgeries scheduled in the weeks ahead. In addition to going Canada-wide, the registry announced some other milestones, including:
- the first LDPE surgeries performed in the province of Nova Scotia;
- the first patients in Saskatchewan, Nova Scotia and Newfoundland and Labrador receiving transplants;
- matches and transplants for highly sensitized (difficult-to-match) patients; and
- first instance where kidneys were shipped as part of a living donor exchange from one Canadian center to another, demonstrating that transporting the kidney rather than the donor is feasible in some circumstances.
Paul Shay, National Executive Director of The Kidney Foundation of Canada explains why the LDPE is important.
“A transplant is generally the preferred treatment for people whose kidneys have failed but far too many patients are dying while waiting. Each kidney transplant saves the health care system up to $40,000 annually. The 57 transplants that have happened as a result of this registry will save the system millions of dollars and improve the quality of life of the transplant recipients beyond any monetary value.”
The concept of a national registry for LDPE was proposed by the Canadian Society for Transplantation and the Canadian Council for Donation and Transplantation (merged with Canadian Blood Services). It was developed, implemented, and is currently operated by Canadian Blood Services. Two more registries, the national organ urgent wait list and a registry for highly sensitized (difficult-to-match) kidney patients are now in development and are planned for roll-out in 2011.