Canadian Organ Replacement
Register (CORR)
Recent Trends in Donor Activity
CAT Clinical Donation Symposium
Dr. Lilyanna Trpeski
Program Lead for CORR
CORR Annual Meeting, Banff
Friday March 16, 2007
OUTLINE
• About CORR
• New Initiatives at CORR
• Donor activity and characteristics
• Retrieved organs usage
What is CORR?
•
Canada’s national database on patients treated for end-stage organ failure
•
Captures information on:
– Treated patients
– Specifics of the treatments
– Organ donors : deceased and living
– Transplant and dialysis facilities
– Transplant and waiting list aggregate statistics from OPOs
cont
• A fairly limited dataset with respect to organ donation and
transplantation, but coverage is extremely high (95%+)
especially given the voluntary nature of the registry
• Initiated in 1981, largely through the grassroots efforts of
the nephrology community
• In 1988 Transplant and OPO community joined CORR
• Strategic direction is governed by a Board of Directors
comprised of representatives from CSN, CST, KFOC,
CANNT, CAT and Health Canada
• Current President, Dr. Joanne Kappel (St Paul’s Hospital,
Saskatoon – Kidney)
• Greg Kalyta (TGLN) is the CAT representative
• Kim Young –CCDT representative
Data Sources
Prov
Waiting List
Donor
Transplant
AB
HOPE – Edmonton; HOPE
Calgary
Deceased - HOPE – Edm; HOPE
Calgary
Living – Transplant programs
Transplant programs
BC
BCTS
BCTS
BCTS
SK
SK Transplant Program
Provincial office
Regina Office
SK Transplant Program
SK Transplant Program
MB
Transplant Program
Gift Of Life Program
Transplant Manitoba
Gift Of Life Program
Transplant Program
ON
TGLN
TGLN
TGLN
QC
Québec-Transplant
Deceased - Québec-Transplant;
Living – Transplant programs
Transplant programs
NS/PE
MOTP (Halifax)
MOTP (Halifax)
MOTP (Halifax)
NB
Multiple Organ Retrieval and
Exchange Program
NL
OPEN
Transplant and Donor Data Flow at CORR
TRANSPLAN
TED
PATIENTS
DONORS
LINKING AT CORR
Kidneys
KidneyLivers
Livers
RETRIEVED
ORGANS
TRANSPLAN
TED
ORGANS
Hearts
HeartLungs
Lungs
Pancreas
OPO’s
Type
Transplanted
Outcomes
OPO’s or
Transplant
Programs
Type
Characteristics
Intestine,
multivisce
ral
KidneyHearts
KidneyPancreas
New Initiatives in CORR
Current Activities & Directions
• Expansion of data set in 2007/8
• Increased focus on data quality (includes
linkage projects)
• Enhanced presence on www.cihi.ca/corr
• Enhanced analytical support to the research
community – includes the initiation of a
Research Subcommittee chaired by Dr.
Louise Moist
• Still working on improved timeliness of data!
Data Quality Initiatives Example 1:
Reported Deaths Validation Process
• Investigated discrepancies of number of deaths
among transplant patients obtained from facility
profile data and record level data
• Surveyed OPO’s for routine collection of follow up
data including deaths among transplanted patients
Transplant Programs-AB
SK Transplant Program-SK
Transplant Program-MB
Transplant Hospitals –ON
(TGLN??)
Transplant programs- QC
MOTP (Halifax)- NS/PE
Example of Tracking Missing Death
Infromation
Patient Level Data
Facility profile
Difference
Deaths ftx
Death failured graft
Total
Deaths ftx
Death failured graft
Total
Deaths ftx
Death failured graft
Total
26
4
30
24
7
31
2
-3
-1
Data Quality Initiatives Example 2:
Examinations of HLA Values
• Dr Nickerson evaluated HLA data received from
OPO’s between 2000-2004
• HLA data re-collection obtained with a help from
OPO’s
• New data elements for HLA and PRA proposed
Proposed Changes to the Serology Test
Capture in CORR
• SEROLOGY RECIPIENT
TABLE CHANGES
• ADD FIELDS:
•
HLA Cw1 and Cw2
•
Class II PRA current and Class II PRA peak
•
Test Methods ( ELISA, CDC,
FLOW/LUMINEX)
•
Donor specific antibodies Y/N
• RENAME
•
current cytotoxic to Class I PRA current
•
peak cytotoxic to Class I PRA peak
•DONOR SEROLOGY
CHANGES
•ADD FIELDS:
•HLA Cw1 and Cw2
www.cihi.ca/corr
• Privacy Impact Assessment
• Presentations
• E-Reports on Statistics on Organ Transplants,
Waiting List and Donors produced bi-annually
• CORR inSITES (2 issues in 2007) – ideas welcomed!
http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=reports_corrinsites_may2006_e
•
•
•
•
•
Media releases (2 per year)
List of publications where CORR data have been used
Historical reports/Last CORR Highlight Report in 2006
Directory of participating centres – free PDF
Instruction Manuals
Donor Activity and Usage
Organ Donors,1 Canada, 1996-2006 (Number)
600
12%
500
400
300
200
100
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Deceased
420
429
415
421
471
420
405
428
414
414
464
Living
265
283
368
392
409
447
440
431
468
504
543
1 Deceased
donors are defined as donors originating in Canada where at least one solid organ was used for
transplant. Data are from Quarterly Reports provided by Canadian OPOs.
Source: Canadian Organ Replacement Register, Canadian Institute for Health Information- eStatistics (2007)
Number of Living Related Donors (LDR) and
Living Unrelated Donors (LUR) in Canada,19962006
500
450
400
350
300
250
200
150
100
50
0
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
LRD
221
230
295
296
309
349
328
318
349
391
429
LUR
44
53
74
96
100
102
114
117
124
113
115
Source: Canadian Organ Replacement Register, Canadian Institute for Health Information-eStatistics (2007)
Distribution of Deceased Donors by Age
Groups, Canada, 1999-2006
2006
2005
2004
2003
2002
2001
2000
1999
0%
10%
20%
30%
<1yr
1-14 yrs
40%
15-39 yrs
50%
40-54 yrs
60%
55-69 yrs
70%
70+ yrs
80%
90%
100%
Distribution of Living Related Donors by Age,
Canada, 1999-2006
2006
2005
2004
2003
2002
2001
2000
1999
0%
10%
20%
30%
40%
50%
60%
15-39
40-54
55-69
70%
80%
90%
100%
Deceased Donors (DCD), Living Donors (LD) by
Gender, Canada, 1996-2006
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Deceased
Living related
Females
Males
Unknow n
Living unrelated
Ethnicity by Donors in Canada, 1996-2006
5000
other
unknown
aboriginal
pacific islander
indian
black
asian
white
4500
4000
3500
3000
2500
2000
1500
1000
500
0
NDD
LRD
NDD- Neurologically determined death; LRD-Living related donor; LUR-Living unrelated donor
LUR
Distribution of Deceased Donors by Cause
of Death, Canada, 1999-2006
2006
2004
2002
2000
0%
20%
40%
60%
80%
Trauma from M otor Vehicle Collison
Cerebrovascular Accident/Stroke
Gunshot
Anoxia/hypoxia
Other Trauma
Other
Unknown
100%
Distribution of Deceased Donors by Cause
of Death, Province of Retrieval, 1996-2006
SK
QC
ON
ATL
MB
BC
AB
0%
20%
40%
Trauma from Motor Vehicle Collison
Gunshot
Other Trauma
Unknow n
60%
80%
Cerebrovascular Accident/Stroke
Anoxia/hypoxia
Other
100%
Proportion of Deceased Donors with MVA as a
Cause of Death, Canada and US, 1999-2006
30
25
%
20
15
10
5
0
2006
2005
2004
2003
2002
2001
2000
1999
US
20.6
20.1
21.3
22.1
23.7
22.6
24.2
23.1
CA
10.9
10.1
14.3
13.6
12.8
17
21.4
22.27
Change in Numbers of Patients on Waiting
Lists, Canada 2005-2006
180
160
Percentage Change
140
120
100
80
60
40
20
0
kidney
pancreas
double
lung
single
lung
pancreas
heart
liver
-40
kidney
-20
Transplants1 and Waiting List at Year-end,2 Canada, 1995-2004
(Number)
4500
4000
3500
3000
2500
2000
1500
1000
500
0
95 9 96 9 97 9 98 9 99 0 00 0 01 0 02 0 03 0 04 0 05 0 06
9
1
1
1
1
1
2
2
2
2
2
2
2
Donors
Transplants
Waiting List
1Includes single and combination transplants.
2Waiting list includes active and on-hold patients and excludes patients who died while on the waiting list. Excludes
patients waiting for islet cell transplants.
Source: Canadian Organ Replacement Register, Canadian Institute for Health Information (2006)
Usage of Organs Obtained
from Deceased Donors
Average Number of Organs Used for
Transplantation, Canada, 1996-2006
3.45
3.4
Average
3.35
3.3
3.25
3.2
3.15
3.1
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Average Number of Organs Transplanted per Donor
Organs Retrieved, Transplanted, Shared Between
Province, Canada and Us, 1995-2006
2000
1800
1600
2001
2002
2003
1400
2004
1200
2005
1000
2006
800
600
400
200
0
Imported
Exported
Between
provinces
Transplanted
Retrieved
Resons Deceased Organs Retrieved and Not
Transplanted in Canada , 2000-2006
361
1135
1639
404
5889
non medical
medical
no consent
unknown
research
Reason Other then Medical for Not Used
Organs, Canada 2003, 2004, 2005
2005
2004
2003
0
50
100
Team/logistic
No suitable recipient
Other
No program
Unknown
150
Growth in Number of Transplanted and
Recovered Organs, 2005-2006
Organs Transplanted
Transplanted
2005
Organs Recovered from Deceased Donors
2006
Percent Change
Organs
Total
Recovered
2005
2006
Percent Change
1,726
1,807
4.69%
0
10
Kidney
713
790
10.80%
Pancreas (all)
143
85
-40.56%
Liver
372
403
8.33%
2
8
300.00%
Organs
1,905
2,124
11.4%
1,401
1,569
12.00%
504
555
10.0%
1,055
1,198
13.5%
Deceased donor
612
711
16.1%
Living donor
443
487
9.9%
66
72
9.09%
417
459
10.07%
357
393
10.08%
60
66
10.00%
1
1
0.00%
Intestine
Heart
173
177
2.31%
Heart
167
159
-4.79%
Lung
140
165
17.86%
Lung
133
199
49.62%
139
164
17.99%
1
1
0.00%
Deceased donor*
Living donor
Kidney
Pancreas**
Liver
Deceased donor
Living donor
Intestine
Deceased donor
Living donor
All DD organs
All CDD organs
* Including 8 CDD kidneys in 2006; ** Including pancreas and kidney pancreas transplants;
What is New in 2006 !!!!
• First 4 CDD Donors procured at TGLN in 2006
• 10 CDD Organs were transplanted:
– 8 kidneys
– 2 livers
Number of Referred Patients,Potential
Donors and Procured(Actual) Donors,
2001-2006 Canada
1400
1200
1000
Procured
Potential
Referals
Potential/Referrals=42%
800
600
400
Procured/Potential=85.6%
200
0
2001
2002
2003
Data from e-CORR Annual Report-2005
2004
2005
2006
Deceased Donor Practice by Province
120.0
100.0
80.0
proc/poten
60.0
pot/ref
40.0
20.0
0.0
AB
BC
MB
ATL
ON
QC
SK
CA
Donor Aggregate Collection Form
• 1.
Number of POTENTIAL deceased organ donors identified by
your OPO: ____________ NDD _____________ CDD
(Declared NDD/CDD, consent obtained, organ offered - may not be
accepted and/or retrieved)
• 2.
Number of ACTUAL deceased organ donors identified by your
OPO: ____________ NDD _______________ CDD
(All conditions for POTENTIAL DONOR, plus at least one organ
retrieved and transplanted)
• 3.
Number of in-province referrals to your OPO: ____________
NDD _______________ CDD(All Patients referred to the OPOs as
possible potential donors)
• Total number of organs retrieved locally: ____________ NDD
_______________ CDD
Completeness of Serology Data
100%
80%
60%
40%
20%
0%
CMV
Hep BCAB HepBSAG
HepC
HIVF
Epstein_B
arr virus
Unknown
5448
3822
4009
5273
3654
2527
Negative
4522
3160
8416
7120
8795
9283
Positive
4278
183
36
68
12
651
Data Completeness in CORR
Completeness of Height and Weight
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
N
Y
Height
Weight
Completeness of Blood Type
4%
33%
A
AB
B
O
51%
3%
9%
U
Completeness of Race
29%
Y
N
71%
Conclusions
•Number of deceased donors increased in Canada by more then
10% in 2006 compared to n005
•New Donors after Cardiac Death procured in Ontario
• Average age of donors remained similar to year 2005
• CVC remained a main cause of death in deceased donors in
Canada. Need to differentiate ECD in the future.
cont
• Need for better communication and some
decisions need to be made
• Teleconference between OPO and LABs
• More timeliness reporting to CORR
Acknowledgements
• The Canadian Organ Replacement Register
(CORR) is a register of the Canadian Institute for
Health Information.
• CORR data would not exist without the support of
transplant programs and organ procurement
organizations across Canada.
• CORR has support and participation from the
CSN, CST, The Kidney Foundation of Canada,
CANNT and CAT.
QUESTIONS ???????
Ltrpeski@cihi.ca