Dialogue Volume 13 Issue 2 2017 - Page 49

practice partner Organ donation: Rare opportunity too often lost By Dr. Andrew Healey, Chief Medical Officer, Trillium Gift of Life Network and Medical Director of Critical Care, William Osler Health System O rgan and tissue donation pro- vide a rare opportunity to save or improve lives; however that rare opportunity is too often lost. In 2016, Trillium Gift of Life Network approached more than 1,200 families about organ and tissue donation. Just over half of those families and patients consented to do- nation – and still – only half of those could go on to donation due to medical suitability. Even with these difficult odds, there were more donors and more lives saved than ever before in Ontario. Why? Owing to a culture shift amongst families and health-care pro- viders, organ and tissue donation is increas- ingly recognized as an integral component of end-of-life care. Organ donation, with the potential to save up to eight lives, can occur after a patient or family decides to withdraw invasive physi- ologic support, i.e., ventilator and other life supports (non-heart beating donation). Organ donation can also occur after a severe neurological injury which leads to deter- mination of death by neurological criteria (heart beating donation). Tissue donation, with the potential to improve the quality of up to 75 lives, occurs after death. There are many legitimate reasons why a potential donation opportunity does not proceed to transplantation – active meta- static malignancy or extreme organ dysfunc- tion, for example. But unfortunately, many patients at risk of imminent death or who die are not referred to Trillium Gift of Life Network until the opportunity to speak to families has been lost. Although there has been an increase in the number of families approached for organ donation, many times, the window of opportunity has been closed. As physicians, our role is to ensure this deci- sion is never made for a family by default. All of us would want that information delivered to the substitute decision-maker, and where possible the patient, in the most Issue 2, 2017 Dialogue 49