Trillium Gift of Life Network is a not-for-profit agency of the Government of Ontario dedicated to the planning, promotion, coordination and support of organ and tissue donation and transplantation. Its mission is to save and enhance lives through the gift of organ and tissue donation in Ontario.
Please call Trillium Gift of Life Network’s Provincial Resource Centre, toll free, at 1-877-363-8456. They are available 24 hours a day, seven days a week to answer your questions.
Organs and tissue that can be donated include the heart, kidneys, liver, lungs, pancreas, small intestines, eyes, bone, skin, and heart valves.
Everyone is a potential donor regardless of age, medical condition or sexual orientation. The oldest Canadian organ donor was ninety-two and the oldest tissue donor was a hundred and four. Even individuals with serious illnesses can sometimes be donors. Your decision to register should not be based on whether you think you would be eligible or not. All potential donors are evaluated on an individual, medical, case-by-case basis.
Yes, regulations set by Health Canada for blood donation differ from organ and tissue donation. Everyone is a potential donor. Your decision to register should not be based on whether you think you would be eligible or not. All potential donors are evaluated on an individual, medical, case-by-case basis.
By registering consent for organ and tissue donation, you give hope to the thousands of Ontarians waiting for a transplant. Individuals on the transplant wait list are suffering from organ failure and without the generous gift of life from an organ donor, they will die. Tissue donors can also enhance the lives of recovering burn victims, help restore sight, and allow people to walk again. Transplants not only save lives, they return recipients to productive lives.
Organs or tissue not suitable for transplantation can be used for organ and tissue research (if indicated by donor upon registration). This research is specific to the field of organ and tissue donation, and is not the same as whole body donation.
If you are already registered, you do not need to register again. If you would like to confirm your registration, it takes two minutes at www.BeADonor.ca. You will need to enter your health card number and date of birth.
Paper donor cards are no longer in use as they often were not available when needed. In 2008, Trillium Gift of Life Network adopted an affirmative registry and now your consent to donate organs and tissue is stored in a Ministry of Health and Long-Term Care database. By formally registering, either online at www.BeADonor.ca or in person at any ServiceOntario location, you ensure that your decision is recorded and can be made available to your loved ones at the right time. You only need to register once.
There are two ways to check if you are already registered as an organ and tissue donor:
1. On the www.BeADonor.ca home page choose “Check Now.” This will take you to the ServiceOntario online registration page. Click on “Register, check or update your consent online.” The system will ask for identification. Enter in that information, and click on “Check or Update Registration.” If your registration has been processed, the system will respond, “Yes, you are a registered organ and tissue donor.” (If not, the system will then ask you if you wish to register.)
2. You can also check the back of your photo health card. If the word “Donor” is present, you are registered and do not need
to register again.
If the system is not able to register you online, it may ask you to contact ServiceOntario directly. There are a number of reasons that might prevent you from registering online. Visit any ServiceOntario location to register in person.
You can update or withdraw your consent at any time at www.BeADonor.ca, simply choose “Check or Update Registration” on the home page. You can also visit any ServiceOntario centre to update or withdraw in person. You can also withdraw your consent by mailing a letter to the below address with your name, date of birth, health card number and mailing address.
Organ Donor Consent
P.O. Box 48
Kingston, ON K7L 5J3
Trillium Gift of Life Network manages organ and tissue donation in Ontario. If you live outside of the province, please contact the organ procurement agency in your jurisdiction. A full list can be found here.
In order to register consent in Ontario, you must have a valid Ontario health card. This is because the registered consent will be stored in a Ministry of Health and Long Term Care database. Without an Ontario health card, you will not be able to formally register. However, it is important to talk to your family about your wishes. When someone passes away and donation is possible, an Organ and Tissue Donation Coordinator will approach families to talk about donation. By talking to your family about your wishes, you can help relieve the burden of making that choice without confirmation of your wishes.
Though everyone has the potential to be an organ donor, the reality is that the opportunity for organ donation is rare. Only 2-3% of hospital deaths occur in a way that allows for donation, as deceased organ donation can only take place when an individual passes away in a hospital and on a ventilator. Vital organs require blood flow in order to keep them suitable for transplant.
There is a far greater opportunity for tissue donation, which is possible if an individual passes away in a hospital (but not on a ventilator) or at home. Tissue includes eyes, bone, skin and heart valves.
The first and foremost concern for health care professionals caring for critically ill patients is to do everything possible to save lives. The possibility of donation is only considered when all lifesaving efforts have failed.
When an Organ and Tissue Donation Coordinator is preparing to speak with a family about donation, they will access the Ministry of Health and Long Term Care database to see if their loved one was a registered donor. That information would be shared with the family and they would be asked to reaffirm that choice. Once consent is given, medical tests are completed to determine what organs and tissues are suitable for transplant. The organs are then matched with someone on the transplant wait list and surgery takes place in an operating room at the hospital. The entire donation process, from the time the family agrees to move forward with donation to recovery, takes about 24 to 36 hours to complete.
It is Trillium Gift of Life Network’s practice to reaffirm an individual’s consent to donate with the family. In descending order of priority, the appropriate legal authority may be as follows:
1. The patient’s spouse or same-sex partner.
2. A child of the patient.
3. A parent of the patient.
4. A brother or sister of the patient.
5. Any other relative of the patient.
6. Any person who is lawfully in possession of the body (e.g., an executor of the will, or
administrator of the estate).
In cases where there is no next of kin for the deceased, donation can proceed when registered consent has been recorded with the Ministry of Health and Long-Term Care database.
When you register your consent to donate, this information is recorded and stored in a Ministry of Health and Long-Term Care database. Your decision will only be accessed should there be potential for donation, and your status as a registered donor will be shared with your family. It is Trillium Gift of Life Network's practice to reaffirm an individual's consent to donate with the family. In most cases, families honour their loved ones' decision to donate if they have evidence that it's what they wanted.
Register as an organ donor and talk to your family about your wishes; one day this act could save a life.
Eligibility to donate is assessed at the time of death from information obtained during a medical social questionnaire completed with families. In addition, every organ is tested for suitability to ensure that as many people as possible can be helped through transplant.
Trillium Gift of Life Network will work with transplant centres to match the tissue and blood type of the donor to an individual(s) on the wait list. Medical urgency, blood type/group, the size of the organ, and the relative distance (of a prospective match) all form the basic criteria for organ allocation. If a match is found, the individual(s) who, for medical reasons, is the sickest will receive the donated organ. If the medical urgency is the same, the individual who has been on the wait list the longest will receive the organ. If there is no suitable match within Ontario, a check is made through databases of prospective recipients across Canada and possibly in the United States, in order to save lives.
There are no costs to the donor’s family for organ and tissue donation. However, expenses related to funeral arrangements remain the responsibility of the donor’s family.
The body is released to the family, and funeral arrangements can continue as planned.
Organ and tissue donation does not impact funeral plans. Cremation and an open casket funeral are both possible.
• Organ recovery from the abdomen or chest usually involves one surgical incision that clothing would cover.
• When corneas are donated, typically the whole globe of the eye is removed. Funeral homes provide eye caps to maintain the shape and form of the eyes. This is usual practice whether eyes are donated or not.
• The appearance of the skin after recovery is similar to that of sunburn. A paper-thin layer of skin is removed from the back of the body permitting an open casket funeral.
Trillium Gift of Life Network’s mandate and jurisdiction remain strictly within the province of Ontario. If you wish to be an organ and tissue donor, and your death occurs outside the province of Ontario, you may still be considered donation. That will depend upon the presence and availability of donation programs in that country. It is very important to share your wishes with your family so they understand what you would want to have happen in any situation.
A foreign citizen who dies in Ontario could also be an organ/tissue donor, if the family gives the final consent.
Many hospitals across Ontario are equipped with advanced ventilator capacity necessary to maintain the viability of organs for transplant. If an individual is identified as a potential donor in a hospital that does not have the capability of facilitating donation, Trillium Gift of Life Network will pay the cost of transporting the potential donor to the nearest hospital that does have the capability. This is only done with the support and consent of a family.
Most major religions support organ and tissue donation because it can save the life of another. If your religion restricts the use of a body after death, consult your religious leader: these restrictions may not include organ and tissue donation, if the donation could save another life. More information can be found here.
There are two main ways people choose to donate after they pass: organ and tissue donation and whole body donation. Trillium Gift of Life Network manages organ and tissue donation. More information on whole body donation can be found here. It’s not possible to donate your organs and tissue and donate your body to science. If you give your body to medical science, your organs and tissue will not be available for transplantation. Similarly, if you donate organs or tissue, you cannot donate your body to science.
Organ transplantation is a surgery that replaces a damaged organ or tissue with a healthy organ or tissue.
Once you are added to the organ transplant wait list, you may receive an organ that day, or you may wait many years. Factors affecting the wait include the fit of the match and health of the patient.
Tissue wait lists are managed by individual physicians. At this time the wait list for eye tissue (corneas) can range anywhere from six months to three years to receive a transplant. Trillium Gift of Life Network coordinates the recovery of the tissue and ensures that it is delivered to the appropriate tissue bank which will process and distribute the tissue across the province for transplantation.
Many different factors are considered when matching an organ to a potential recipient. While the specific criteria differ for various organs, matching criteria generally include:
• blood type and size of the organ(s) needed
• time spent awaiting a transplant
• the relative distance between donor and recipient
For certain organs other factors are vital, including:
• the medical urgency of the recipient
• the degree of immune-system match between donor and recipient
• whether the recipient is a child or an adult
All organs are matched by blood group. The heart and the liver are matched by size, urgency, and time waiting. Kidneys are assigned by genetic matching (DNA) and time waiting. Size is sometimes taken into consideration.
Once the transplant physicians make the decision to list a patient, that person is then registered on the wait list database that is managed by Trillium Gift of Life Network. Patients on the wait list are categorized by factors such as blood/tissue type, health status and length of time waiting.
Hospitals notify Trillium Gift of Life Network that there is a potential donor and specially trained coordinators work with family members to offer the opportunity to proceed with organ donation. After the family has given their consent, a complex and delicate matching process is initiated to determine the best possible recipient for each available organ and limit the chances of rejection. This process is based upon a mutually-agreed-upon set of algorithms and rules in which all of the transplant teams in the province have participated.
Trillium Gift of Life Network facilitates the donation case, recovery of the organ, and the transportation of the organ to the transplant site - right up to delivery to the operating room where the patient is to receive the transplant.
All costs for the surgery, whether for donation after death or for living donation, are covered under Ontario Health Insurance Plan (OHIP), for all Ontarians (i.e., citizens of Ontario) who qualify for health care. In the case of living donation, the recipient’s OHIP coverage will also cover the cost of a donor from another country – but only when that donor is in Ontario. OHIP does not cover the travel costs or the required preliminary tests for that donor (in the country of origin).
• Kingston General Hospital: kidney
• London Health Sciences Centre: kidney, kidney/pancreas combination, liver and heart,
and small bowel
• The Ottawa Hospital: kidney
• St. Michael’s Hospital: kidney transplants only
• The Hospital for Sick Children: kidney, heart, liver, lung, small bowel, liver/bowel
• The Ottawa Heart Institute: heart
• University Health Network: kidney, kidney/pancreas combination, pancreas, heart, lung,
heart/lung, liver, small bowel, multivisceral, liver/bowel/stomach
There are three different donation scenarios:
- Deceased organ donation takes place when someone suffers a traumatic event, such as a stroke or severe head injury, which progresses to neurological death, or “brain death.” The patient, though deceased, is maintained with the help of mechanical support (e.g., a ventilator, or breathing device) to keep oxygenated blood flowing to vital organs for a limited time until donation can take place. As of 2006, DCD (Donation after Cardiac Death) is now also an option for organ and tissue donation. DCD offers families the option of donation in situations where neurological criteria for death have not been met, but the decision to withdraw life sustaining treatment has been made.
- Tissue donation can take place when someone has succumbed to either neurological death or cardiopulmonary death. With tissue donation, there is no need for blood flow to be maintained after death.
- Living donation takes place when someone donates an organ or part of an organ to another person and goes on to lead a healthy life. For example, individuals with two healthy kidneys may be able to donate one of their kidneys to a loved one or close friend. Similarly, a healthy individual may donate a portion of his/her liver (lobe). It is interesting to note that the liver, in both the donor and recipient, will regenerate to full size within months.
- Vascularized Composite Allotransplantation (VCA) is the transplantation of multiple tissues such as muscle, bone, nerve and skin as a functional unit. Examples of VCA include upper limb (hand), facial tissue and abdominal wall.
Organ donation after cardiac death is now an opportunity to donate organs for families who have decided to withdraw life support for a loved one after a physician has determined that there is no long-term prognosis for recovery. DCD may also be possible for patients who do not meet the full criteria for brain/neurological death. Improved medications and surgical techniques have dramatically improved the outcomes for recipients of DCD-recovered organs. DCD is widely accepted in the United States, and donation rates have increased by as much as 20% because of the acceptance of DCD in organ and tissue donation and recovery.
Neurological death involves the irreversible loss of brain stem reflexes, such as cough, gag, pupillary response to light and response to painful stimuli.
- The capacity for consciousness has been irreversibly lost.
- The ability to breathe is no longer present (apneic) and mechanical ventilation is required.
- A known etiology capable of causing death by neurologic criteria must be established.
- To preserve the opportunity for donation, ventilation and IV medication to support hemodynamics must continue.
- The time of the first completed determination of neurological death is the legal time of death for that person. This is the time that is written on the death certificate.
- Prior to organ donation, neurological death is always diagnosed by two physicians.
Many conditions may result in neurological death. Some of the most common include:
- Intracranial hemorrhage
- Cerebral ischemia
- Traumatic brain injury
- Brain tumor
- CNS infection
Contact TGLN to determine donation potential and to learn the patient’s registered donation decision on the back of their Ontario Health Card and in the OHIP database. To donate organs, the patient must be on a ventilator and their heart must continue to beat; organs need to be perfused with oxygenated blood until they are recovered for transplant.
Statistics show a joint approach involving a member of the healthcare team and a TGLN coordinator with special training on speaking to families about donation is the most successful method in offering the opportunity for donation.
TGLN's Provincial Resource Centre (PRC), staffed 24/7 by a team of Clinical Services Coordinators is responsible for intake of organ and tissue donation referrals, and facilitates donation, including recovery of organs and tissue for donation. The PRC supports health care professionals; obtains consent for donation; facilitates donor testing and screening; coordinates essential logistics; and by telephone, offers organs and tissues to transplant programs and tissue banks respectively. The PRC is also responsible for looking up potential donors' registered consent decision on the Ministry of Health and Long-Term Care's database.
Call when there is a plan for mechanically ventilated patients to perform testing to confirm neurological death OR set a planned time with the family for withdrawal of life sustaining therapy (extubation or removing ventilator or IV medication supporting hemodynamics).
Other times to call TGLN:
- As per hospital policy and/or established Clinical Triggers
- Prior to offering the opportunity for donation to families
- When the patient/family is requesting information about organ and tissue donation
- Within one hour of the patient’s death
- As per hospital policy and/or established Clinical Triggers
- When the patient/family is requesting information about organ and tissue donation
During the initial call:
- TGLN will collect demographic information and ask baseline questions to determine if there is the opportunity to donate tissue
- A TGLN number will be provided to document in the medical chart
Once preliminary eligibility to donate tissue has been established:
- A TGLN coordinator who is a specialist in the area of both donation and speaking with families will arrange with the healthcare provider to speak to the family by phone while they are at the hospital
- If the family is not at the hospital, the healthcare provider will be asked to provide contact information to TGLN for follow-up with the family
- Blood samples as well as eye care instructions may be requested by TGLN
- TGLN will collect further information about the patient’s current admission and past medical history prior to contacting the families in situations where the family is not at the hospital
- As directed by TGLN, the body is then transferred to the morgue while the recovery is organized (eyes may be recovered on the unit where death occurred)
- An operating room is required for the recovery of skin, bone and cardiac tissue
- Recovery staff and OR will be arranged by TGLN
- Upon request, TGLN will contact family when recovery is complete
- TGLN (or the Eye Bank of Canada, if appropriate) will send a letter to the family to thank them for the donation and to inform them of the donation outcome
TGLN has organized the order of the clinical history questions and has worksheets available to help hospital staff streamline the process. This enables TGLN to determine if the person is eligible for donation for transplant, or research and teaching.
Yes. Consistent with the Trillium Gift of Life Network Act, telephone consent requires two witnesses to confirm the patient substitute’s identity and document consent for donation. The Provincial Resource Centre at TGLN always has a second TGLN staff member available to enable telephone consent.
Hospitals who have implemented Routine Notification are required to report every impending patient death to TGLN so that specially trained staff can identify potential donors and approach families to re-affirm consent. In late 2010, the Auditor General of Ontario recommended the expansion of Routine Notification to all hospitals with advanced ventilator capacity (necessary to maintain the viability of organs for transplant). Work continues to roll this program out across the province, with 45 hospitals on board as of March 2013.
Specially trained coordinators in the Provincial Call Centre are the first point of contact for hospital referrals, allowing TGLN to immediately begin work to determine a patient’s eligibility for organ and tissue donation.
Research indicates that experience and a person’s comfort level in speaking to families about donation impacts both the family’s experience and its choice to donate tissue. Under the Trillium Gift of Life Network Act regarding the discussion of donation, TGLN has the authority to specify the manner in which contact with the family is made. TGLN coordinators receive quarterly training in approaching families both by telephone and in person. As a result, the TGLN coordinators have higher positive consent outcomes than hospital staff when they approach families.
The ultimate responsibility for speaking with families belongs to TGLN. In situations where a healthcare provider indicates the family does not wish to donate, a TGLN coordinator may contact the family to ensure the family had the information needed to make an informed decision (e.g., a registered consent decision to donate by their loved one).
Yes. The Program for Reimbursing Expenses of Living Organ Donors (PRELOD) was launched in April 2008 to provide reimbursement of qualified expenses that may include: travel, parking, transit, meals, accommodation, and a loss of income subsidy. For program details please contact the PRELOD Administrator at firstname.lastname@example.org, or at 1-888-9-PRELOD / 416-619-2342.
Eligible visits include visits to an Ontario hospital with a living donation transplant program where a person undergoes specific testing for the purposes of organ donation. Expenses related to attending a visit to a transplant hospital are considered ‘eligible’ after the transplant hospital has determined that you are suitable to undergo further testing as a living organ donor based on your health history and blood type. The transplant hospital will document the date of each of eligible visit, the purpose of your visit, and verify that the appointment has not been cancelled. This information will be documented on the Appointment Verification Form.
Any person who donates or intends to donate an organ or part of an organ to an Ontario resident covered by the Ontario Health Insurance Program (OHIP) can apply to PRELOD. These includes potential donors who were accepted by a transplant program for further assessment and proceeded to be assessed and evaluated for the purposes of living donation, but were unable to proceed to surgery.
On August 3, 2007, the Premier of Ontario announced Ontario’s Organ Donation Strategy, which included the establishment of a reimbursement program for expenses incurred by living organ donors. Accordingly PRELOD will accept applications of reimbursement of actual and reasonable expenses of eligible living organ donors incurred on or after August 3, 2007.
PRELOD is available to anyone in Ontario, out-of-province or out-of-country who donates or intends to donate an organ or part of an organ to an Ontario resident covered by the Ontario Health Insurance Program (OHIP). At this time, Ontario living donors who donate an organ to a recipient from another province are not eligible for reimbursement through PRELOD. Other provinces within Canada have reimbursement programs or are considering development of such programs.
Eligible out-of-pocket expenses covered by PRELOD include certain travel (with distance requirements), parking/transit, meals, accommodation, meal allowance, and a subsidy for loss of income after surgery. All claims must meet the requirements as set out by the PRELOD policy (see www.giftoflife.on.ca for PRELOD eligibility requirements). In special circumstances, PRELOD may consider reimbursement to non-working living donors for childcare expenses.
Eligible out-of-pocket expenses include travel, parking/transit, meals, accommodation, and meal allowance. Eligible expenses are determined the Ministry of Health and Long-Term Care’s PRELOD policy and guidelines. At this point in time, expenses such as prescriptions are not covered by PRELOD.
The purpose of PRELOD is to assist in reducing the financial burden associated with living donation. PRELOD is a last resort program available after all other sources of funding –public or private- have been exhausted. PRELOD has been designed to meet the needs of living donors who incur the greatest expenses: donors who travel significant distances and will be away from home for long periods of time, and donors who experienced a loss of income after surgery.
Actual donors are eligible for the PRELOD loss of income subsidy only after surgery and it does not cover time off work for testing and evaluation prior to surgery. The loss of income subsidy is intended to assist those who experience a loss of income after surgery and have no other sources to support their needs. Other sources of income include but are not limited to: paid time off work (including sick and vacation time), disability benefits and Employment Insurances. Eligible applicants can apply for the loss of income subsidy after surgery for any 8-weeks in a 14-week period, but not prior to surgery.
The loss of income subsidy is available to employed or self-employed actual living organ donors who experience a loss of income after surgery, and have no other income sources available to them. The loss of income subsidy is not available to non-working actual living donors.
Reimbursement is subject to the Ministry of Health and Long-Term Care’s PRELOD policy.
Reimbursement calculation is dependent on where the applicant lives (e.g., geographical distance from place of residence to transplant program) and whether other sources are available (e.g., employment insurance). It is possible to qualify for the maximum $5,500 if expenses incurred meet the threshold of all expense categories.
Reimbursement is calculated in accordance to the policy and guidelines established by the Ministry of Health and Long-Term Care. Claims are reimbursed in accordance with the PRELOD policy. Reimbursement of eligible out-of-pocket expenses and the loss of income after surgery subsidy are subject to the PRELOD policy guidelines. All categories have an upper limit that can be claimed. For further details on eligibility criteria please review the PRELOD policy.
Trillium Gift of Life Network administers a Ministry of Health and Long-Term Care program (Transplant Patient Expense Reimbursement or TPER) to reimburse patients waiting for heart, heart-lung, or lung transplantation who are required to relocate near the transplant hospital for the purposes of transplantation. Patients may apply for reimbursement of qualified relocation accommodation expenses incurred as of May 1, 2009. For more information: TPER Background and TPER Application Form.
Only eligible out-of-pocket expenses incurred prior to surgery and the immediate post-surgery period after discharge from the hospital and prior to return home can be claimed through PRELOD. However, applicants may apply for the loss of income after surgery subsidy if they meet eligibility requirements.
If you have been assessed by an Ontario transplant program and have donated an organ to an Ontario resident, you may apply for financial assistance.
To learn more about PRELOD or TPER (including eligibility criteria) or to download an application package, visit the PRELOD/TPER Page. For program details please contact the PRELOD Administrator at email@example.com, or at 1-888-9-PRELOD / 416-619-2342.
You can make a donation to Trillium Gift of Life Network as a memorial gift (via cheque). Please include your name and address on the envelope. Trillium Gift of Life Network is a registered charitable organization and does issue tax receipts for donations over $10.00. Trillium Gift of Life Network does not engage in proactive fundraising activity. Trillium Gift of Life Network is not affiliated with, nor endorses any organization that may solicit funds from you for these purposes.
Please send the cheque to the following:
Ms. Rosemary Travers
Trillium Gift of Life Network
Suite 900, 522 University Avenue
Toronto, ON M5G 1W7