Trillium Gift of Life Network (TGLN) is a not-for-profit provincial government agency dedicated to the planning, promotion, coordination and support of organ and tissue donation and transplantation across Ontario. TGLN was created by the Ontario government’s Trillium Gift of Life Network Act in 2002 to improve the organ and tissue donation and transplant system so that more lives can be saved.
Though everyone has the potential to be an organ donor, the reality is that the opportunity for donation is rare. Only 2-3% of hospital deaths occur in circumstances that will actually permit organ donation. Potential organ donors are patients who have died of brain death or neurological death as a result of traumatic brain injuries, such as those sustained from motor vehicle accidents, falls, or other traumatic events, or an intracranial hemorrhage, stroke or aneurysm.
Donation after cardiac death is an option for families of patients who have decided to withdraw life support after a physician has determined that there is no long-term prognosis for recovery, and for those patients who do not meet the criteria for neurological death.
A far greater percentage of people who die in hospitals or at home may be suitable tissue donors. An estimated 75% of these patients who die may be eligible to become tissue donors.
Organs and tissue that can be donated include the heart, liver, kidneys, pancreas, lungs, small bowel, corneas, bone, skin, cardiovascular tissue, the islet cells of the pancreas, and connective tissue.
There is a chronic shortage of organs and tissue available for transplantation across Canada, and the need for organs and tissue in Ontario continues to outweigh their availability. As of October 2015, 1,600 Ontarians were waiting to receive life-saving organ transplants, and thousands await life-enhancing tissue transplants. In 2012, approximately 68 Ontario residents died while waiting for organs because suitable donors were not found in time.
Much medical research depends on the use of human biological material. It often provides the best way of understanding how the body works and reacts to treatment. It can also help advance and improve organ and tissue transplantation. If for some reason your organs and tissue cannot be transplanted, they can be donated for research purposes if you have specifically indicated consent to donate organs and tissue for both transplant and research.
Medical staff and transplant professionals take great precautions to avoid disease transmission through transplantation, while understanding that a small degree of risk is always present. In December 2007, Health Canada implemented the Safety of Human Cells, Tissues, and Organs for Transplantation Regulations, which ensure safety in the processing of cells, tissues and organs (CTO) in an effort to minimize the potential health risks to recipients of human CTO. The Regulations provide the requirements for donor screening, testing and suitability assessment to minimize any the risk of disease transmission in transplantation.
Laboratory testing takes place prior to organ recovery, and a detailed medical and social history of every potential donor is obtained from family members and/or others with detailed knowledge of the donor, in the determination of donor suitability. The transplant team for each transplant recipient reviews a detailed set of available information and compares any potential donor risk factors to the benefit of performing a transplant.
Donation is confidential. No one will know about your gift of life unless your family chooses to share their story.
Trillium Gift of Life Network will work with the hospitals and the transplant centres to match the tissue and blood type of the donor to an individual(s) on the waiting 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 waiting list the longest will receive the organ. If there is no suitable match within Ontario (after a local check, a regional check and then a province-wide search), a check is made through databases/ lists of prospective recipients across Canada and possibly in the United States, in order to save lives.
Please call the Trillium Gift of Life Network 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 and will help refer you to the Organ and Tissue Donation Coordinator for your area.
If you are 16 years or older, and have a photo I.D. health card or red and white health card, you can register your consent online in two minutes at BeADonor.ca, or by visiting your local ServiceOntario centre. If you have previously registered a decision of “Yes” to donate organs and tissue with Ontario Health Insurance Plan (OHIP), you do not need to re-register.
It is critical to share your decision with your family so they can understand, support and respect your decision in the future.
The online registry takes about two to three minutes to complete:
Go to www.beadonor.ca and click on “Register Now”. The link will take you to the Service Ontario online registration page. Click on “Register, check or update your consent online.” The system will then ask you for your health card number, your date of birth, and if you have a red-and-white or a green-and-white health card (the latter card has photo ID).
Enter in all this information, and click on “Register.” The system will then search through the OHIP database to see if you have already registered – and, if not, the system will then ask you to specify if you wish to donate for “transplant only,” or for “transplant/organ and tissue research”. You will also be asked if you wish to donate all/any needed organs and tissue, or if you wish to specify the organs and tissues that you do not want to donate.
At the end of the process, the system will ask you to confirm those choices. When you have done so, click “Submit” – and you have registered your consent.
When you register online, a confirmation letter will be sent to the address related to your health card. Donor cards no longer exist. When you register your consent, it is recorded in the OHIP database against your name and OHIP number, and so the information is now on your health card – and there is no need to carry anything else, such as a donor card. Your health card will have all the information needed, and it will be accessible to authorized staff when required at the time of your death in the hospital.
Go to www.beadonor.ca and click on “Check Now.” This will take you to the Service Ontario online registration page. Click on “Register, check or update your consent online.” The system will prompt you for your health card number, type of health card (red-and-white or green-and-white with photo ID), and date of birth. Enter in that information, and click on “Check or Update Registration.” The system makes a search on the OHIP database. 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.)
You can also look on the back of your green-and-white health card (with photo ID). If the word “Donor” and a two-digit code (the most common ones being “Z9” or “9Z”) present, you have registered to be a donor – and you do not need to re-register again.
If the system is not able to register you online, it may ask you to contact Service Ontario directly. There are a number of reasons that might prevent you from registering online. The most common is the address on file may be out of date.
If you cannot register online, there are two options:
- Visit any Service Ontario location and register in person, or
- Download a form from www.beadonor.ca and mail in the completed form.
The confirmation letter is sent to the address on file related to your health card. If your address is not up to date, please contact Service Ontario to update it.
Any Ontario resident who is at least 16 years of age can register their consent to donate their organs and tissues upon their death. Everyone is a potential organ and tissue donor, regardless of age, sexual orientation or health status.
The Trillium Gift of Life Network Act only permits individuals over 16 to register consent, and it does not allow parents to register their living children as organ/tissue donors. In the case of an untimely death of a child, parents will be approached and asked for their consent in the hospital if a child can be an organ/tissue donor. Your child may register himself or herself as an organ/tissue donor when he/she reaches the age of 16.
A donor card is a paper card carried by the prospective donor; it is private and meant strictly for you and for your family. Your decision to donate is only known to the extent that you share this decision with your family and friends and in many cases it is hard to find when it is required.
When you register your consent to donate organs and tissue through beadonor.ca or in person at ServiceOntario, this information is stored in a Ministry of Health and Long-Term Care database. The Ministry will disclose information about your decision to Trillium Gift of Life Network, Ontario's organ and tissue donation agency, for the purpose of ensuring that your decision to donate is known and respected. By registering your consent to donate, you ensure that your donation decision is recorded and is made available to the right people at the right time, and is shared with your loved ones.
You may withdraw your consent at any time by visiting www.BeADonor.ca and choosing to check or update your registered consent.
You may also change or withdraw your consent at any time by visiting any ServiceOntario centre, or by writing to:
Organ Donor Consent
P.O. Box 48
No. If you are a potential organ and tissue donor, your family will be approached by Trillium Gift of Life Network (and health care professionals) to discuss the option of donating your organs and tissue. Your family can consent to donate on your behalf, if you are unable to do so.
Therefore, it is important that you share your donation decision with your loved ones, so that they can fulfill your donation decision in the event of your death. If you register consent to donate, this information will be shared with your family so that they can respect your wishes. Also, you relieve them of the burden to make this decision on your behalf.
Our goal is to increase organ and tissue donation in Ontario. Our research shows jurisdictions that have instituted a “Yes” only registry have experienced an increase in donor registrations.
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. The health care professional teams responsible for supporting donation are separate and independent from the health care professional teams responsible for transplantation.
Yes. Organ and tissue donation is a provincial program, and so if you wish to be part of the organ and tissue donation registry maintained by the Ontario Health Insurance Plan (OHIP), you need to register in this province. You can do so at www.BeADonor.ca. Remember to talk to your family and loved ones about your decision, so they can understand and respect it in the future.
Our research indicates that Ontarians don’t generally support presumed consent because they see organ and tissue donation as a gift. Unfortunately, until our registration rate matches the support we know exists for donation, this question will continue to arise. TGLN is working to build a culture in which everyone has the opportunity to make a decision about registering consent to organ and tissue donation. In a 2015 opinion survey, 66% of Ontarians stated that they believed organ donation in the province should be an opt-in system. More: Organ donation - Opt-In vs. Opt-Out infographic
Even individuals with serious illnesses can, sometimes, be organ or tissue donors. No one will be automatically turned away because he/she currently has, or had in the past, a certain disease or illness. No single case will be exactly like any other case, and so each donor will be tested and evaluated on an individual, medical, case-by-case basis. The doctors will perform all required checks to see if any prospective recipients match the prospective donor’s organs/tissues that are medically suitable for transplant.
Everyone is a potential organ and tissue donor, regardless of age, sexual orientation or health status. To register, visit www.BeADonor.ca.
A transplant is a type of surgery where an organ or tissue is removed from one person (the donor) and given to another (the recipient) to replace the recipient’s damaged organ or tissue. An organ is a part of the body, made up of various types of tissues that perform a particular function and a tissue is an collection of similar cells that perform a special function.
A part of the body, made up of various types of tissues that perform a particular function. Organs that can be transplanted are the liver, small bowel, (liver/small bowel can be transplanted at the same time), kidney, pancreas, (kidney/pancreas can be transplanted at the same time), heart, lung, (heart/lung can be transplanted at the same time).
The transplantation of multiple tissues: muscle, bone, nerve and skin as a functional unit. Examples of VCA include: upper limb (hand), facial tissue and abdominal wall.
Ontarians must wait for organ and tissue transplants because there aren’t enough donors to meet the need. Ultimately, more registered donors will increase the number of organs and tissue available for transplant. To register your consent to organ and tissue donation, visit www.BeADonor.ca.
Once you are added to the organ waiting list, you may receive an organ that day, or you may wait many years. Factors affecting how long you wait include how well you match with the donor, how sick you are, and how many donors are available in your local area compared to the number of patients waiting.
Many different medical and logistical characteristics 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. Hearts and livers are matched by size, urgency, and time waiting. Kidneys are assigned by genetic matching (DNA) and time waiting. Size is sometimes taken into consideration.
No, TGLN only oversees transplantation in Ontario and its territories.
Once the transplant physicians make the decision to list a patient, that person is then registered on the waiting list database that is managed by TGLN. Patients on the waiting list are categorized by factors such as blood/tissue type, health status and length of time waiting.
Hospitals notify TGLN that there is a potential donor and specially trained coordinators work with family members to determine if they would like 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.
TGLN 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 (OR) where the patient is to receive the transplant.
University Health Network – Toronto General Hospital – kidney, kidney/pancreas combination, pancreas, heart, lung, heart/lung, liver, small bowel, multivisceral, liver/bowel/stomach
St. Michael’s Hospital – kidney transplants only
Hospital for Sick Children – kidney, heart, liver, lung, small bowel, liver/bowel
London Health Sciences Centre – University Campus – kidney, kidney/pancreas combination, liver and heart, and small bowel (Children only)
The Ottawa Hospital – kidney
The Ottawa Heart Institute – heart
Kingston General Hospital – kidney
St. Joseph’s Hospital – kidney
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).
In general, for organ donation and the donation of corneas, skin, bone and heart valves, a hospital setting is required – for access to the skills of the doctors and surgeons, for the sterilized equipment and the operating room, and for the ventilator/ breathing machine that will keep blood and oxygen flowing to the organs until they can be recovered in surgery.
Every year in Ontario, more than 2,000 people have their lives enhanced or saved by tissue transplants. But as is also the case for organ donation, there are many more people who could benefit from transplants than there are tissue donations. Because the need is greater than the amount of donated tissue available, some operations have to be delayed or cancelled; some people who need help don't get it. You can change that. Your decision to give the gift of life can make a difference. Register your consent to donate and talk with your family about your decision.
Corneas, skin, bone, cardiovascular tissue (heart valves and veins) and connective tissue (tendons, ligaments) are the most common types of tissue transplanted. One donor can provide tissue for as many as 75 recipients.
Donated tissue is used for reconstructing bones and joints; for repairing damaged hearts; for renewing eyesight; and for saving burn survivors' lives through skin donation.
Donated tissue is surgically removed with great care as soon as possible after death. These procedures do not cause a significant delay in funeral arrangements nor do they interfere with an open casket viewing for the donor.
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. TGLN 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.
Donating your organs and tissues for research is different than donating your body to science. If you do not wish to donate organs, you may want to support teaching and research activities at a medical school by considering whole body donation, an important gift to the training of professionals in health-related disciplines.
For more information about whole body donation, please call the anatomy school of your choice. 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.
Trillium Gift of Life Network is mandated to support organ and tissue donation across Ontario. Whole body donation is administered by schools of anatomy. You must choose either organ/tissue donation or whole body donation; you cannot do both.
Here is a list of universities in Ontario with medical schools/schools of anatomy, and their telephone numbers:
Department of Anatomy
Faculty of Health Sciences
1200 Main Street West
|University of Ottawa|
Health Sciences Centre
School of Medicine
Department of Anatomy
451 Smyth Road
Department of Anatomy
|University of Toronto|
Department of Anatomy
Medical Sciences Building
|University of Waterloo|
School of Anatomy
200 University Avenue West
|University of Western Ontario|
Department of Anatomy
Health Sciences Centre
|Canadian Memorial Chiropractic|
Department of Anatomy
1900 Bayview Avenue
|University of Guelph|
Department of Human Health and
Human Anatomy Program
24-Hour "Human Body Donation" Line:
No. TGLN is not involved in the recovery of brain tissue for medical research.
Living donation occurs when a living person donates an organ or part of an organ for transplant to another person in need. At this time living donation is possible only for kidney and liver transplants, though research is being done to facilitate living donation of other organs.
There are currently four types of living kidney donation in Canada:
Living donors are brothers and sisters, parents, children 18 years of age and older as well as other blood relatives, including aunts, uncles, cousins, half-siblings, nieces and nephews.
Living donors are spouses, partners, in-law relatives, close friends, and co-workers.
Paired exchange is when two separate but willing donors are each unable to donate to their intended recipients due to blood group (ABO) incompatibility or more rarely because of incompatibility of cross matching. In this program, the willing donors are matched with the other's respective recipient so that each recipient can receive a kidney with a compatible blood type. The Living Donor Paired Exchange (LDPE) registry is administered by Canadian Blood Services.
An anonymous donor is a person who does not know the intended recipient, but donates to a person in need at the top of the transplant waiting list. The first step for anyone wishing to be an anonymous donor is to contact the transplant coordinator at the transplant hospital nearest to them. For more information, please see the Canadian Blood Services website: Living Donation.
The first step for anyone wishing to be an anonymous donor is to contact the transplant coordinator at the transplant hospital nearest to them. For more information, please see the Canadian Blood Services website: Living Donation.
Canadian Blood Services manages the One Match registry for bone marrow and stem cell donation and research, as well as blood donation. To find out more information, please call the “One Match” Registry at 1-877-366-6717, or visit the web site at www.blood.ca.
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, meal allowance 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. Although donors prior to August 3, 2007 are not eligible for reimbursement through PRELOD, Trillium Gift of Life Network acknowledges the altruistic gift made by potential and actual living organ donors.
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. If you donated an organ to a resident of British Columbia (B.C.), contact the Kidney Foundation of Canada – B.C. Branch for information on their Living Organ Donation Expense Reimbursement Program (LODERP). In addition, the Government of Manitoba has announced its plans to create a living donor reimbursement program. Contact the Government of Manitoba for further details.
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. Contact the PRELOD Administrator for further details at 1-888-9-PRELOD or PRELOD@giftoflife.on.ca.
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.
Contact the PRELOD Administrator for full eligibility requirements (1-888-9-PRELOD or PRELOD@giftoflife.on.ca).
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. If you have any further questions or comments, please contact PRELOD at PRELOD@giftoflife.on.ca, or at 1-888-9-PRELOD.
You can make a donation to TGLN as a memorial gift (via cheque). Please include your name and address on the envelope. TGLN is a registered charitable organization and does issue tax receipts for donations over $10.00. TGLN does not engage in proactive fundraising activity. TGLN 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
It is illegal to buy or sell organs in this country and in most countries around the world.
No. It is illegal to buy or sell organs in this country. If there is no medical match for the organs among persons on the Ontario waiting list (after a local, regional and provincial search for a match), then medical personnel will check lists in all provinces across Canada – and if no match is found, then they will check lists in the United States. All these checks will be based on medical criteria.
No. Income tax receipts are not issued to organ or tissue donors.
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).
It is Trillium Gift of Life Network’s practice to reaffirm an individual’s consent to donate with the family. In almost all cases, families honour and respect their loved ones’ donation decision if they are given evidence that it’s what the loved one wanted. Therefore it is important to register your consent to donate so that your family can be advised of your decision.
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).
Any person who has attained the age of sixteen years may give consent to be an organ and tissue donor.
Donation can occur with registered consent in the Ontario Health Insurance Plan (OHIP) database in cases where there is no will or next of kin for the deceased.
Yes. As you go through the process to register consent (either online at www.BeADonor.ca or in person at a ServiceOntario centre) you will be asked if you would like to restrict consent to certain organs and tissue.
Eligibility to donate is assessed at the time of death by Trillium Gift of Life Network Coordinators, the Transplant Programs and the Tissue Banks. Most diseases do not automatically exclude a person from donating.
A medical social history interview, similar to the one completed to donate blood, is performed with the family.
Every organ is tested for suitability to ensure that as many people as possible can be helped through transplant.
Organs or tissue not suitable for transplantation can be used for scientific research and medical education. Currently important research is being done on diseases that affect organ and tissue.
As of March 2013, 45 hospitals with advanced ventilator capacity (necessary to maintain the viability of organs for transplant) are required to report potential donors to TGLN so that specially trained staff can identify potential donors and approach families to re-affirm consent. Work continues to expand this program to qualifying hospitals across the province.
If a person is identified as a potential organ donor in a community that does not have a hospital with the capability of facilitating the donation process, Trillium Gift of Life Network will pay the cost of transporting the potential donor’s body to the nearest hospital that does have the capability and the facilities for the subsequent tests and surgery required. Trillium Gift of Life Network will pay for the return of the donor’s body from that hospital back to the donor’s home community for the subsequent funeral arrangements.
If you wish to be an organ/tissue donor, and your death occurs outside the province of Ontario, you may still be considered for organ/tissue donation in the province/state where the death occurred; that will depend upon the presence and availability of organ/tissue donation programs in that Canadian province, American state, or other foreign jurisdiction. It is very important to share your wishes with your family so they understand what you would have wanted in any situation. Please note that, in another jurisdiction, certain health care costs (outside of the tests and surgery for transplant) may be charged to the family.
Trillium Gift of Life Network’s mandate and jurisdiction remain strictly within the province of Ontario.
A foreign citizen who dies in Ontario could also be an organ/tissue donor, if the family gives the final consent.
Every effort is made to schedule the recovery of organs and tissue in a timely fashion to avoid any delay in making funeral arrangements. The TGLN coordinator who worked with your family will fully discuss this matter with you, and make every effort to ensure that the donation process takes place while meeting your family’s needs. Serological and other medical tests, and the surgery, all take place usually within 24 - 36 hours (on average) from the time of consent.
Yes. Your body will be returned to the family, in the hospital, as soon as possible after the recovery surgery has been completed. On average, there will be a delay of 24 - 36 hours due to the time required for the medical and serological tests and the subsequent surgery to recover organs and tissue.
You may have an open casket at the funeral if you wish. Organ and tissue recovery takes place with surgical skill, respect and dignity, in an operating room environment where the medical team members are very sensitive to the dignity of the donor and his/her family.
A very thin film of skin tissue (the equivalent of a one-ply tissue) is generally recovered from the front or the back of the legs, and/or from the stomach/abdomen and the back. Prosthetics are put in the place of removed bone tissue.
It is important to think about what clothing you may wish to dress your loved one in if your family intends to have an open casket viewing. If you choose to dress them in something that is sleeveless, and have consented to bone donation, you should bring this to the coordinator’s attention so that the bones from the arms are not recovered.
In the case of corneas, a thin removal takes place from the back of the eye; in the case of eye recovery, a prosthetic eye cap is placed under the eyelid as a replacement. The surgery will not have a significant effect upon the appearance of the body in the casket.
For more information on the financial implications of cremation, please contact the Board of Funeral Services at the following address:
The Board of Funeral Services
777 Bay Street
Tel.: (416) 979-5450, or 1-800-387-4458
Fax: (416) 979-0384
No. Your family will still be required to pay the funeral expenses.
Most major religions support organ and tissue donation because it can save the life of another. Our section on The importance of culture and religion will provide you with more information about religious and cultural perspectives on organ and tissue donation.
If you have questions about how your faith views organ donation, consult your religious leader.