Focus on Transplantation


This section of the Trillium Gift of Life Network (TGLN) website provides basic information to those waiting for an organ and tissue transplant and those that have received the gift of life. TGLN, in collaboration with the Ministry of Health and Long-Term Care, is overseeing and managing the Transplant Program for the Government of Ontario.



Responsibilities include:

Icon1 Working with key system stakeholders to ensure standards of practice are developed and implemented for all patients. Icon4 Putting plans in place to meet the needs of current and future transplants.
Icon2 Directing, monitoring and overseeing the system to ensure that accountability measures for transplant services are aligned. Icon5 Working with key transplant professionals and organizations to identify standards for continuous improvement. TGLN Transplant Stakeholder Publications (January 2013 - May 2014)
Icon3 Using electronic information and technology to support healthcare professionals to improve safety, quality and efficiency TGLN continues to grow the awareness and importance of organ and tissue donation and transplantation in the drive to save and enhance lives.    

 

What is a Transplant?

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. A tissue is a collection of similar cells that perform a special function. There are hundreds of diseases that affect organs and tissues to the point that a transplant is required, but not everybody that suffers from disease requires one.

Organ Transplantation Tissue Transplantation VCA Transplantation

Organ Transplants

Organs that can be transplanted are the liver, small bowel, kidney, pancreas, heart, and lung.

Kidney
Seventy one percent of people on the waiting list need one.

A kidney transplant operation places a healthy kidney in your body. This kidney takes over the work of the two kidneys that failed, so you no longer need dialysis. Transplanted kidneys come from a deceased or living donor.

Often, the new kidney will start making urine as soon as your blood starts flowing through it.

After surgery, most patients return to work and their normal levels of activity.

Liver
Stores iron reserves, as well as vitamins and minerals.
Your liver helps fight infection and cleans your blood. It helps digest food and stores energy for when you need it. Transplanted livers can come from a deceased or living donor. Doctors do liver transplants when other treatment options fail. Post surgery, you will need to take medication to prevent organ rejection.
Lungs
An average person breathes in around 11,000 litres of air every day.

Lung transplant surgery can replace one or both diseased lungs. Lungs can come from either a deceased or living donor.

A transplant may be recommended if you have chronic obstructive pulmonary disease, cystic fibrosis, idiopathic pulmonary fibrosis, interstitial lung diseases, or primary pulmonary hypertension, among others.

Heart
A healthy heart pumps approximately 2,000 gallons of blood a day.

A heart transplant replaces a damaged/diseased heart with a healthy one from a donor who has died. This is the final treatment option for people with heart failure where all other options have failed. Heart failure may occur due to congenital heart disease, coronary heart disease, damaged heart valves, heart muscles, or viral infections.

As with other transplants, you must take medication to prevent your body from rejecting the new heart.

Islet Cells
The pancreas helps to control blood sugar by producing hormones such as insulin and glucagon.
Islet cell transplantation replaces only the part of the pancreas that makes insulin. It is a treatment for people with type 1 diabetes who have trouble controlling their blood sugar level. Islet transplants are done alone or together with a kidney transplant. Transplanted islet cells come from deceased donors.
Pancreas
The Pancreas is the storage depot for the digestive enzymes.

The pancreas makes insulin and enzymes that help the body digest and use food. A pancreas transplant is surgery to place a healthy pancreas from a deceased donor into a person with a diseased pancreas. A common reason for this type of damage is diabetes.

People who have transplants must take medication to keep their body from rejecting the new organ.

Small Bowel
The intestine's walls are thin, but they are folded, so that their surface is large.

Small bowel transplant replaces a diseased or shortened small bowel with a healthy bowel from a donor. A small bowel transplant is considered when complications develop from total parenteral nutrition (TPN) or when a person is unable to tolerate this form of feeding. TPN nutrition is where liquid nutrition is given through a drip. After surgery, you will need to take medication to prevent organ rejection.

Tissue Transplants

Tissue transplantation includes corneas, skin, bone, cardiovascular tissue the islet cells of the pancreas and connective tissue. One donor can provide tissue for many recipients undergoing various procedures.

Cornea
Your eye contains 107 million cells which are sensitive to light.
Your cornea is the transparent, dome-shaped surface of your eye. It provides two-thirds of your eye's focusing power. Cornea transplant surgery replaces part of your cornea with corneal tissue from a person who has died. Surgery can restore vision, reduce pain and improve the appearance of a damaged or diseased cornea.
Skin
Skin accounts for around 15% of your bodyweight.
Skin is one of the most common types of tissue transplanted. Some people think that age determines whether they can register to donate their skin - The fact is, everyone is a potential donor. Skin is life-saving for critically burned patients. It is also used for hernia repair, pelvic floor reconstruction, and for breast reconstruction following mastectomy. One tissue donor can enhance the lives of 75 people.
Cardiovascular
The heart beats about 100,000 times each day.
Cardiovascular tissue transplant surgery commonly replaces poorly functioning heart valves and veins. Surgery improves the health and vigor of people with heart valve disease. A replacement valve may be taken from a person that has died and agreed to donate their tissue. Cardiovascular tissue is one of the most common types of tissue transplanted.
Bone
Over half the body's bones are in the hands and feet.

Bone grafts repair or rebuild diseased bone in hips, knees, spine and other joints - often as a result of fractures or cancers. Once your body accepts the bone graft, it provides a framework for growth of new, living bone.

Bone for transplant comes from donors who have died.

Connective Tissue
Ligaments are made up of bundles of tough collagen and strechy elastin.
Reasons for connective tissue transplantation might be due to trauma or cancer. Connective tissue is like 'cellular glue'. It is the material inside your body that gives tissues shape and keeps them strong. Tendons and ligaments are examples of connective tissue. Tissues are surgically removed with great care and respect without significantly impacting funeral arrangements.

VCA Transplantation

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.

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Canada's Firsts

One of the most successful achievements in the history of medicine is in the world of transplantation. Regardless of the medical and technological advancements, more needs to be done. Canada is still faced with a greater need for organs and tissue than the number available for transplantation.

Here are some of Canada’s significant ‘firsts’.



Preparing for Transplant

Even though the list of people waiting for a lifesaving or transforming transplant continues to be long, the success rates for transplants continue to improve each year. If you are thinking about transplantation or are already on the organ/tissue transplant waiting list, you probably have lots of questions. The following pages provide a few basic answers to help you as you move through your transplantation journey. Don’t be afraid to raise any questions with your healthcare team at your transplant centre.

 

 

Find a designated transplant centre near you by clicking the pins on the map of Ontario.

 

Transplant Process

The 6 Steps

Icon Pre-Listed

Pre-Listed

Step 1: Diagnosis and Referral
Step 2: Assessment for Suitability
Icon Listed

Listed

Step 3: The Waitlist
Step 4: Managing Patient Care (Health & Financial)
Step 5: Planning Ahead
Icon Post

P
ost

Step 6: Post-Transplant Care and Follow-up
Download Questions for Your Transplant Team

Pre-Listed Pre-Listed

Step 1: Diagnosis and Referral

A diagnosis by your primary care physician is the first step you need to take. This could mean your family physician, general practitioner or members of your family health team. Once you and your primary care physician have discussed transplantation as an option and agreed to move forward, you will be referred to a team of specialists in the Transplant Centre.

 

Step 2: Assessment for Suitability

You will be invited to meet the specialists at the Transplant Program to determine your suitability for transplantation. You will need to undergo relevant medical and psychological assessments. If the results of your assessment indicate that you are a suitable candidate and you determine to move forward for transplantation, you will be placed on the waitlist. The specialists along with other healthcare professionals are part of the transplant team that will be treating you throughout your journey. Should transplantation be deemed unneeded or unsafe, alternative options will be presented to you.

Consider the following:

  • Do I have a choice other than transplantation?
  • What are the benefits and risks?
  • What are the organ and patient survival rates for my type of transplant at this hospital?
  • How many of my type of transplant do you perform each year?
  • How long have you been doing them?
  • When an organ is available for transplant how do you decide who will get it?
  • How long will I have to wait for a transplant?
  • Does the hospital do living donor transplants?
  • Is a living donor transplant a choice in my case?

Listed Listed

Step 3: The Waitlist
Once you and your transplant team have agreed to pursue transplantation, you will be placed on the waitlist.

Organ Matching Guidelines

Donation and recipient matching is conducted 24 hours a day, 365 days a year. Once a donor organ is deemed suitable there is a matching system to ensure that the distribution of organs is based on fair criteria. These may include suitable blood type match, medical urgency, the amount of time already spent on the waiting list, the size of the organ(s) needed, and other factors.

Step 4: Managing Patient Care
Since an organ can become available at any time, it is important to stay as healthy as possible. This not only ensures that you are ready for surgery, but can also enhance your recovery afterwards. There are many ways for you to manage your health while on the waitlist. Your transplant team and primary care physician will be able to help.

Consider the following:

  • Attend scheduled appointments with healthcare providers including blood testing, if required
  • Refrain from smoking and drinking alcohol
  • Practice oral hygiene
  • Follow prescribed medications and treatments
  • Control body weight and blood pressure
  • Stay active and/or exercise
  • Limit exposure to direct sunlight
  • Undergo regularly scheduled cancer screening
  • Keep up-to-date records of your medical information

Financial Assistance

Many patients waiting for heart, heart-lung or lung transplantation face financial barriers in accessing transplantation. This is because patients are often required to relocate in order to access the waitlist, receive on-going assessment, and be provided with follow-up care.

The Transplant Patient Expense Reimbursement (TPER) program, funded by the Ministry of Health and Long-Term Care, was created to relieve some of the financial burden to the patient. The program provides reimbursement to transplant patients for limited accommodation-related expenses. If the transplant hospital requires the patient to temporarily relocate closer to the transplant hospital to access a life-saving transplant, some of the costs for the patient may be covered.

 

TPER Application Form
TPER Backgrounder
Support for Relocation
(transplant coordinators only)
Pre-payment
Eligibility

Step 5: Planning Ahead

Carefully plan your transplant and be sure to include your caregivers and family in this process. It is also very important to prepare yourself emotionally, educationally and spiritually. Support and preparatory tools are available through your Transplant Program. Don’t be afraid to ask or to seek help from your team.

Icon1Identify transportation routes to the transplant centre
Icon2Pre-pack a bag of clothing and toiletries in anticipation of your stay at the hosptial
Icon3Prepare a list of your contact coordinates (telephone/email) for your caregiver(s), family, and friends
Icon4Organize banking and other personal affairs in advance
Icon5Pre-arrange care for your dependents/pets

Receiving Notification

It is vital that you answer your telephone/pager at all times. The Transplant Program may be calling you regarding an available organ.

In most cases, they will ask you to stop eating and/or drinking in preparation for the surgery. You may receive additional instructions such as discontinuing certain medication in advance of your arrival at the hospital. You will be asked to report to a specific section of the hospital, at a certain time, to prepare for the surgery.



Following your transplant surgery...


Immediately after your surgery, you will be placed under the care of experts in an intensive care unit (ICU). The length of hospital stay after the surgery will vary by patient and type of transplant. As you progress in your recovery, you will be moved to a rehabilitation unit. Once you are well enough to be discharged from the hospital, you will be released with appropriate instructions for your ongoing care at home.





If you have further questions,
please see the FAQs or contact TGLN

Thank you note



Thinking of writing
to your Donor's
Family?

In Canada, the identities of the recipient, the donor and both their families are kept confidential out of respect for everyone’s right to personal privacy. For this reason, all correspondence is anonymous.

Even without a name, your message can be one of the most powerful and meaningful acknowledgements a donor’s family will ever receive.


 

beadonor.ca



Interested in registering your
consent to donate?

Organ donation from one individual can help up to 8 others. Tissue donation from one individual can help up to 75 others.

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Living donation advantages

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Living donation has the potential to reduce wait times to a matter of months rather than possibly years for deceased donation.

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Typically, the organ donated by a living donor is healthier at the time of the operation. This often leads to a better-functioning organ and longer graft survival.

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From the donor’s perspective, there is often a sense of pride in saving or improving the life of another.

Did you know?

Reimbursement Program

To minimize the potential financial burdens associated with the living donation process, the Government of Ontario established the Program for Reimbursing Expenses of Living Organ Donors (PRELOD). PRELOD reimburses eligible reasonable out-of-pocket expenses for costs incurred by potential and actual donors for travel, parking, meals, accommodation and loss of income. Potential and actual Living Organ Donors may apply to PRELOD for reimbursement of eligible expenses.


All PRELOD application forms are available for download

Application
Checklist
Prelod
Application
Income and Benefit Verification
Loss of income certificate
Consent to share personal information 
Travel Support Letter


Please note that additional supporting documentation may be required for verification of applications. For hard copy versions of the application forms, please visit your Transplant Hospital. If you are having difficulty completing the forms or following the process, refer to the Income Loss Form Guideline and the ‘sample’ forms for additional help.


For more information on PRELOD

FAQ - Public
FAQ - Transplant Hospitals
Backgrounder for Transplant Program

Types of Living Donation

Icon Related Related

Living donors are blood relatives. They can be brothers, sisters, parents, aunts, uncles, cousins, half-siblings, nieces and nephews.

Icon Non-Related Non-related

Living donors are spouses, partners, in-law relatives, close friends, and co-workers.

Icon Paired Exchange Paired Exchange (Kidney)

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. 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.

Icon Anonymous Anonymous

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.
Living Kidney Donation Living Liver Donation

Living Kidney Donation

A healthy kidney regulates water, removes waste from the blood, balances chemicals in the body, regulates the building of bones, regulates blood pressure, and controls the production of red blood cells.

If one kidney is damaged, the other kidney can enlarge and do the work of two. Unfortunately, if both kidneys fail, waste and fluids will accumulate in the body necessitating dialysis treatment (the cleaning of blood either by a machine or in the abdomen) or a kidney transplant.

Living donor kidney transplants now exceed the number of transplants performed from deceased donors. As a result, there are more organs available for transplantation. In Ontario, the majority of people waiting for an organ transplant are waiting for a kidney. Although transplantation - from either a living or a deceased donor - is not a cure for kidney disease, it may prolong and enhance one's quality of life.

For more information on kidney disease please go to www.kidney.ca.



Who can donate?

Living kidney donors must be older than 18 and generally less than 70 years of age, in good general health without any evidence of significant high blood pressure, diabetes, cancer, kidney disease and heart disease or hepatitis. Gender and race are not factors in determining who can donate.

Making the decision

This decision to offer to donate is yours alone to make.
Speak with the social worker or counselor affiliated with the transplant team or a living donation coordinator. You will have a better sense of how prepared you are to donate through these discussions.

Talk to family members, close friends, a religious or spiritual leader or someone who has donated already to get more information and support. When a potential donor has access to another living donor and others such as living donor support groups, they are better prepared to make a decision.

What to expect after donation

While the consequences of donating a kidney are minimal and few, there are some precautions that should be taken. For instance, rough contact sports such as football and hockey that could damage the remaining kidney are not advised. Any kidney donor who becomes pregnant after donating should let her physician know so that as a precaution, kidney function can be monitored.

Living Liver Donation

The liver carries out many functions and damage to it can affect every major organ in the body.

Liver impairment can affect the body's ability to absorb life-enhancing vitamins and nutrients, prevent waste products from being effectively eliminated and reduce the production of proteins. When the liver is damaged, energy levels plummet, the blood loses its ability to clot, concentration becomes poor and heart and lung function deteriorates.

Although the liver often can recover from injury, extensive disease throughout the entire organ sometimes makes this impossible. When 80-90% of liver function is lost, a liver transplant is the only treatment option. Living donor liver transplantation, made possible by the unique ability of the liver to regenerate within 6-8 weeks, is a life saving procedure.

For more information on liver disease please go to www.liver.ca

Who can donate?

A potential donor must be older than 18 years of age and younger than 60 years of age. The potential donor must be in good overall health and physical condition, have a liver that is the right size for the recipient and have a blood type that is compatible with the recipient. The other consideration is that the donor must have a Body Mass Index of < 35 to be worked up for consideration of being a liver donor. At the time of surgery, the BMI can be no greater than 32.

Making the decision

It is important that you discuss your decision to donate with the transplant team, a living donation coordinator, as well as with the recipient and the families involved.

The transplant team will determine whether or not you are mentally, emotionally and physically fit to become a donor. The good news is that the evaluation process takes place in stages, leaving time between appointments for a donor to discuss any questions or concerns as they arise. If at any time you decide that donating is not for you, you should inform your contact on the transplant team right away.

What to expect after donation

Most donors are in the hospital for 5-10 days and experience pain and discomfort for about 4-6 weeks after surgery, particularly during the first week. A living liver transplant donor needs time to rest and recover from surgery and it is recommended that 8-10 weeks be allowed for this before returning to work.

Barring any post-operative complications, the living liver donor can expect to return to a completely normal life within 2-3 months of surgery and to remain healthy for the rest of his or her natural life. The procedure is major surgery, so monitoring in the immediate post-operative period is very important.

Click here for our complete Living Liver Donation information package.
 

Tissue Banks

Tissue Handled 
Ocular Tissue

Location            
Eye Bank of Canada (Ontario Division)
1929 Bayview Avenue, Suite 203
Toronto, ON M4G 3E8

Contact Information 
Linda Sharpen, Manager
Phone: (416) 978-2637
Fax: (416) 978-1522
Email: eyebank@utoronto.ca 
Web: www.eyebank.utoronto.ca

Tissue Handled 
Cardiovascular Tissue Heart Valves, Pericardium

Location                  
Paediatric Laboratory Medicine, Hospital for Sick Children
555 University Avenue, Room 3677
Toronto, ON  M5G 1X8

Contact Information 
Sonny Lazaro, Supervisor
Phone: (416) 813-5423
Email: bienvenidosonny.lazaro@sickkids.ca 
Web: www.sickkids.on.ca

Tissue Handled 
Skin

Location 
Clinical Pathology
Sunnybrook Health Sciences Centre
2075 Bayview Ave.
Room B-219
Toronto, ON M4N 3M5

Contact Information 
Lisa Merkley, Supervisor
Phone: (416) 480-6100 ext. 7391
Fax: (416) 480-4185
Email: lisa.merkley@sunnybrook.ca

Tissue Handled 
Musculoskeletal and Femoral heads

Location 
Douglas Lab II
Transfusion Medicine
76 Stuart St.
Kingston, ON  K7L 2V7

Contact Information 
Dr. Lois Shepherd, Medical Director
Phone: (613) 549-6666 Ext. 4166
Fax: (613) 548-6076
Email: shepherd@cliff.path.queensu.ca

Tissue Handled 
Musculoskeletal & Connective tissue

Location 
The Ottawa Hospital - Civic Campus
Transfusion Medicine
501 Smyth Road
Ottawa, ON  K1H 8L6

Contact Information
Dr. Paul Kim, Medical Director
Phone: (613) 737-7777 ext. 78774
E-mail: pkim@ottawahospital.on.ca 

Doris Neurath, Manager
Phone: (613) 737-8301
Fax: (613) 761-4974
Email: dneurath@ottawahospital.on.ca

Tissue Handled 
Musculoskeletal & Connective tissue; Femoral Heads

Location 
Pathology Dept.
700 University Avenue, 8th Floor, Room 8-400-6
Toronto, ON M5G 1Z5

Contact Information                    
Dr. David Howarth, Medical Director
Phone: (416) 586-8870
Email: dhowarth@mtsinai.on.ca 

Balram Sukhu, Manager
Phone: (416) 586-4800, ext. 7929
Fax: (416) 586-8628
Email: bsukhu@mtsinai.on.ca

Tissue Handled 
Musculoskeletal

Location 
290 Munro Street, Suite 2000
Thunder Bay, ON  P7A 7T1

Contact Information 
Ms. Heather Hill, Tissue Processing Manager
Telephone: (807) 346-2265
Email: hhill@regenmed.ca 
Web: www.regenmed.ca

Tissue Handled 
Femoral heads

Location 
Laboratory Medicine and OR
3045 Baseline Rd.
Nepean, ON
K2H 8P4

Contact Information 
Diane Varette
Bone Bank Coordinator
Phone: 416- 864-3036
Email: dvarette@qch.on.ca

Tissue Handled 
Femoral heads

Location 
Juravinski Hospital
711 Concession St.
Hamilton, ON 
L8V 1C3

Contact Information 
Debra Harrison, Technical Coordinator
Phone: 905-389-4411 ext 42755
Email: harrideb@hhsc.ca

Tissue Handled 
Femoral heads

Location 
30 Bond Street
Toronto, ON 
M5B 1W8

Contact Information 
Yvonne Davis-Read, R.N.
Bone Bank Coordinator
Phone: 416- 864-3036
Email: davisy@smh.toronto.on.ca

Tissue Handled 
Femoral heads

Location 
2075 Bayview Avenue
Toronto, ON 
M4N 3M5

Contact Information 
Lisa Merkley, Manager
Phone: (416) 480-6100 ext. 7391
Fax: (416) 480-4185
Email: lisa.merkley@swchsc.on.ca

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