A medical team in London, Ont., has achieved a Canadian first: a groundbreaking technique that boosts the viability of donor organs.
This breakthrough offers new hope for transplant patients by significantly increasing the pool of available organs, potentially saving countless lives.
The technique, called abdominal normothermic regional perfusion (A-NRP), works by pumping blood to abdominal organs after circulatory death (when the heart stops beating). This allows organs to be re-oxygenated and warmed to normal body temperature — minimizing damage and enhancing their chances of survival after transplantation.
The team at Lawson Health Research Institute, led by Dr. Anton Skaro, is pioneering the use of A-NRP in Canada. They believe this technique has the potential to increase organ transplants in Canada.
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“The biggest challenge that transplant physicians and surgeons face is organ shortage. There are just not enough organs to go around. And patients die every year on the wait-list in the hundreds to thousands range in Canada,” said Skaro, director of livery transplant surgery at the London Health Sciences Centre.
“There are many donors and donor families with wonderful intentions to donate this beautiful gift of life. Unfortunately, through the dying process, many of those organs are just too damaged to be safely transplanted.”
Of the 952 deceased donors in 2023, 67 per cent donated following neurological determination of death, often known as brain death, and 27 per cent donated following death determination by circulatory criteria, often known as cardiac death.
Circulatory death and organ donation
Organ donation after circulatory death is historically been less reliable compared with brain death donations, Skaro said. This is because there is a higher risk of organ damage after circulatory death since oxygen and blood flow stop.
Once a patient’s heart stops beating, blood pressure drops and the circulation of oxygen and nutrients to the organs is compromised. This leads to a condition called warm ischemia, which irreparably damages the metabolic machinery of the organs, Skaro explained.
“Unfortunately, through the dying process, the organs are very seriously damaged and many of them are not rendered suitable for transplantation … and that’s a heartbreaking situation,” he said.
However, the use of A-NRP has the potential to protect organs after circulatory death and could significantly increase the likelihood of successful transplants.
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How it works
A-NRP works by using a specialized pump to restore blood flow to the abdominal organs of a donor after circulatory death, Skaro explained.
“After death declaration, there’s a mandatory five-minute period of time that we call a hands-off period. And that’s to reduce the likelihood that the patient can auto-resuscitate spontaneously,” he said.
“Once that’s done, the patient is brought to the operating room. And at that point, we exclude the abdomen from the rest of the body and then insert cannulas (flexible tubes) into the artery and vein and then start circulating blood to the abdominal organs.”
This allows the organs to receive a fresh supply of oxygen and blood, aiding in their recovery after the damage incurred during the dying process.
An image of the machine using the A-NRP technique.
London Health Sciences Centre
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“We’re able to get rid of many of the toxic agents that are circulating within the organs that compromise their function,” Skaro said. “And so, essentially, what we’re doing is preconditioning that organ, so that it’s able to replenish its energy, replenish its molecules that are capable of counteracting this injury. And so they behave and perform far better during the transplantation.”
He said using this method is a great opportunity to not only “vastly increase the organ supply” but also provide better quality organs.
While the procedure is a first in Canada, it has been used in other nations, including in Europe, he explained.
The technology required for this has been available for a long time in Canada — Skaro described it as a portable heart and lung machine typically used to transport patients who have experienced cardiac arrest. However, his team has adapted this pump and integrated it into the organ donation process as well.
“We’re using these amazing techniques, thinking outside the box to try and solve our organ shortage problem,” he said.
First in Canada
On April 10, the medical team at the London Health Sciences Centre successfully implemented A-NRP for the first time in Canada. This procedure optimized organs from two donors, allowing for the transplantation of two kidneys and two livers to four patients.
“The liver is here in London, as well as one kidney. And we actually were able to send one of the kidneys to Hamilton. And our colleagues in Hamilton were able to transplant that kidney successfully as well,” Skaro said.
“This is a huge team effort that we’re looking to scale, not just throughout the province, but eventually nationally to all jurisdictions in the country, hoping that we can do everything in our power to increase the number of available organs and stop anyone from dying on the wait-list without one.”
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Currently, the technique has been limited to abdominal organs. The next step is to scale up this method to include thoracic organs, such as the heart and lungs.
“We have interested parties both on the side of the heart transplant and the lung transplant realms. And this is going to potentially move into their domain where heart transplants will be feasible from these kinds of donors, which is astounding,” Skaro said.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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