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.
Some Ontario doctors have started offering a free shot that can protect babies from respiratory syncytial virus while Quebec will begin its immunization program next month.
The new shot called Nirsevimab gives babies antibodies that provide passive immunity to RSV, a major cause of serious lower respiratory tract infections for infants and seniors, which can cause bronchiolitis or pneumonia.
Ontario’s ministry of health says the shot is already available at some doctor’s offices in Ontario with the province’s remaining supply set to arrive by the end of the month.
Quebec will begin administering the shots on Nov. 4 to babies born in hospitals and delivery centers.
Parents in Quebec with babies under six months or those who are older but more vulnerable to infection can also book immunization appointments online.
The injection will be available in Nunavut and Yukon this fall and winter, though administration start dates have not yet been announced.
This report by The Canadian Press was first published Oct. 21, 2024.
-With files from Nicole Ireland
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
ISLAMABAD (AP) — Polio cases are rising ahead of a new vaccination campaign in Pakistan, where violence targeting health workers and the police protecting them has hampered years of efforts toward making the country polio-free.
Since January, health officials have confirmed 39 new polio cases in Pakistan, compared to only six last year, said Anwarul Haq of the National Emergency Operation Center for Polio Eradication.
The new nationwide drive starts Oct. 28 with the aim to vaccinate at least 32 million children. “The whole purpose of these campaigns is to achieve the target of making Pakistan a polio-free state,” he said.
Pakistan regularly launches campaigns against polio despite attacks on the workers and police assigned to the inoculation drives. Militants falsely claim the vaccination campaigns are a Western conspiracy to sterilize children.
Most of the new polio cases were reported in the southwestern Balochistan and southern Sindh province, following by Khyber Pakhtunkhwa province and eastern Punjab province.
The locations are worrying authorities since previous cases were from the restive northwest bordering Afghanistan, where the Taliban government in September suddenly stopped a door-to-door vaccination campaign.
Afghanistan and Pakistan are the two countries in which the spread of the potentially fatal, paralyzing disease has never been stopped. Authorities in Pakistan have said that the Taliban’s decision will have major repercussions beyond the Afghan border, as people from both sides frequently travel to each other’s country.
The World Health Organization has confirmed 18 polio cases in Afghanistan this year, all but two in the south of the country. That’s up from six cases in 2023. Afghanistan used a house-to-house vaccination strategy this June for the first time in five years, a tactic that helped to reach the majority of children targeted, according to WHO.
Health officials in Pakistan say they want the both sides to conduct anti-polio drives simultaneously.
WASHINGTON (AP) — Millions of people with private health insurance would be able to pick up over-the-counter methods like condoms, the “morning after” pill and birth control pills for free under a new rule the White House proposed on Monday.
Right now, health insurers must cover the cost of prescribed contraception, including prescription birth control or even condoms that doctors have issued a prescription for. But the new rule would expand that coverage, allowing millions of people on private health insurance to pick up free condoms, birth control pills, or “morning after” pills from local storefronts without a prescription.
The proposal comes days before Election Day, as Vice President Kamala Harris affixes her presidential campaign to a promise of expanding women’s health care access in the wake of the U.S. Supreme Court’s decision to undo nationwide abortion rights two years ago. Harris has sought to craft a distinct contrast from her Republican challenger, Donald Trump, who appointed some of the judges who issued that ruling.
“The proposed rule we announce today would expand access to birth control at no additional cost for millions of consumers,” Health and Human Services Secretary Xavier Becerra said in a statement. “Bottom line: women should have control over their personal health care decisions. And issuers and providers have an obligation to comply with the law.”
The emergency contraceptives that people on private insurance would be able to access without costs include levonorgestrel, a pill that needs to be taken immediately after sex to prevent pregnancy and is more commonly known by the brand name “Plan B.”
Without a doctor’s prescription, women may pay as much as $50 for a pack of the pills. And women who delay buying the medication in order to get a doctor’s prescription could jeopardize the pill’s effectiveness, since it is most likely to prevent a pregnancy within 72 hours after sex.
If implemented, the new rule would also require insurers to fully bear the cost of the once-a-day Opill, a new over-the-counter birth control pill that the U.S. Food and Drug Administration approved last year. A one-month supply of the pills costs $20.
Federal mandates for private health insurance to cover contraceptive care were first introduced with the Affordable Care Act, which required plans to pick up the cost of FDA-approved birth control that had been prescribed by a doctor as a preventative service.
The proposed rule would not impact those on Medicaid, the insurance program for the poorest Americans. States are largely left to design their own rules around Medicaid coverage for contraception, and few cover over-the-counter methods like Plan B or condoms.
