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BC Transplant

BC Transplant Update

BC Kidney Days, October 6, 2016

Dr. David Landsberg, Physician Lead, Transplantation

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BC Transplant

BC Transplant provides oversight for all aspects of organ donation and transplantation across BC.

Provincial scope and model of care is unique in Canada.

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Strategic Direction

BCT’s 3 key Operational Goals in support of the PHSA Mission: • Increase organ donation • Reduce the number of patients on the transplant waitlist • Improve how we deliver care to patients and donor families

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Deceased Donation by Province (pmp)

22.0 Call to Action

Target

23% 59% -19% -14% 23% 30% 13% -27% 4% -55%

-5.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Cda. B.C.* Alta.** Sask. Man. Ont. Que. N.B. N.S.*** N.L.

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Notes *Rates for BC - population of Yukon is included **Rates for Alberta - populations of NWT & Nunavut are included *** Rate for Nova Scotia – population of PEI included

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Factors Contributing to Higher Donation Rates (2015)

B.C. ALTA. SASK. MAN. ONT. QUE. N.B. N.S. N.L.

Mandatory Referral

Donation Physicians

NDD Leading Practices

DCD Programs

(% DCD donors)

(25%)

(13%)

(10%)

(0%)

(31%)

(11%)

(0%)

(15%)

(0%)

Donor Management LP

Deceased Donors (DPMP) (Number of donors)

20.1* (95)

12.2**(52)

8.8 (10)

13.1 (17)

19.5 (269)

20.8 (172)

10.6 (8)

21.2* **(20)

15.2 (8)

2011-2015 % change DPMP 76 33 -17 89 22 26 14 -20 -20

Implementation complete or near completion Implementation in progress Implementation not started

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Deceased Donation

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Increasing Utilization of DCD

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Living Donation by Province (pmp)

20.0 Call to Action

Target

-9% 1% 8% -243% -89% -7% -2% -81%

-3000%

-2500%

-2000%

-1500%

-1000%

-500%

0%

500%

0

5

10

15

20

25

30

Can B.C.* Alta.** Sask. Man. Ont. Que. Atlantic

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Notes *Rates for BC - population of Yukon is included **Rates for Alberta - populations of NWT & Nunavut are included Atlantic includes New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland and Labrador.

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Kidney Transplants – Deceased and Living Donors

44.0 Call to Action

Target Call to Action Target 44

12% 51% -8% -57% -35% 15% 27% -28%

-30000%

-25000%

-20000%

-15000%

-10000%

-5000%

0%

5000%

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Can BC AB SK MB ON QC Atl

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 % Increase in 10 Years

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Number of Transplants

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Living Donors

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2016 Donation and Transplant Statistics

DONOR_TYPE 2015 2016*

DCD 24 17

NDD 71 55

Total 95 72

*Jan. 1- Sept. 30, 2016

# of Deceased Donors originating in BC

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2016 Donation and Transplant Statistics 2015 2016 (January 1 – Oct. 3)

Heart 19 24

Kidney – deceased donor 161 131

Kidney – living donor 110 77

Liver – deceased donor 76 62

Liver – living donor 3 0

Liver-Kidney 2 0

Pancreas 3 3

Pancreas Islet 9 4

Pancreas-Kidney 1 1

Lung 35 30

TOTAL 422 332

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Kidney Paired Donation Successes Candidates and Transplants by Transplant Centre

SPH VGH

FMC

UAH SPH HS

C SJH LHSC

TOH

HSC

SMH

TGH

HMR

HND

HRV

HDQ

CHS QEII QEII QEII QEII

BC AB SK MB ON QC NB NS NL PEIRegistered Candidates 116 76 50 46 21 41 34 15 50 8 68 114 7 22 24 20 4 15 21 12 2Transplants to Reg. Recipients 73 41 18 19 10 16 8 6 19 5 34 49 4 11 5 5 2 5 7 7 1

0

20

40

60

80

100

120

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Kidney Paired Donation Successes Power of the Domino

21 31 38 41 55

43 48

12

4 16

20 20

25 23

40

18

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

20

40

60

80

100

2009 2010 2011 2012 2013 2014 2015 2016

Domino Closed % from Dominos

# NDADs Donated:

6 11 9 13 15 11 17 4

% from Dominos: 84% 66% 66% 67% 69% 65% 55% 40%

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NDADs

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BCT 2016 Priorities

• Living Donation First • Introduce preemptive living donation into KCC’s • Education • Donor Outreach

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Time to LDKD

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Majority of Patients Transplanted Within 5 Years of Listing

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Dialysis Exposure (months)

Blood type ALL patients 2014

ALL patients 2015

A 31 31.5

AB 26.6 15.7

O 58.3 52.1

B 87.7 73.3

*By age and blood type, 2014, 2015

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Outcomes

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Outcomes

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Donor Age

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Rejection

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Unadjusted Patient Survival, by Centre

Center 5 Year Patient Survival 10 year Patient Survival

Overall 92 84 A 90 80 B 98 95 C 94 87 D 90 73 E 95 84 F 95 85 G 92 82

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Unadjusted Graft Survival, by Centre

Center 5 Year Graft Survival 10 year Graft Survival

Overall 87 72 A 85 68 B 96 85 C 88 73 D 85 62 E 92 71 F 86 69 G 86 78

CONGRATULATIONS on

Thank you to all the transplant care teams for your hard work and dedication!