Life After Life
- SEPTEMBER 2006
- Français
The issue of organ and tissue donation is gaining more press these days, as Ontario continues to lag behind other provinces and industrialized countries in the number of organ donations made to extend life for those in need. In Niagara, the number of patients waiting for an organ donation is growing. Currently, there are 46 Niagara residents waiting for a kidney, nine waiting for a kidney/pancreas, nine waiting for a liver and two waiting for a new lung. Current wait times can be an astonishing seven to 12 years for an organ transplant in Ontario.
Growing Need for Dialysis
Dr. Eli Rabin, Niagara Health System Chief of Nephrology, says many of the patients waiting for a kidney transplant are currently on dialysis. "The situation in Niagara is that the need for dialysis is growing, and while the NHS is providing the necessary services to patients as this program grows, the reality is that dialysis is a very major lifestyle-affecting treatment for patients who have to endure four hours of treatment, usually three times a week, and often for years."
Why is the need for dialysis increasing? Kidney dysfunction is a common problem as people age, as well as for those with diabetes, explains Dr. Rabin. "With the increased number of adults with diabetes, we subsequently have higher numbers of patients in our dialysis program. Right now, we have 350 dialysis patients in Niagara that are served through outpatient dialysis programs at St. Catharines' Ontario Street Site and Welland Hospital Site." The NHS is planning to open a third dialysis centre in Niagara Falls in a few years.
"As people age, hardening of the arteries and high blood pressure can cause kidney failure. Controlling blood pressure, preventing the onset of diabetes, and managing diabetes properly can make an enormous difference," Dr. Rabin says. "New medical information suggests that vascular disease, triggered by high cholesterol, can also ultimately affect kidney function."
When kidneys fail, they lose their ability to control the removal of liquid waste from the body, Dr. Rabin explains. Those wastes build up and can become quite toxic. Dialysis restores metabolic control of the liquid waste and liquid products the body produces – organic acids, sometimes drugs, and ions such as potassium. Dialysis also controls fluid balance in the body.
Hemodialysis and Peritoneal Dialysis
There are two types of dialysis. In hemodialysis, a patient's blood is put through a special type of filtering device to allow waste products to be removed, and the fluid chemistry is normalized. The blood moves through a cartridge, equilibration takes place, and the blood is returned to the body.
Peritoneal dialysis is where fluid is infused into the abdomenal peritoneal cavity, usually at home using a night cycle machine. The cavity allows two to three litres to be inserted, and chemical equilibration takes place across the peritoneal lining of the cavity. The process is repeated daily and is much slower and gentler, allowing for a better lifestyle. "We currently have about 45 patients out of 350 on peritoneal dialysis," Dr. Rabin says.
Organ and Tissue Donations
While dialysis is a treatment that prolongs life, it must be viewed as a temporary measure to fight kidney failure. A kidney transplant is still a renal patient's best chance for improved quality of life and ultimate survival. Unfortunately, the waiting list for a kidney transplant, as with other organs such as liver, lungs and heart, is long and the availability of organs for transplantation is short.
To combat this, a new NHS Organ and Tissue Donation Committee is strengthening the partnership between the NHS and Ontario's Trillium Gift of Life Network. Trillium Gift of Life Network is a service agency of the Ontario government, established in 2002 and dedicated to increasing the number of organ/tissue donations in the province through education, support and awareness. Many new initiatives are being used to address the severe shortage of organ donors in Ontario. Recently, new legislation was passed that requires all deaths be reported to Trillium Gift of Life Network. This initiative is to ensure all citizens of Ontario have the opportunity to make the choice that is the right one for them.
Nancy Glover, Organ and Tissue Donation Co-ordinator for Trillium Gift of Life Network in Niagara/Haldimand, says the NHS is committed to improving organ and tissue donation rates in the Niagara area. "This new committee is focusing on ensuring that hospital policies and procedures are in place, so that a patient's end of life wishes can be honoured," Nancy says.
Hospital training is being offered this fall to key healthcare professionals in the critical care areas to provide them with the tools they need to respectfully discuss donation with family members and to help families determine their loved one's wishes for end of life.
"It is a difficult conversation for nurses or doctors to have with a newly-bereaved family, but it is important because so many people need a life-saving organ," Nancy says. "We are already seeing improvements in the system throughout Ontario. We want the people of Niagara to know that the NHS is actively working with the Gift of Life Network to help those on the organ waiting lists."
Less than one per cent of all hospital deaths are candidates for organ donation, making it crucial to ensure that the opportunity for donation is presented to every eligible patient's family. Organs that can be donated for transplant include heart, lungs, liver, pancreas, kidneys and small bowel. For tissue donation (eyes, heart valve, bone, skin, tendons), more than 75 per cent of hospital deaths could be potential tissue donors, so signing your donor card and talking to your family is vital.
A Niagara Story
A recent Niagara donation story occurred when the Dubé family of Welland suddenly lost their wife and mother Linda, age 57, who suffered an aneurysm. With no surgical treatment options available, she succumbed to her injury and was declared neurologically dead. The family knew of Linda's wishes to be a donor, and immediately set the wheels in motion with Welland Hospital Site staff to connect with the Trillium Gift of Life Network. A team of doctors travelled into Niagara that day from Hamilton and London, and worked alongside Trillium staff and hospital staff to retrieve vital organs and tissues. As a result of this family's generous decision, Linda's organs and tissues went to six different recipients and included her kidneys, liver, pancreas, small bowel, and eyes.
Her husband Denis says the impact of his wife's wishes has been widespread. "People I worked with were overcome by my family's story and not only has it helped in raising awareness, but it has helped our grieving process," Denis says. "If the Trillium Gift of Life Network needs me to help them get the message out, I am more than ready."
"Organ and tissue retrieval does not usually take place in Niagara hospitals, but we are working with the NHS to change that," Nancy says. The committee is really excited about this new partnership to improve the health of residents who desperately need a transplant today, not seven years from now.
Be a Lifesaver – Walk for Organ Donation Awareness
Local efforts to raise funds and awareness will reach a peak the end of September with three community fundraiser walks in Niagara. The Niagara Chapter of the Kidney Foundation invites participants to raise awareness about organ donation and support the Kidney Foundation of Canada at the same time. There will be three 5 km walks occurring in Niagara: Niagara-on-the-Lake, Sat., Sept. 30, starting at NOTL Hospital Site; St. Catharines, Sun., Oct. 1, at 391 Vine St.; and Welland, Sun., Oct. 1, at Chippawa Park. Registration at 9 a.m., walk at 10 a.m. (rain or shine). For more information and to get your pledge forms, please contact the Kidney Foundation office at 905-934-4083. You may also register on-line and begin your fundraising early! Visit the Kidney Foundation web-site.
This event is supported by the NHS Organ and Tissue Donation Committee
For more information on organ and tissue donation, go to www.giftoflife.on.ca.