Cue the music—"The winner of a National Quality Institute Canada Award for Excellence for 2000 is the British Columbia Transplant Society!"

Such was the scene before nearly 500 delegates, as Bill Barrable, CEO, Loretta Kane, Manager, Retrieval Services and Yvonne Attwood, Executive Assistant for the B.C. Transplant Society, walked onto the stage to accept the award on behalf of the Society’s staff.

Representatives from a cross-section of businesses in Canada gathered at the Toronto Convention Centre on Thursday, October 26th, 2000 to honor the four Canada Award for Excellence trophy recipients, and the two winners of Certificates of Merit. These awards are presented to organizations that meet certain quality criteria including: Leadership, Planning, Process Management, Patient Focus, People Focus, and Supplier Focus.

The Canada Awards for Excellence Gala opened with a "Breakfast of Champions", which included inspiring speeches from Paul Henderson, sports legend, David Crombie, Chair of the Toronto 2008 Olympic Bid Committee and former Mayor of the City of Toronto, and Silken Laumann, Olympic champion rower.

The National Quality Institute had also gathered representatives of quality companies (MDS Nordian, SITEL, Durham College) to talk about their quality journeys in breakout sessions that continued throughout the morning.

The Canada Awards for Excellence 2000 – Gala Luncheon featured CBC Broadcaster/Journalist, Hana Gartner as Master of Ceremonies. Bobbie Gaunt, President and Chief Executive Officer of Ford Motor Company of Canada Ltd., gave the keynote address and presented Ford Canada’s newest advertising campaign, featuring singer Charlotte Church.

Prior to each Award recipient being announced, a video about that organization was shown to the delegates. The BC Transplant donor/recipient video brought a tear to many eyes.

In the afternoon delegates had an opportunity to hear presentations from each of the winning organizations in breakout sessions. Bill Barrable, CEO of the B.C. Transplant Society, gave a presentation on "Building Relationships" that was well received by the delegates.

"I am proud of the work we do," said Bill Barrable "and I am proud of the people I work with. The Canada Award for Excellence trophy is a significant milestone in the B.C. Transplant Society’s continuing journey to be the best."

Other 2000 award winners were: Honeywell Water Controls, ATS Canada, and Delta Hotels.

If you were stopped by the police in Delta on September 28th, chances are they didn’t give you a ticket—and instead gave you an Organ Donor Registration form.

For the past six months, the Delta Police Department has been instrumental in promoting BC’s Organ Donor Registry.

Under the direction of Constables Gain and Kiefer, the department implemented a three-phase project. The first included having the Organ Donor Registration brochures available at Delta’s three community policing stations. The next phase involved distributing the registration forms and having BC Transplant Society representatives speak to every member of the Department, including civilian staff.

Finally, on September 28th, the Department’s Traffic Section and Patrol members handed out Organ Donor Registration forms to motorists instead of issuing them tickets. Brochures were also handed out during an evening Counter Attack.

The entire Delta Police Department should be commended for their commitment to BC’s Organ Donor Registry. They also hope thie efforts will encourage the public and other Police Departments to support the BC Transplant Society and the Registry.

British Columbians want more money for health research

A sometimes-overlooked area of the health care system, health research, is an important contributor to better health care and a healthier economy. The Coalition for Health Research in British Columbia recently commissioned a survey to measure attitudes of British Columbians to health research and their view of its priority for funding by the provincial government. The survey sought to establish whether or not BC citizens support the Coalition’s drive to get more funding for health research.

British Columbia stands second to last in Canada in terms of funding allocated for health research. This has wide-spread health and economic implications for our province. Besides leading to better treatments and cures and more effective systems of health care delivery, health research is an important part of our knowledge-based economy. Yet, without more provincial support to build and maintain a strong, supportive research environment, BC cannot compete for the researchers it needs. They are being recruited by other provinces like Alberta and Quebec as well as outside the country.

The Coalition is an umbrella group of teaching hospitals, universities, health research institutes, foundations and industry groups working to correct the current imbalance in provincial funding for health research.

The survey, conducted by MarkTrend, indicates that seven in ten British Columbians rate the importance of conducting research in the province as very important.

When asked how much of the provincial health budget is spent on health research, on average respondents said 16% of the $8 billion annual budget goes to health research. In fact, spending in 1999, amounted to less than one-fifth of one percent.

"We must move now to build our research capacity or the monies British Columbians pay in federal taxes, which are directed to health research, will continue flowing to research programs in other provinces. We’re giving a bonus of our tax dollars to provinces such as Alberta, Ontario and Quebec because we don’t have the people and infrastructure needed to put the available funds to work," said Coalition Chair Aubrey Tingle, who is also a BCTS Board Member, Vice President Research and Education at Children’s & Women’s Health Centre and Assistant Dean Research, UBC Faculty of Medicine.

While those polled clearly understand the importance of health research as it relates to curing and preventing disease, they are less aware of the economic benefits health research delivers. Still, over half (six in ten) polled consider health research provides important economic returns to the provincial economy. It is estimated that, in 1998/99, benefits accruing from health research undertaken at UBC’s four teaching hospitals and the main Pt. Grey campus, were valued at $94 - $118 million (calculated using the provincial government input-output model).

The Coalition wants to raise the profile of health research and to ensure that new health dollars made available from the federal and provincial government include a reasonable portion for health research.

The group is working with the provincial government to get approval for a multi-year plan to increase BC’s health research capacity and help secure a future of health and economic gains for the people of British Columbia.

As a young child, Dr. Alice Mui imagined being a scientist. "I’ve always had an interest in why and how things work. I especially was interested in medical science and I wanted to make a positive contribution to our understanding of human disease," she says.

Dr. Mui grew up in Kamloops and studied for her doctorate at UBC. She recently spent seven years in California doing post-doctoral work. Looking out the window at the ceaseless Vancouver rain, and no doubt longing for those sunny California days, Mui says she returned to Vancouver because of family connections and because she likes the research community here. "There is a good group of scientists here and I enjoy working with them," she exudes.

Mui has been conducting research for the BC Transplant Society for the past two years. She is currently working on two projects. Titled, Molecular Basis for Differing Cellular Response to Viral Interleuken-10 (IL-10) is the first. The purpose of this research is to study the difference in the cellular and molecular actions of two closely related immune system regulators (IL-10) that have opposite effects on the rejection rates of transplanted organs.

Both IL-10 and Viral IL-10 suppress the immune system; however, IL-10 has an additional property that activates a sub-set of cells that are detrimental to the graft. On the other hand, Viral IL-10, found in the Epstein-Barr virus has only the suppressive activity. "We’ve been researching IL-10 for a year and a half, and I think we are on the right track¼there are some real positive signs. IL-10 is a potential therapeutic if we get rid of the its undesirable properties," says Mui.

Mui is also collaborating with Drs. Stephen Chung and Christopher Ong on research that is trying to discover new gene expression patterns. "When our immune system does something¾either responding to a graft or is suppressed, the cells express different sets of genes. "Our hypothesis is to follow the expression of certain genes so we can monitor graft-immune status," Mui explains.

This research will be especially relevant to transplant recipients because we can tell early on whether the immune system is accepting or rejecting a graft. Mui says this is extremely important because the current markers come too late when rejection is already occurring. If successful, this will lead to a better balance with our anti-rejection drug regime and can rationalize how we design therapy for individual patients. "Some patients don’t respond to some types of drugs, but if we didn’t have gene expression we couldn’t tell¾we then rely on trial and error until we find the right combination."

While Dr. Mui loves the research community in BC, she laments that it is more difficult to support research in this province. She notes that Alberta and Ontario receive much more support than does BC, and that it is difficult to take advantage of new opportunities. "The federal government tends to only fund proven ideas. Fortunately the BC Transplant Foundation and the BC Health Research Foundation fund new ideas that are worth following," she says. "But as researchers, we have an obligation to do a better job at telling people why research is important and how it will affect them."

Excerpts from a report written by David Baxter, Urban Futures Institute

In its second report in several months, the Vancouver based, Urban Futures Institute, has focussed on issues relating to organ donation in Canada.

This report, entitled A Decade of Organ Donation, proposes a standard measurement for the effective rate of cadaveric solid organ donation in Canada and its provinces. In doing so it suggests that our donor rate should be calculated as a percentage of donors per potential donors versus donors per million populations, thus reflecting the efficiency of donor programs not high mortality rates. The report further explains that an effective donor rate must have as its numerator the number of actual donors, which requires that not only a donor, but in addition that at least one organ is retrieved from the donor and is transplanted into a recipient.

Furthermore, the base of an effective donor rate must be reflective of the universe of eligible donors. Cadaveric organ donations can only be obtained in the context of deaths that occur in hospitals, where patients are on ventilators, come from eligible sources (brain death vs. cardiac death) and where there are no medical or consensual contraindications.

The single most significant fact that emerges from the analysis of the available mortality data for the past decade is that while the population of Canada has increased, the number of potential donors has decreased. However, despite lower death rates, increased population and a decrease in potential donors the number of donors has increased by 5%. This is due to both the improving efficiency of the donor system and the willingness of Canadians to be donors.

The effective donor rates reflected in this article are calculated as the number of actual donors in a year divided by the number of deaths in hospitals from eligible mortality of persons under the age of 65 during the year. The effective donation rate in Canada reached its record level of 43.9 donors per 1000 eligible deaths in 1997 (the most recent year for which data are currently available). The rate of effective donation has increased almost every year since 1992, when it was only 30.6 donors per 1000 deaths. The 43% increase in the effective donor rate between 1992 and 1997, and a 3.8% increase from 1996 to 1997, are indicative of a significant improvement in the efficiency of the donor system, particularly in the face of a decline in the number of potential donors from 11,066 in 1994 to 9,765 in 1997.

British Columbia has been, until recently the leader in effective donation rates in Canada. From 1988-1990 to 1993-1995, the province’s rate was the highest (48.5 to 55.2 range) and in 1994-1996, BC and Alberta were tied at an average of 52.8. In 1995-1997 BC fell to second place with a rate of 54.5 donors per 1000 eligible deaths in hospital. The drop in the number of donors on BC between 1997 and 1998 to the record low of 38 donations, compared to Alberta’s and Ontario’s constant numbers over the same period, indicates that BC may have dropped to third place in effective donation rates.

The general stability of the BC donor rate over the 1988 to 1997 period was the result of both a relatively stable number of donors and a relatively stable universe of potential donors. In seeking to explain this relative stability, and the significant drop in the number of donors in 1998, it will be important to ask the same demographic questions as will be asked for Alberta, which since 1996, has matched or exceeded British Columbia in terms of annual donors.

Since 1996, British Columbia has lost a net of 30,000 mostly young labour force to Alberta, overwhelmingly, and Ontario. In BC, this loss may have significantly increased the age and contraindications composition of deaths occurring in hospitals from Class I and Class II causes to persons under the age of 65, thereby reducing in 1998, the number of actual donors. The 1998 mortality data, and further investigation into contraindication, will be most useful in evaluation of the change in donor rate for British Columbia in the past three years.

Calculation and comparison of effective donor rates is not explanation or evaluation: it is merely the first step in the process. Many questions may be answered through more direct research on factors, both medical and procedural, that affect organ donation. Factors such as differences in access to medical infrastructure for in-hospital deaths. For example, it would be enlightening to measure the total in-hospital deaths that are in hospitals that are without ventilator capacity: the distribution of medical equipment itself may turn out to be a significant factor in explaining temporal and regional differences in effective donor rates. Research into the rates of referral and consent would also be of value in this regard.

While there is no question that more organ donations are required now, and will be required in the future, the focus of evaluation of the donor system must be to make a good system better. Over the past decade, the efficiency of organ donation system has improved: as medical technology and life style change continue to reduce the number of potential cadaveric donors in Canada, it will be essential to continue to find ways of improving efficiency. It will also be essential to shift from a reliance on cadaveric donation, which in many senses describes the history of organ donation in Canada, to a reliance of living donation, which may describe its future.

For more information on this study or to purchase a copy in its entirety, please contact the Urban Futures Institute at (604) 682-8323 or visit their website at www.urbanfutures.com

A widely used measurement of transplant activity is the organ donor rate, which is always measured by the number of organ donors per one million population. The BC Transplant Society doesn’t believe that this is an accurate measurement of transplant activity.

It is common to use comparative statistics as the basis for judgment of the effectiveness of programs within a region. While the desire to compare is understandable, it must be done with caution and qualification, as fundamental differences in socio-economic and demographic conditions between regions may invalidate conclusions drawn from simple comparisons.

Recently, the organ donation rate in Canada has been compared unfavourably with those of other countries, with higher donor rate countries such as Spain. Before anyone makes a judgment as to the superiority of Spain, or any other region, some qualifications must be made.

The definition of donation used in the data is not the same for all countries. The reference to Spain’s superior rate is solely within the context of cadaveric donation: the data for Spain includes all instances where permission for a cadaveric donation is given, even if no transplant subsequently occurs. The data for the US includes those instances where permission is obtained and where an organ is recovered, regardless of whether or not a transplant occurs. The data for Canada includes only those instances where a transplant occurs

Cadaveric donation rates must also be qualified by the conditions that prevail in each country. For example, consider one of the major causal factors for cadaveric donation: road accidents. The fact that road mortality rates in Spain (142.5 deaths annually per million) and the US (156.8 per million) that are more than 40% higher than Canada’s (101.2 per million population), certainly provides some indication that the relative size of the potential donor pool in these countries is much greater than that of Canada’s: to this extent it is not surprising that they rank above Canada on a donations per population base.

If you have a question for Mrs. D,
please send it to:

Mrs. D
c/o Transplant Times
BC Transplant Society
West Tower, 3rd Floor
555 W. 12th Ave.
Vancouver, BC
V5Z 3X7

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