Alex Medos credits his mother and uncle, both long-time blood and plasma donors, for inspiring him to save lives and become a donor himself. Now a regular plasma donor, Alex has made over 85 lifesaving donations.
Maintaining a large pool of healthy blood donors. Securing Canada’s future supply of plasma. Aligning stem cell collection with our nation’s unique demographics. Coordinating efforts around organ and tissue donation and transplantation. Everything we do is aimed at ensuring the best possible treatment and care for the people who depend on our products and services.
Changing eligibility criteria for blood donation. Uncertainty over fluctuating demand for whole blood. Disruptions such as the emergence of the Zika virus. And simple attrition, as past donors move, become less engaged or are no longer eligible to donate. These are the kinds of challenges we face while working to increase our base of loyal donors — who in turn contribute to the good health of all Canadians.
In 2016–2017, nearly 406,000 blood donors visited our collection sites as we surpassed our donor base target by just over 4,000 people. This number represents an increase of about five per cent over the previous year. But what can appear at first glance to be modest growth becomes more remarkable when we consider that more than 220,000 donors were either new (84,000) or reinstated (136,500) following a lapse of at least 12 months. So we in fact replaced 54 per cent of the total number of blood donors in a single year.
Several factors contributed to replenishing the pool of blood donors across the country. Our mobile and online initiatives are reaching new segments of the population while helping to cement engagement with donors. Universities, colleges and high schools are another key source of new donors. So too are the many organizations and affiliated groups that are partnering with us on blood donation campaigns — an area of special focus. Renewed outreach in all of these areas resulted in one of our best years ever for attracting brand-new potential donors. As for reinstated donors, the investments we’ve made in data analytics and relationship management systems are helping us to build more meaningful relationships.
Underpinning all of these efforts is a multi-year donor recruitment, engagement and retention strategy we call Deeper Connections. Combining digital communication tools with proven targeted marketing techniques, this comprehensive program is transforming our ability to attract, interact with and retain donors while helping us keep pace with their changing expectations. Our ultimate goal is to build a vibrant community of donors (as well as transplantation registrants) who are consistently available to meet patient needs in a cost-effective way — and who are personally engaged in contributing to the health and well-being of Canadian society.
The progress we’ve made to date is encouraging. But when half of Canadians are eligible and able to donate, yet only one in 60 give, we have more work to do in continuing to secure our blood supply.
During the past year, we introduced more stringent eligibility guidelines to ensure those who want to donate meet minimum requirements for iron in their blood, after new research indicated that donating too often can sometimes lead to iron deficiency and problems such as anemia. Ensuring donors maintain sufficient iron levels is increasingly important to their general health and well-being — something we care deeply about.
As of December 2016, all female blood donors must wait at least 12 weeks between blood donations, up from the previous standard of eight weeks. And as of March 2017, all male donors must have a slightly higher level of hemoglobin to be eligible to give blood.
To make up for donors giving blood less often, we need about 35,000 additional blood donations per year. Clearly this means we must attract more donors. On the other hand, the percentage of potential female donors deemed ineligible to donate because of low iron levels declined significantly after the new criteria were introduced. We did see an increase, as expected, in the proportion of ineligible male donors after we introduced the higher hemoglobin requirement. Nevertheless, by March 2017, our operational data — more robust since we started gathering information digitally at our collection sites — showed that the overall percentage of donors who were ineligible to donate due to hemoglobin levels was just over eight per cent, the lowest level we’ve ever seen.
At a time when so many factors make it difficult to increase the number of people who donate blood, we were pleased to make several changes to our eligibility criteria during 2016–2017:
We have removed the upper age limit for donation for first-time donors. Donors over the age of 71 no longer require a physician’s assessment.
Most donors with a history of cancer — not including blood-related cancers such as lymphomas and leukemia — can now donate if they’ve been cancer-free for five years.
Recipients of most vaccines no longer need to wait two days before donating.
Donors who were born or lived in seven African countries where the HIV virus is prevalent are now eligible to give blood.
The waiting period for men who have sex with men was reduced from five years to one year.
Former residents of Western Europe who may have been exposed to variant Creutzfeldt-Jakob disease, often called mad cow disease, may now be eligible to donate, depending on when they lived there.
“Over the past year, we’ve had both successes with our new recruiting efforts and challenges we needed to overcome — from changes to our criteria that reduced the eligibility of some donors, to extreme weather that made it harder for people to make it in to donate. Our priority is to engage with donors in a manner that works best for them and to develop processes that can be more responsive to changing conditions.”
We’re working with governments and all of our stakeholders to secure Canada’s future supply of plasma needed to manufacture immune globulin (Ig), a lifesaving drug. The comprehensive plan we’ve presented to governments recommends significantly increasing the amount of plasma we collect domestically. At the same time, we need to avoid the risk of relying solely on Canadian sources by maintaining a balance of international supply. We cannot put all of our eggs in one basket.
In January 2017, Canadian Blood Services presented federal, provincial and territorial ministers of health with an ambitious business plan entitled Ensuring Security of the Canadian Plasma Supply for Immune Globulin. It outlines a comprehensive strategy for securing a sufficient supply of Canadian plasma to manufacture Ig for patients in Canada.
Canadian Blood Services is accountable to Canadians and their governments (except Quebec) to meet 100 per cent of patient need for Ig. Used to treat a wide range of immune disorders, infections and other conditions, Ig can be essential for patients’ survival. In our role as the arm’s-length, publicly funded blood authority acting in the best interests of Canadian patients, we’ve always collected plasma and other blood products from volunteer, unpaid donors. Our proposed plan details how we can maintain that model, which is supported by the majority of Canadians, while safely and sustainably securing this country’s supply of plasma for Ig into the future.
Canada is self-sufficient in plasma used for direct transfusion. But when it comes to plasma used as raw material for processing through fractionation into Ig, right now we only collect enough to meet about 15 per cent of demand. We meet the remainder of our Ig needs by purchasing finished drugs from international pharmaceutical companies (largely from the U.S.).
In the past, this approach helped us successfully balance the risk of supply interruptions with the relative affordability of products from international manufacturers. It also provided some important redundancy in our potential sources of plasma. Large blood operators agree that 100 per cent domestic sufficiency is not actually desirable, as it creates an overdependence on a single source and opens up the risk of a pathogen infecting the supply of an entire country (as occurred in the U.K. with variant Creutzfeldt-Jakob disease).
In the last few years, however, the situation has changed. As medical advances regularly suggest new uses for Ig and other plasma protein products, demand is rising quickly. Canada and other countries that depend largely on U.S.-based suppliers for these products — 80 per cent of the world’s commercial plasma collection sites are in the U.S — risk having their supply reduced as more production is allocated to the U.S. domestic market. We also see that in large emerging markets like China or India, even a slight increase in demand could disrupt the price and availability of Ig. Our plan therefore concludes, through detailed analysis, that Canada must increase its plasma sufficiency for Ig to 50 per cent — the level required to protect those patients whose lives depend on Ig-based treatments. In others words, half of all Ig products used in this country would be made from plasma donated by Canadians through the non-remunerated, publicly funded model operated by Canadian Blood Services.
Working closely with provincial and federal governments, we plan to build as many as 40 new plasma collection sites across the country to ensure Canadian patients have access to a secure source of Ig into the future. To reach 50 per cent sufficiency in the plasma required to manufacture Ig, we need to collect an additional 600,000 litres (or 866,000 units) of plasma annually — a significant increase over the 180,000 litres we collect today. We estimate this increase in volume will require at least 144,000 new plasma donors each year. We’re confident that a large number of Canadians, recognizing the vital role that Ig plays in maintaining and improving their health and that of their families, friends and neighbours, will be up for the challenge.
In assessing the security of Canada’s plasma supply for Ig, we’ve used the internationally recognized Risk-Based Decision-Making Framework developed by the Alliance of Blood Operators with the leadership of Canadian Blood Services. We apply this framework when analyzing potential threats to the blood system — for example, the global outbreak of the Zika virus in 2015. It sets out a clear methodology for ensuring that decisions are based on evidence and built on trust by ensuring the voices of stakeholders are heard. It also ensures these decisions allow for resources to be effectively redirected proportionate to the risks at hand.
The process considers not only potential disadvantages and benefits, but also costs, ethical issues and — critically — the perspectives of various stakeholders. In developing and refining our plan to ensure a secure supply of plasma for Ig, we’ve reached out to patient groups, labour groups, government officials and a wide range of practitioners and organizational leaders across the health sector.
Plasma, like whole blood, is a public resource that must be safeguarded. Our commitment to seeking input and support from a broad range of stakeholders reflects the role of Canadian Blood Services as a not-for-profit enterprise owned by, and accountable to, the people whose interests we’re entrusted to protect.
“The comprehensive plan we’ve developed to boost Canada’s plasma sufficiency reflects our depth of experience and expertise. It also reinforces our role, as the trusted steward of Canada’s blood system, in ensuring we have sufficient domestically sourced plasma to meet the changing needs of patients across the country.”
We’re working with partners across the organ and tissue donation and transplantation (OTDT) community to enhance donor registries and share leading practices, professional education resources and important system data — all in an effort to improve patient care, recognizing all stakeholders have limited budgets. The result: more successful transplants than ever.
Many Canadians are prepared to act as living donors when a friend or family member needs a kidney transplant. Often, though, they’re not suitable matches for the people they wish to help. When a second pair is in the same situation, but the kidney from the potential donor in this pair matches the person who needs a transplant in the first pair, swapping the donors in these two pairs provides kidneys to each patient in need.
Donor exchanges can also occur in what is called a domino chain. These chains begin with someone who offers to donate to anyone in need of a kidney transplant, referred to as a non-directed anonymous donor (NDAD). The chain ends with a candidate on the NDAD program wait-list receiving a kidney from the last donor in the chain who does not match anyone in the Kidney Paired Donation program.
Last year, because all of the living donor programs in the country are working together with Canadian Blood Services, the Kidney Paired Donation program reached a major milestone with its 500th kidney transplant through paired-exchange donation. Over half of those donated organs crossed interprovincial borders. And as health-care professionals take advantage of better data sharing and analytics through the Canadian Transplant Registry, we expect the number of kidney transplants to continue to grow.
As of the end of March 2017, we facilitated 320 kidney transplants through the Highly Sensitized Patient Kidney program — a collaborative effort launched in 2013 with our provincial OTDT partners to find matches for people with a higher risk of rejecting new organs. Before this program, these immune-sensitive patients made up about 20 per cent of provincial transplant wait-lists but received less than one per cent of available kidneys. Now, using the Canadian Transplant Registry, health-care professionals can save many of these patients from years of dialysis — or from dying before a suitable donor can be found.
Between 2006 and 2015, the number of transplants performed in Canada rose by 23 per cent.
In that same period, the transplantation rate — from both deceased and living donors — increased from 63.7 to 71.4 per million people.
In addition to potentially doubling the life expectancy of a patient with end-stage kidney disease, a transplant can avoid significant costs to the health-care system — between $33,000 and $84,000 annually per dialysis patient, depending on where they live. We estimate that total cost avoidance for dialysis in the coming year will be at least $16 million. Transplantation also frees up dialysis capacity within the system, making it possible to offer treatment to more patients without expanding existing resources.
Despite great progress across the country, about 4,600 Canadians are currently waiting for organ transplants. Each year, every one and a half days a Canadian patient dies while on the wait-list before an appropriate donor is found. Many others become so sick they cannot receive a transplant and are taken off the list. These patients were all suitable for transplant and may have lived had organs been available.
As of March 31, 2017, Canada’s organ donation rate by deceased donors had risen to a record 21.2 per million population (pmp) thanks, in part, to improving practices and effective collaboration among organ and tissue donation communities across the country.
The deceased donation target of 22 pmp, set collectively in 2011 when the national rate was less than 15 pmp, has nearly been surpassed. By coordinating efforts to raise awareness, refine donor registries and support donors’ families, the number of deceased donors in Canada continues to grow, expanding access to a broader range of organs and tissues for transplantation. However, the wait-list is also growing, and the gap between available donors and those waiting for transplantation remains high. Ongoing focus and commitment by all provincial programs is needed to save as many patients waiting as possible in the years to come.
These are just a few of the findings shared in Organ Donation and Transplantation in Canada: System Progress Report 2006–2015, published in September 2016 by Canadian Blood Services in partnership with the Canadian Organ Donation and Transplant Network. A first for Canada, the report analyzes a decade’s worth of data on donation and transplant rates, levels of access to organ transplants by region, and the benefits of transplantation to both patients and health-care systems.
Our work over several years to improve the Canadian Transplant Registry, a web-based service that links living and deceased organ donors with potential recipients across the country, entered its final phase this past year. With the next-generation version of the registry now online, we’re able to support better information sharing and sophisticated data analysis and reporting. Health-care providers have faster, easier access to qualified donors across the country. They can also learn more about how the system is performing. And most importantly, we expect to see better transplant outcomes, especially for patients who are hard to match. By early 2017, the registry had helped to facilitate 820 kidney transplants that might never have happened otherwise.
Historically, Canadians needing liver transplants faced an added challenge: the criteria for making donated livers available varied from province to province. In May 2016, Canadian Blood Services helped organize a forum on liver listing and leading practices in liver allocation. Leaders in organ and tissue donation and transplantation were invited to develop a national consensus on listing criteria and prioritization. By defining urgency of need for liver transplantation in the same way across jurisdictions, we can help ensure transparent policies are now available for fair access to liver transplants. These efforts build on the commitment of provincial programs to share organs when they become available.
Canada has lagged behind other nations in supporting organ and tissue donations from children after cardio-circulatory death. Although cardio-circulatory death is relatively uncommon among children, it’s vital that health-care professionals consider every possible referral.
During the past year, we worked with our partners in organ and tissue donation and transplantation to develop the world’s first guide for pediatric practitioners on how to broach the sensitive subject of donation with families facing the loss of a child from cardio-circulatory problems. Early signs suggest that these cases are now being referred as potential donors.
Eliminating or reducing potentially harmful microbes, or bioburden, from tissue grafts is essential to minimize the risk of transmitting diseases during transplantation. Until now, the limited data on this subject has largely been held by private tissue-processing firms. As part of our mandate to help organ and tissue donation and transplantation communities ground their practices in the best available evidence, over the past year we produced a series of research reports, along with guidelines for reducing bioburden in all phases of tissue processing, from recovery through transplantation. These data sets have been published in a number of peer-reviewed journals.
Over the past decade, Canadian Blood Services has advanced more than 20 rigorously researched leading practices in organ and tissue donation and transplantation, ranging from new strategies in multiple-organ transplantation to end-of-life conversations with the families of potential donors. In 2016–2017, we pursued a number of initiatives to ensure these practical guidelines remain well known and widely used. Whether consulting with practitioners in clinical settings, hosting and attending international meetings of experts, or partnering on training programs with the Royal College of Physicians and Surgeons of Canada, we’re sharing and promoting evidence-based insights that will produce better outcomes for patients while helping the health-care system operate more efficiently.
“The results we're seeing today demonstrate how the kind of national collaboration the organ and tissue donation and transplantation community is engaged in delivers excellent results for Canadian patients. There’s more we can do to bring our practices in line with the world’s top performers, but the work we’ve done together so far has better equipped us to tackle the challenges ahead.”
We continue to move our coordinated national stem cell strategy forward. Aligning efforts with our provincial partners and the transplant medicine community, we’re adding value to the health-care system by sharing data, optimizing processes and better serving Canadian patients who count on stem cells — whether from adult donors or cord blood — for their future health.
In June 2016, Canadian Blood Services’ Cord Blood Bank shipped its first unit of umbilical cord blood for use in a stem cell transplant in Europe. At the time of this report’s publication, five more shipments had followed, as Canada’s national public cord blood bank began fulfilling its mission. These very encouraging results, at such an early stage in the bank’s development, attest to the outstanding quality of cord blood units banked to date.
Medical practice around the use of stem cells has changed dramatically since planning for the bank began nearly a decade ago. Scientific advances now make it possible for transplant patients to receive stem cells from a wider range of unrelated donors, which has reduced the overall demand for cord blood. On the other hand, demand for high-quality stem cells from cord blood continues to grow among patients with complex medical conditions, or whose mixed ethnicity makes them difficult to match.
Meanwhile, the supply side of the equation has been affected by shifting trends in child delivery. Physicians increasingly favour delayed umbilical cord clamping, which allows newborn babies to receive blood from the mother’s placenta for a longer period — but which also means donated cord blood units are less likely to be rich enough in stem cells to qualify for banking.
Responding to these changes, Canadian Blood Services’ Cord Blood Bank focuses on providing high-quality stem cells for those patients who still depend on this source to thrive. As a second-generation bank, we have an advantage over long-established facilities that invested heavily in collecting high volumes of cord blood units — in many cases stockpiling lower-quality units that may never be used. Our bank, while holding a smaller inventory, is now considered to be among the highest-quality suppliers of cord blood in the world.
As of March 31, 2017, we had collected more than 15,000 cord blood units at five hospital sites across Canada. Over 2,000 donated units were found to be bankable for potential transplant use and stored at our operations facilities in Edmonton and Ottawa.
Donated units that don’t meet our banking criteria may be used or shared for research purposes through the Cord Blood for Research program. This program supports research that promotes advances in the fields of transfusion, cellular therapies and transplantation medicine in Canada.
Most significantly, for the three-quarters of Canadian patients who must look outside their families for stem cell donors, 58 per cent of the bank’s cord blood units are from donors with ethnically diverse backgrounds, reflecting the needs of Canadians of all backgrounds.
The OneMatch Stem Cell and Marrow Network, a national registry of adult donors operated by Canadian Blood Services, grew by seven per cent in the past year to nearly 410,000 registrants. One of the 10 largest programs of its kind in the world, OneMatch is evolving to better reflect Canada’s ethnic diversity and changing transplant practices.
As of March 2017, we had made modest year-over-year gains in three key segments of the population most likely to be selected as donors: males under 36, shown by evidence-based research to be the best stem cell donors; males in this younger age group who are ethnically diverse and therefore more likely to match similarly diverse recipients; and potential donors of all ages with mixed ethnicity, who now make up 29 per cent of the registry. This progress underscores the success of our ongoing efforts to grow our donor base.
Working closely with provincial stem cell programs, Canadian Blood Services’ OneMatch team identifies suitable donor candidates, ensures they are able to donate and coordinates the delivery of stem cells to recipients. We also work to advance transplantation science and medicine by sharing research insights and best practices, and through collaborations with Canadian and international research and transplant organizations.
At year-end, Canadian Blood Services had facilitated a total of 317 stem cell transplants through the OneMatch program. This is an encouraging milestone as we help people manage a wide range of challenges, from leukemia and lymphoma to immune system and metabolic disorders. But when nearly half of the patients in this country who need stem cell transplants aren’t able to find a matching donor, we know we still have work to do.
Canadian Blood Services’ Centre for Innovation is our hub for research, education and discovery. Our partners and labs across the country do research — and support the research of others — to help Canadian patients and ultimately, benefit our health-care systems. Over the last year, our programs and services have delivered value in a number of ways. Detailed highlights from the past year can be found in the 2016-2017 Centre for Innovation Progress Report at 2016–2017 Centre for Innovation Progress Report.
“Patients rely on us, and our many partners, to process stem cells efficiently, find matches quickly and expedite transplants as smoothly as possible, so they can look forward to a healthier future. Our integrated stem cell strategy gets complementary services working together to do just that.”