Matching donor and recipient is an inexact science, but it does lean heavily on mathematics.
When an organ becomes available in Ontario, a complex computer program uses blood type, age, body size, genetics, medical severity, presence of certain antibodies (protein substances made by the body’s immune system) length of time on the waiting list and geographic area to select the most suitable people at the top of the lists.
There is a significant amount of scientific judgment at play,” says Frank Markel, president of Trillium Gift of Life, the provincial agency that oversees the procurement, distribution and delivery of donated organs and tissue.
The computerized algorithm was created from rules devised by transplant committees, but there are different protocols for different organs, Markel says. Hearts and lungs have one list for the entire province, and livers and kidneys have separate waiting lists, divided among the regional transplant centres of Toronto, Hamilton, London, Kingston and Ottawa.
A kidney or liver is offered first to the local transplant centre and, if the transplant surgeon deems it an unsuitable match for anyone in that region, the other lists are amalgamated and it goes to the best match province-wide.
About half the kidney transplants done at St. Michael’s Hospital and the Toronto General Hospital — 47 at St. Michael's and 86 at the Toronto General Hospital — are from live donors, the other half from deceased donors. And TGH has the largest live liver transplant program in North America, having performed more than 300 living liver donation surgeries to date. There are nation-wide lists for high-status cases needing lungs, liver and hearts, but not for kidneys, as dialysis can keep people alive for years, Markel says.
That’s why the GTA — with the most in need, yet lowest number of donors per capita — has the longest wait list for kidneys.
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