Lack of B.C. transplant surgeons means donated kidneys are sent elsewhere: doctors

Sukinder Mangat has been waiting 11 years for a kidney transplant while enduring dialysis three times a week as part of a routine that leaves him exhausted, worried and unable to work.

"I have not gone on holidays in the last 11, 12 years," Mangat said before a four-hour appointment at a Richmond, B.C., community dialysis unit, where his blood will pass through a machine to be cleaned of waste products and excess fluids because his kidneys can't do that job.

"Basically, I just come home, have dinner and just go to bed," the 59-year-old said.

Mangat is on a wait list for a second kidney transplant after his first donated kidney failed because of a viral infection.

But getting a compatible kidney could be a challenge because patients awaiting a second transplant are considered "highly sensitized," meaning their immune system, primed with a high level of antibodies after the first transplant, could more easily reject a new kidney.

However, there's a bigger problem for everyone waiting for a kidney in British Columbia, where only four surgeons do all the transplants at two Vancouver hospitals: kidneys that can't be used are getting shipped to other provinces.

B.C. Transplant, the provincial agency responsible for organ transplants, said 56 kidneys were sent elsewhere last year.

"To honour the wishes of our deceased donors and their families, every effort is made to ensure suitable organs are successfully transplanted," it said in an emailed statement.

By comparison, the Ontario Ministry of Health, which has seven transplant sites, said 10 kidneys from that province were shipped to other provinces last year. Ontario, which has triple the population of B.C., has 25 kidney transplant surgeons, the Ontario Medical Association said.

Dr. David Harriman, a kidney transplant surgeon at Vancouver General Hospital, said between eight and 10 more surgeons are needed in B.C. so residents waiting for a kidney can benefit from the organs that were donated within the province.

"We have fewer surgeons doing the volume of work we're doing than other jurisdictions,'' said Harriman, adding that kidney donations have risen while the number of transplant surgeons has not changed in B.C.

"It's not a sustainable situation here," he said.

'Thrown to the wolves'

The B.C. Health Ministry said the province had six kidney transplant surgeons in 2018.

B.C. Transplant, a program under the Provincial Health Services Authority, did not respond to questions about efforts to recruit more surgeons.

However, Harriman said the four surgeons have been working with health authorities and government representatives to try to attract the needed specialists.

"Anybody coming into our landscape and situation is immediately going to be thrown to the wolves, so to speak," he said of the long hours. "We've already lost two potential hires to other jobs that were looked at more favourably than the work we have here in Vancouver."

Doctors of B.C., the province's medical association, echoed Harriman's concerns. It said each of the four B.C. surgeons does more transplants and works on call more often than their colleagues elsewhere in Canada.

In 2020, for example, each B.C. surgeon transplanted 70 kidneys and was on call every other day, the association said.

By comparison, surgeons in Calgary transplanted 27 kidneys each and were on call every third day and surgeons at Toronto General Hospital transplanted 37 kidneys each but were on call every eight days, it added.

"As it stands, the four remaining surgeons have had to take on increased workloads. They are understandably overworked, frustrated, and tired," Doctors of B.C. said in an emailed statement.

Data from the Canadian Institute for Health Information (CIHI) show 288 kidney transplants were done in B.C. last year, a rate of nearly 55 per million people. That's compared to 730 transplants in Ontario, or 49 organs per million people.

Data from CIHI also show 37 transplants were done in Saskatchewan last year, at a rate of 31.4 per million people.
However, that province has three transplant surgeons, the Saskatchewan Health Authority said.

B.C. missing multiple transplant opportunities: surgeon

Dr. John Gill, a nephrologist at Vancouver General, said 10 kidneys were not recovered last year from older donors because there were not enough surgeons to transplant them, but the organs could not be shipped to other provinces because they were more fragile and would not travel well.

"Those opportunities for transplants just didn't happen," Gill said.

B.C. also could not recently accept two kidneys for "highly sensitized" patients, such as Mangat, from a national program run by the Canadian Blood Services, he said.

"This is probably their only shot at a transplant because they're very, very hard to match. We couldn't accept those kidneys because we had no one to implant them," Gill said.

"That's the human toll of what's transpired because of this surgical crisis."

Gill said patients who are waiting for a kidney stay on dialysis instead of getting a life-saving transplant that would improve their quality of life and allow them to work. Those of child-bearing age could also have children after a transplant.

"What we should all be concerned about from a societal perspective is that each transplant, compared to treatment with dialysis, results in health-care savings of over $500,000 (over a decade)."

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