Organ donation: “We had a gem and we broke it in Quebec”

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Organ donation: “We had a gem and we broke it in Quebec”

In 2013, Quebec set up the Organ Retrieval Center at the Hôpital du Sacré-Coeur de Montréal (CPO), a unique formula in Canada. But in 2019, the Legault government ended the experiment. Was the CPO closed for good reasons?

How the Quebec Organ Recovery Center works

“We had a jewel, and we broke it in Quebec. »

This is how Dr. Pierre Marsolais sums up the experience of the Organ Retrieval Center at the Hôpital du Sacré-Coeur de Montréal, more commonly known as the CPO.< /p>

The pilot project existed between 2013 and 2019, in response to long-identified problems in the organization of organ donation. In particular, difficult access to resources such as intensive care units or operating theaters.

As long as an organ donor is a source of competition for resources in a hospital, that will discourage professionals. It's normal, he explains. Medical teams want to prioritize the living, those who can still be saved. Organ donation is often synonymous with complications.

The internist and intensivist presented several versions of his pilot project before it was accepted.

To promote organ donation in an overburdened healthcare system, the idea was to centralize services.

The CPO was a unique model in Canada. It offered two intensive care beds and an operating room, dedicated entirely to organ donation and staffed with on-call teams 24 hours a day, 7 days a week. If the experiment proved successful, the formula was to be repeated elsewhere in the province.

We don't "bumpait" nobody, recalls surgeon Michel Lallier, a big supporter of the CPO from the start. Even if there was another emergency, a cesarean for example, the donation room worked.

The Test Center is quickly gaining praise. Dr. Marsolais is invited to international conferences. The organ and tissue donation manager at SwissTransplant, Candide Font-Sala, even comes to Montreal to be inspired. I was convinced, she says, by this support for families, the care of donors with these dedicated resources, this whole team that only takes care of organ donors.

But in October 2019, the Organ Removal Center closed its doors. It costs too much compared to its results, summarizes the Minister of Health at the time, Danielle McCann.

There have been good years, acknowledges the medical director of donations at Transplant Quebec, Dr. Matthew Weiss. But in other years, it was very similar to the other centers. We reviewed this with the government, and we decided that, as it was structured, the investment was not worth it.

Dr. Marsolais counters that the savings generated by the CPO were not taken into account in the department's evaluation reports. The organ donor who occupies an intensive care bed or an operating room causes costly cancellations or postponements of surgeries. A patient who received a kidney transplant costs about $250,000 less over five years than a patient on dialysis.

In addition, the doctor says that many of the data presented in the ministry's appraisal reports were flawed. People who will watch it will say: the CPO is no better, he laments. But that's because they base their analysis on errors.

Pierre Marsolais, internist and intensivist instigator of the CPO pilot project.

In the first two years, he points out that 388 organs were transplanted from CPO donors, compared to 218 and 194 organs transplanted from nearest rival hospitals.

In 2016, Dr. Marsolais presented his analysis to the Minister of Health at the time, Gaétan Barrette, and managed to convince him of the good performance of the Sacred Organ Harvesting Center. Heart.

It's a fact. I confirm it to you, says Dr. Barrette, now retired from political life.

After these first two years of the Organ Harvesting Centre, Transplant-Québec is however reducing the population pool it serves by a third. The number of potential donors is decreasing and the centre's performance is suffering.

Investigation spoke to several people who were involved in the file of the CPO. Beyond the official reasons to explain its closure, there was also a whole behind-the-scenes game. First, around the call premiums of approximately one million dollars per year paid to the team of medical specialists at Sacré-Coeur.

Seen from the outside, we cannot know that there were turf wars, says Gaétan Barrette. And I would even tell you that there were jealous people because there was money attached to it.

Other sources have confided that large university hospitals found that the CPO took umbrage at them. And that the intense personality of Pierre Marsolais bothered some.

The CPO has been at the center of many tensions.

Over the years existence of the Organ Retrieval Centre, Quebec has seen an increase in the number of organ donors. And a drop after it closed in 2019.

What influence did the CPO have on these results? The COVID-19 crisis has clouded the issue.

To improve Quebec's performance in organ donation, the government is now counting on the deployment in hospitals of coordinating physicians in organ donation and transplantation.

Where they are present, Transplant Québec has noticed an increase in the identification of donors. This year, their number should increase from 10 to 32. They will no longer only be present in university hospitals, but also in smaller regional centers, where there is less expertise in organ donation.

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After Montreal, the Saguenay region has the most donors in relation to its demographic weight. Jean-Sébastien Bilodeau is the coordinating physician for organ donation. But access to resources remains problematic, according to him.

Sometimes there are operating rooms that are not available, he says. Sometimes transplant teams are not available. When there are several simultaneous donors, it can completely compromise the organ harvesting.

According to the figures sent to the Investigation team >, the waiting time between family consent and the removal of organs has increased considerably in the province. In 2014, it averaged 35 hours. Last year, at 86 hours, it had more than doubled.

This time required to proceed with the removal of organs is the main obstacle to family consent, according to Transplant Québec.< /p>

Last February, the prestigious National Academies of Sciences, Engineering and Medicine in the United States recommended the establishment of specialized care units for blood donors. organs for each of the 57 OPOs, the country's organ procurement organizations.

The report by Chantal Lavigne and Sophie Lambert is broadcast on Enquête Thursdays at 9 p.m. on ICI Télé. It is also available in catch-up on ICI Tou.tv.

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