EVALUATION OF THE DEMAND FOR ORGAN TRANSPLANTATIONS IN QUEBEC

Objectives: To evaluate the demand for organs for transplantation and to recommend a reorganization of transplantation services in Quebec. Design: Retrospective study. Setting: Province of Quebec, 1988 to 1992. Patients: All patients on waiting lists for organ transplantation and patients who received transplants registered in national data banks. Main outcome measures: The actual annual demand for organ transplantation and the rate of transplantations performed. Results: The rates of heart transplantation were lower than the actual annual demand, which resulted in many patients dying while awaiting transplantation. The actual annual demand for heart transplantation decreased during the last 5 years from 10.9 per million people in 1987 to 6.7 in 1992. The rates of heart transplantation in Quebec were higher than the Canadian average. The actual demand for lung transplantation was only 2.9 per million people on average in 1992. Demand for liver transplantation increased annually, reaching 8.6 per million in 1992. The rate of transplantation increased likewise but remained insufficient. The demand for kidney transplantation reached 27.2 per million people in 1992, and the transplantation rate was 17.8. Conclusions: Taking into account the actual demand for and supply of organ transplantation, to insure high-quality service and to control costs associated with organ transplantation, we recommend that the present system in Quebec be reorganized so that transplantations are performed in 12 centres: 7 for kidney transplantation, 2 for hearts, 2 for livers and 1 for lungs.