Canada does not have a national donor program. Each province and territory has an organization that is responsible for coordinating all organ and tissue donations. The organization serves as the link between donors and recipients, and is responsible for the retrieval, preservation and transportation of organs for transplantation.

Each province also manages its own transplant waiting list as there is no national list. All patients are assessed based on a clearly defined set of criteria before a decision is made about where a patient needs to be placed on the waiting list.

Usually, representatives from the province's transplant centers, as well as the province's transplant governing body's medical advisory board, ethics committee and transplant surgeons evaluate each patient according to criteria, which may vary by province.

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Although transplantation is considered an established treatment for end-stage renal failure, it is not suitable for everyone, so the transplant team must carefully assess every potential transplant patient. The assessment phase starts when your kidney specialist refers you to the transplant team.

As part of the initial assessment, you will have several tests and be interviewed by various team members to determine whether transplantation is the best treatment option for you and to determine your surgical eligibility for transplant.

These tests may include:

• blood work;
• x-rays;
• cardiac studies to determine if the heart can withstand the stress of surgery and anesthesia;
• vascular studies to look at the blood vessels that supply the legs.

You will also receive information that will help you make a decision regarding transplant. The goal of the assessment phase is to find out whether transplant is a safe and reasonable procedure for you.

It is not unusual for additional tests to be ordered to determine your physical ability to undergo surgery and achieve a good quality of life. In some instances, arrangements will be made for patients to be seen by additional specialists such as cardiologists. The goal is to enable you to be fit for transplant and to also determine your mental preparedness for the entire process.

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It depends on many factors and varies from program to program. Living donors must come forward of their own accord. If they decide that they want to donate a kidney they must contact their own doctor who will arrange for a series of tests to see if they are a suitable candidate. The living donor's name is then placed in a provincially administered donor registration program. In most cases, living donors come forward because they want to help relatives or friends who are in need of a kidney transplant. The process could take anywhere between 6 to 9 months.

In February 2009, Canadian Blood Services launched the Living Donor Paired Exchange Registry, a new and innovative registry that is designed to facilitate kidney donations among live donors.

The registry is designed to match live kidney donors with suitable recipients who are suffering from end stage renal disease (kidney disease) and in need of a transplant. Frequently, healthy and motivated Canadians are unable to be living kidney donors because their blood group or tissue type is incompatible with their intended recipient - such as a friend or relative. In a paired exchange, these live kidney donors - healthy people who donate one of their two kidneys - are matched with other compatible recipients. Once an acceptable match is made, a swap occurs between two sets of kidney donors and recipients.

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Some patients stay on dialysis for many years before ever being put on a transplant waiting list. Others are on dialysis for very short periods of time before this happens. Patients must undergo all the transplant related testing necessary. Each individual patient is then assessed on a case-by case basis, according to the evaluation criteria in their province of residence by the pre-transplant assessment team before being entered on the deceased donor list.

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Antibodies (also known in medical terms as immunoglobulins) are gamma globulin proteins that are found in blood and tissue fluids, as well as other bodily secretions and are used by the immune system to identify and prevent foreign objects, such as bacteria and viruses, from attacking the body.

In other words, your antibodies are your own personal army. When they detect something foreign in your body, like a virus or bacteria, they will work together to fight whatever it doesn't recognize as belonging to the body it is trying to protect.

A donated organ by definition comes from someone else's body. When that organ is transplanted into the recipient's body, the antibodies do their job and attack the foreign organ that is not recognized. This is why taking immunosuppressive medication (anti-rejection medication) at the appropriate time every day is so important. The medication ensures that the transplanted organ is protected from attacks by the recipient's antibodies and is not rejected by the body.

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The Centers for Disease Control and Prevention classifies people taking immunosuppressive medication as being at high-risk for complications of novel influenza (H1N1) virus infection, popularly known as the swine flu.

At this time, there is no vaccine available yet to prevent swine-origin influenza A (H1N1). It becomes more important then if you have chronic kidney disease or had a transplant that you take special precautions to protect against this new strain of the influenza virus.

The guidelines for protecting against the swine influenza should be followed to a greater degree by people who are taking immunosuppressive medications.

The risk for swine-origin influenza A (H1N1) might be reduced by taking steps that include frequent hand washing, staying away from people that have a cough or fever, reducing unnecessary social contacts, and avoiding crowded settings whenever possible. If used correctly, protective face masks may help reduce the risk of getting influenza, but they should be used along with other preventive measures, such as avoiding close contact and maintaining good hand hygiene.

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• Vaccination for the H1N1 flu virus is recommended for all patients who have been transplanted for over a month.
• Transplanted patients are more at risk for developing serious complications from influenza and that is why they are considered a high priority group for vaccination.
• Given that individuals who have undergone a transplant are considered at risk, your loved ones should also be vaccinated.
• The adjuvant contained in the vaccine is not dangerous for transplanted individuals.
• Please visit www.phac-aspc.gc.ca/alert-alerte/h1n1/index-eng.php for the hours and the vaccination locations nearest you.
• Individuals are encouraged to wear masks and gloves before visiting a vaccination centre and to minimize the risk of infection that can be transmitted by other individuals receiving their vaccines.
• Individuals are also encouraged to bring their list of medications to prove that their immune systems are suppressed as a result of their anti-rejection medications.

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