Ballooning numbers of obese Canadians coupled with an aging population are fuelling a sharp rise in kidney failure, but the demand for transplants can't be met due to stagnant rates of organ donation.
The result is patients waiting up to six years for a new kidney, and the stop-gap measure - dialysis - costs the health-care system almost 10 times more per patient than transplants.
"The supply of kidneys available for transplant has not kept pace with the growing demand," said Louise Moist, a nephrologist and associate professor of medicine at the University of Western Ontario in London.
The annual report of the Canadian Organ Replacement Registry, published on Thursday, contains some startling figures.
About 38,000 Canadians are living with kidney failure, up from 11,000 two decades ago. In that same time period, the number of patients on the waiting list has almost doubled, to 3,000 from 1,600, and the time they wait has stretched by years.
That is because, in the past decade, the number of transplants performed annually has risen only marginally, to 1,171 in 2009 from 1,037 in 1990. While the number of living donors is up a bit, cadaveric donations have flatlined.
Peter Nickerson, a nephrologist and medical director of Transplant Manitoba, said Canada has one of the lowest rates of cadaveric organ donation in the Western world - about 14.5 per one million population. By contrast, the rate in Spain is more than double that of Canada.
"We need to close that gap and I think the donor potential is there. We're just not communicating well with the public."
Dr. Nickerson noted that polling shows about 90 per cent of Canadians support organ donation, but only about 40 per cent sign donor cards. "There's a disconnect between support and action, and if we fix that we will save lives," he said.
Bolstering transplantation would also save money.
Dialysis - a procedure that clears the blood of impurities and toxins as normal kidneys do - costs the health system $2.2-billion annually.
Dialysis treatment is about $60,000 per person annually and requires patients to be hooked up to a machine three times a week for four hours at a time.
By comparison, a kidney transplant costs about $23,000, and the anti-rejection drugs that recipients take cost another $6,000 a year.
The surge in kidney failure is being driven by growing rates of diabetes and vascular disease (caused principally by high blood pressure). These, in turn, are due to the population aging and becoming ever-more obese.
The new CORR data also reveal wide variations in waits for transplant, ranging from 765 days in Nova Scotia to 2,145 days in B.C. The national average is 1,258 days.
"There is no national system at this point in time, so we don't share kidneys between provinces," said Dr. Nickerson, who is also medical director of organ transplantation at Canadian Blood Services. (CBS has been charged with overseeing a more cohesive national system but, unlike most other countries, Canada does not have a single national body that oversees transplants.)
The waits cited above are for patients awaiting a kidney from a cadaveric donor. Nova Scotia has the highest rate of organ donation in the country and B.C. the lowest.
However, an increasing number of kidneys for transplant come from living donors. (People have two kidneys and can safely donate one to a compatible recipient.)
In those cases, patients with kidney failure spend far less time on dialysis, ranging from 135 days in Nova Scotia to 421 days in Saskatchewan.
There were 1,224 kidney transplants performed in Canada in 2009 - about 60 per cent of the organs were harvested from cadavers and the balance came from live donors.
Jean-Christophe Nicolas of Quebec City has had two kidney transplants - one from a cadaveric donor and one from a live donor.
Born with malformed ureters - the tubes that drain urine from the kidneys to the bladder - he ended up on dialysis at age 12 and waited more than a year for a transplant. But his body rejected the new organ and he ended up back on dialysis before receiving a kidney from his father at age 17.
"My dad literally gave me a new life," said Mr. Nicolas, who is now 28.
He said being on dialysis leaves a patient tethered to a hospital and unable to have much of a life.
"Today, there's nothing I can't do. I have a job, I'm very active and I have a family," Mr. Nicolas said.
"I take 13 pills a day, but for me that's nothing. It's way better than dialysis, he said.
The only concern Mr. Nicolas has is knowing that he will eventually require yet another kidney transplant and how long he will have to wait. (The data show that cadaver organs last, on average, about eight years, and kidneys from living donors, 12 years.)
"I have a good life now. But life on a transplant wait list is not good."
André Picard