When Ontario made Canadian history this spring by publishing individual hospitals' organ donation rates, the figures for William Osler Health System looked grim.
The hospital's campuses in Etobicoke and Brampton managed to convince the families of just seven of 21 potential deceased donors to give away their loved one's organs over a nine-month period, for a "conversion" rate of 33 per cent, well below the provincewide average of 52 per cent and the target of 63 per cent.
But behind the scenes, the staff at William Osler's two sites were already hustling to improve their numbers, well aware of both the desperate need for organs and the fact that poor-performing hospitals were about to be named and shamed on the Internet.
The hospital appointed a critical care doctor to champion organ donation, then zeroed in on flagging potential donors early, making such identifications part of daily "bullet" rounds in the intensive care unit and internally auditing how often staff properly notified the network that co-ordinates transplants in the province.
It appears those efforts have begun to pay off: In the most recent quarter, William Osler converted four of five potential donors into actual donors, a success rate of 80 per cent.
Although the sample size is small and the campaign still in its early days, the hospital's experience is instructive for other institutions that have struggled to raise their rates, especially in immigrant-heavy communities where fewer people tend to register their desire to donate.
"Bottom line," said Alex Mcmillan, the system's lead physician for organ and tissue donation, "it came down to changing our philosophy and our approach to this."
Fewer than 3 per cent of patients who die in hospital are medically suited to give away their heart, lungs, liver or other internal parts. In Canada, the need for organs outstrips supply. In 2012, 15 people died waiting for a heart; 62 waiting for a liver; 69 waiting for lungs and 84 waiting for a kidney, according to the Canadian Institute for Health Information.
"We have to capture every possible donor we can," said Lori West, a University of Alberta medical researcher and director of the Canadian National Transplant Research Program. "That's where individual hospitals can have a role, particularly in instituting the role of donation specialists. That's what's been shown in international jurisdictions to have one of the biggest impacts on donor availability."
Dr. Mcmillan was appointed William Osler's physician lead for organ and tissue donation last October. At the time, the two hospitals that make up the system, Brampton Civic and Etobicoke General, were struggling with basic reporting to the Trillium Gift of Life Network, the organization that co-ordinates transplants in Ontario.
In December, the rate at which William Osler routinely notified TGLN of potential donors was 75 per cent. The target is 100 per cent.
The hospital made electronic record-keeping of the notifications mandatory, then conducted monthly internal audits, driving their rate up to 99 per cent in May, Dr. Mcmillan said.
Meanwhile, on so-called bullet rounds in the ICU – during which a team made up of a social worker, dietician, nurse educator, charge nurse and, depending on the day, a doctor, checks in on every patient – staff watched for the four "clinical triggers" that should prompt an official notification to TGLN. Those include a grave prognosis, an injured brain or non-recoverable injury/illness, a family-initiated discussion of donation or a discussion of the withdrawal of life support.
The hospital also put a huge emphasis on educating staff, Dr. Mcmillan said.
All of this happened at hospital campuses in Brampton and Etobicoke, two communities packed with recent immigrants whose mother tongues aren't necessarily English.
"There's a link, in particular, between registration of consent and the diversity of the population in that community," said Ronnie Gavsie, president and CEO of TGLN.
When people do not register their wishes, it can be harder to convince relatives to consent to donation, she added. Brampton's registration rate is 14 per cent and Etobicoke's is 15 per cent, lower than the provincial average of 25 per cent.
But Dr. Mcmillan said diversity has not proved to be a barrier to the hospital's renewed effort to drive up its conversion rates.
"Obviously, it's early," she said. "But even if it's early, I think [the last quarter] shows very clearly that there's not an ethnic predisposition, it's just about education and providing every patient that we have and their families the opportunity to make a decision on organ and tissue donation while respecting their values and wishes."