In the past three years (between 2001 and 2003), 483 heart transplants were performed in Canada (5.1 per million people). This represents a decrease from 524 (6.0 per million people) between 1993 and 1995.

“Despite the continued success of heart-transplantation surgery, we know that patients will die each year while waiting for this lifesaving intervention,” says Dr. Vivek Rao, a heart-transplantation physician and advisor to CIHI. “The rate of heart transplantation is directly tied to the deceased donor rate and the age of these donors.”

On December 31, 2003, 131 people were on the waiting list for a heart transplant. From 1993 to 2003, 375 Canadians died while waiting for a heart transplant.

The organ-donor rate in Canada has remained at 13 to 15 per million people for the last decade, compared to rates of 18 to 22 per million in the U.S. These organ donors are an aging group -- nearly two of every five donors were 50 years or older in 2003.

“The shortage of donors, combined with their increasing age, has had two major impacts,” explains Dr. Rao. “First, there are an insufficient number of small hearts available for children who require heart transplantation. And second, there are fewer medically suitable hearts for adults awaiting heart transplantation. To ensure that children and our sickest patients receive needed treatment, we have relied increasingly on donor hearts offered from U.S. organ-procurement organizations.”

In 2002 and 2003, 33 (10%) of the 321 heart transplants performed in Canada used donor hearts from the U.S., while only three hearts from Canadian donors were sent to the U.S.

Because so many patients on the waiting list have died, “six Canadian transplant programs have resorted to ventricular assistive devices (VADs) to support their patients," Dr. Rao reports, "but ... funding of these VADs remains a problem.”

VADs are mechanical pumping devices that help the heart pump more blood, and are used as bridge treatments to transplantation.

The number of days that recipients waited for their transplants was dependent on their medical condition at the time that they were listed, as well as their blood type.

From 2000 to 2002, patients who were in the intensive care unit (ICU) at the time of listing had a median wait time of 19 days. In contrast, patients who were not in ICU at the time of listing had a median wait time of 97 days. The latter group represents nearly 60% of all patients.

Patients who had type O blood (universal donors) had the longest median wait times, regardless of their medical condition at the time of listing.

There is considerable variation in heart-transplantation rates, according to patients' province of residence. Rates ranged from a high of 9.1 per million people in Alberta to a low of 2.5 in Newfoundland and Labrador for the years 2000 to 2002.

These different rates do not seem to be explained solely by the presence or absence of a provincial heart-transplant program. The rate in Saskatchewan (which, like Newfoundland and Labrador, does not have a heart-transplant program) is over double that of Newfoundland and Labrador, and was higher than all other provinces, except Alberta, from 2000 to 2002.

Heart-transplant rates by province of residence have increased from 1994–1996 to 2000–2002 for Alberta, Nova Scotia, Saskatchewan, P.E.I. and the territories, but decreased in Ontario, Quebec, Manitoba and Newfoundland and Labrador. Heart-transplant rates remained stable for British Columbians and fluctuated for New Brunswick.

There are 12 heart-transplant programs in Canada located at hospitals in five provinces: Nova Scotia (1 program), Quebec (5 programs), Ontario (4 programs), Alberta (1 program) and British Columbia (1 program).

Patients from provinces where there are no transplant programs are typically treated in adjacent provinces with a heart-transplant program. Pediatric patients are treated in Ontario, Quebec and Alberta.