In a typical year, Newfoundland and Labrador's organ donation program oversees five or six transplants a year.
So far in 2022, there have been none.
The reason? Newfoundland and Labrador's organ donation program has been on hold since March due to staffing shortages.
Canadian Transplant Society CEO James Breckenridge says N.L.'s yearly total might seem like a small number of donors to miss out on but it only takes one donor to change someone's life.
"We have almost 4,000 people now in Canada that are sightless that could have their sight back from a donation, Breckenridge told CBC News in a recent interview.
"A mother hasn't seen her child in years and all of a sudden you grant her sight from somebody who passed away in Newfoundland — it's a wonderful thing. So having no donors is just a shame."
The province's health-care system has been experiencing mounting problems over the past several months due to staff shortages, pandemic-related burnout and rolling emergency room closures.
Program may restart later this year: Eastern Health
Dr. Sharon Peters, Eastern Health's clinical chief of regional critical care, said staffing the donation program became unsustainable after one staff member quit and another retired.
"We're a small program, so it doesn't take much in terms of staff turnover to put us in a precarious position," she said.
She said the program has been suspended until new employees can be trained to take over organ co-ordinator positions. She said new staff are expected to complete their training this fall, which would allow the program to resume this year.
While the donor aspect of the program is on hold, Peters said, the part of the program responsible for bringing in tissue for orthopedic and plastic surgeries has continued.
It's a very intense position.… It's very highly emotional and stressful. - Dr. Sharon Peters
Dr. Matt Weiss, an organ donation policy expert and medical director at Transplant Quebec, says Newfoundland and Labrador's average deceased donor rate is about half the Canadian rate.
"We often count these things in terms of donors per million of population," he said, noting that five donations a year would be about 10 donors per million people. "Canada-wide we're roughly at 20 donors per million."
He said N.L.'s low number is not surprising because the province has many logistical hurdles when it comes to harvesting and transporting organs.
The province's health-care workers do not perform transplants. Instead, staff co-ordinate with other provinces to procure and send organs and recipients out of province for transplantation.
Program suspension from lack of staff is unusual, Breckenridge says
Other organ donor programs have been forced to close in Canada in the past few years but they have been due to the ICU capacity hitting its limits because of skyrocketing COVID-19 cases, as has happened in Saskatchewan.
Breckenridge says he had never heard of a program being suspended in Canada for a lack of staff.
"Somebody's not putting any money into the program because you could reasonably recruit somebody from another part of the country to come for six months, become the co-ordinator there now, and teach somebody," Breckenridge said.
Peters said she hadn't yet heard that suggestion, but it wouldn't be feasible.
"Unfortunately, we're not the only ones in Canada with a problem with staffing," she said.
She also pushed back against the assertion that the program is underfunded.
She said the program needs about 2½ full time-equivalent positions to function, which works out to be one full-time and three part-time staff members, and the program does receive enough funding for those positions.
Peters said burnout is behind a considerable amount of organ donor program staff turnover. Staff have to co-ordinate with grieving family members while ensuring organs can be transplanted successfully.
"It's a very intense position," she said. "It's very highly emotional and stressful."
High turnover rate for organ donor co-ordinators
It's not unusual for health-care workers to face stressful decisions and long hours. But according to Canadian Blood Services, organ donor co-ordinators across the country face especially high burnout rates.
The average co-ordinator stays in the position for only three years, according to the non-profit organization, which is studying the burnout rates of donor co-ordinators to come up with strategies to reduce the profession's attrition rate.
Weiss agrees organ donor co-ordinators face many logistical and technical headaches while trying to deal with even just one donor. Because the organ and transplant system in Canada is so interconnected, staff must deal with a variety of medical teams and multiple hospitals in many different areas of the country.
The emotional burden of the job can also be difficult, he said.
"As someone in the ICU that sees similar things, a lot of my patients do well and leave the ICU, but for a co-ordinator all of the families have lost someone. It's all grief, all the time, and so not surprisingly there's a lot of burnout," he said.
Weiss says the coronavirus pandemic has exacerbated the issues staff must deal with, such as frequently changing COVID-19 protocols and the fact they had to test potential donors for COVID-19.
"The last thing we'd want to do is transmit COVID-19 from a deceased donor to someone who's received the organ because those people are going right away on immunosuppression agents that are going to tamp down their immune system and make it more risky if they catch it," Weiss said.
Improving the system
Weiss said he's sure the people behind the organ donation program analyzed all options before putting it on hold.
He sympathizes with health-care workers trying to work with limited resources and staff shortages, he said, but he also stressed the importance of honouring the people who've decided to be donors, as well as the people waiting for a life-saving donation.
"Make sure that donation and transplantation remain a priority," he said. "There are a lot of important priorities in the health care, obviously, but something that can be sometimes lost in the shuffle is just how important a single donor can be for numerous people."