A first-of-its-kind in Canada, Donate Now is a policy being proposed in British Colombia that hopes to offer living kidney donors the opportunity to donate a kidney now while still ensuring that if a loved one needs a kidney in the future they would not be left without an option for timely transplantation. The proposal, developed by Drs. Justin Gill, John Gill, and Jagbir Gill, stands to pave the way for increased living kidney donors, a vast need given the demand for kidney transplants far exceeds the availability of organs in Canada. Dr. Jagbir Gill’s Venture Grant-funded research, “A unique reciprocity-based strategy to improve living kidney donations in British Columbia: Focus group consultations,” explores the views of patients, donors, and key community stakeholders on their views on the proposed policy.
“In both the transplant clinic and through initial research, a clear barrier to living kidney donations is the thought, ‘But what if a loved one needs an organ in the future, and I have already donated mine?’” explains Reetinder Kaur, co-investigator on the study. To remove these types of disincentives that deter living kidney donation, “Donate Now” is a strategy that proposes a reciprocity-based policy that would allow all living kidney donors to nominate between 3-5 individuals, one of whom would be given priority for deceased donor kidney transplant in the future if the need arises.
Dr. Jagbir Gill is passionate about exploring ways to increase living donation opportunities
“What we absolutely know is that living donor kidney transplantation is better for recipients compared to deceased donor kidney transplantation for improved graft and patient survival,” says principal investigator Dr. Gill, transplant nephrologist and Medical Director of Kidney Transplantation at St. Paul’s Hospital. “Living donation is a lifesaving gift and living donors are heroes. It’s our responsibility to continue to remove disincentives to living donation so that more people can participate in the gift of life.”
However, a critical step in this work was to understand the acceptability of this new policy among key stakeholder groups. Thanks to the seed funding awarded by the Organ Donation and Transplant Research Foundation (ODTRF) of BC in 2023, Dr. Gill and Ms. Kaur were able to explore that. “The Venture Grant has been invaluable in establishing a foundational component of Donate Now so we could understand if those most impacted would be supportive of the policy,” says Dr. Gill.
Where Research Intersects Reality
For Rachael Durie, both a living kidney donor and co-chair of the ODTRF, the potential of Dr. Gill’s research resonated greatly.
“While we were in the early stages of determining if I was a match for my husband, we were simultaneously doing a big outreach to anyone and everyone to see if we could find a kidney for Niilo. The biggest deterrent that we were hearing back from anyone we approached was concerns their child or family member would need a kidney transplant in the future,” explains Rachael, who ended up being a match for her husband’s much-needed kidney transplant in 2022. “I ended up being a match so we didn’t have to go down the road of finding a living kidney donor, but this policy addresses that main hesitation for people, which will hopefully provide peace of mind for someone who is considering living kidney donation.”
Gurjit Pawar is a patient partner with Dr. Gill’s study. She has received two living donor kidney transplants over the past 12 years. She participated in policy discussions, the development of the focus group guide, and is reviewing preliminary findings. She says, “As a recipient, I was already overwhelmed with an unexpected number of emotions, guilt being the biggest one. I believe that this project is an opportunity to provide both donors and recipients with a sense of relief when exploring the concept of living kidney donation.”
Rachael Durie donated her kidney to her husband Niilo
Preliminary Venture Grant Research Findings
Dr. Gill’s Venture Grant study included focus groups made up of prior living kidney donors who donated over the past five years, patients on the kidney transplant waitlist and community members from diverse populations, including individuals from Indigenous, South Asian and Chinese communities.
“Overall, all participant groups were supportive of the Donate Now policy. Participants felt that it would address an important disincentive for living kidney donors by putting them more at ease and allow them to make the decision to donate without worrying about the consequences of the decision in the future,” says Dr. Gill.
Paving the Way: Increased Living Kidney Donation
There is still work that needs to be done before Donate Now can be implemented in BC. But the initial research shows the reciprocity approach to living kidney donation would increase the number of potential donors, ultimately saving more lives.
“It is such an incredibly rewarding experience to be a living kidney donor; you are so thoroughly screened throughout the whole process that, by the time you actually get to the donation part, the risk to you is so minimal,” says Rachael. “But the gift that it gives to the recipient? Incomparable. The difference was immediately noticeable. Niilo woke up a whole new human from the surgery.”
“The second chance at life living kidney donation offers, the ingenuity of the transplant procedure itself, the connectedness and community that comes from it. It truly brings out the best in everyone involved.”
Reetinder Kaur presents the preliminary findings of Donate Now at the Canadian Society of Transplantation’s Annual Scientific Meeting in October 2024
It is with profound sadness we share that Niilo McCloud Riksman Edwards passed away in December 2024.