The Impact of Funding and Program Structure on the Performance of Organ Donation Organizations in Canada
Bibliographic record
Abstract
Canada’s performance in deceased organ donation lags behind that of high performing countries and the demand of waitlisted transplant candidates is not being met. We performed a scan of the literature to determine key funding-related components of deceased donation to determine high priority areas for investment. We also surveyed literature on the economic and financial benefits of transplant compared to non-transplant medical care. This literature scan informed the development of a survey and interview conducted of organ donation organizations and donation programs in Canada. The purpose was to gain understanding of the practices of the most successful jurisdictions in Canada, to investigate which financial factors contributed to success in those jurisdictions, to investigate financial barriers that hinder improvement, and to determine if a correlation exists between performance within a province and donation program funding within that province. Five areas were identified that were key components to the success of high performing jurisdictions and critical areas of improvement for those that are underperforming. These were: structure and processes of donation programs, prioritization of new funding, optimization of existing funding and consideration of new approaches, performance and accountability measures, and supporting and guiding these changes with robust research. This study supports the conclusion that a minimum level of funding is required to sustain a functioning deceased donation system and that provinces that invest more seem to outperform others. This report serves to provide an increased understanding of how organ donation is currently funded in Canada, identify key differences that exist between jurisdictions, and provides an overview of current challenges. It is hoped that this information will serve as a resource for donation programs and provincial ministries to guide policy and improve equity of access to organ donation and transplantation across Canada. Sam D. Shemie. Peter Nickerson. References 1. Organ Donation and Transplantation in Canada: System Progress Report 2006‐2015 Ottawa ON: Canadian Blood Services; 2016 [cited 2016 October 10, 2016]. Available from: https://blood.ca/sites/default/files/ODT_Report.pdf. 2. The Madrid Resolution on Organ Donation and Transplantation. Transplantation. 2011;91:S29-S31. doi: 10.1097/01.tp.0000399131.74618.a5. PubMed PMID: 00007890-201106151-00004. 3. Delmonico FL, Dominguez-Gil B, Matesanz R, Noel L. A call for government accountability to achieve national self-sufficiency in organ donation and transplantation. Lancet. 2011;378(9800):1414–8. doi: 10.1016/S0140-6736(11)61486-4. PubMed PMID: 22000137. 4. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism. 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Organs for Transplants - Review of the evidence on the cost and cost-effectiveness of solid organ trasnplantation (heart, liver, lung and pancreas). Brunel University, Group HER; 2010. 31. Zelmer JL. The economic burden of end-stage renal disease in Canada. Kidney Int. 2007;72(9):1122–9. doi: 10.1038/sj.ki.5002459. PubMed PMID: 17700643. 32. Rabeau Y. The Economics of Kidney Failure. The Kidney Foundation of Canada, 2012. 33. Annual Report 2014/15. Toronto, ON: Trillium Gifl of Life Network, 2015. 34. Flatt A, Krueger H. Costing Solid Organ Transplant Procedures in British Columbia. BC Transplant, 2009 November 20. Report No. 35. Preliminary Financial Impact Analysis: BC Transplant Redesign. BC Transplant. 36. Financial Statements of British Columbia Transplant Society Branch. BC Transplant, 2016. 37. Current Statistics - December 1, 2016. BC Transplant, 2016 December 1. Report No. 38. e-Statistics Report on Transplant, Waiting List and Donor Statistics. Canadian Institute for Health Information, 2014. 39. Dor A, Pauly MV, Eichleay MA, Held PJ. End-stage renal disease and economic incentives: the International Study of Health Care Organization and Financing (ISHCOF). Int J Health Care Finance Econ. 2007;7(2–3):73‐111. doi: 10.1007/s10754-007-9024-9. PubMed PMID: 17653860. 40. ODTEAC Meeting Minutes. Organ Donation and Transplantation Expert Advisory Committee; 2016 November 25, 2016.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.026 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.007 | 0.002 |
| Scholarly communication | 0.005 | 0.001 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".