Cells, Tissue and Organ Surveillance System (CTOSS)

Project Progress Report: April 2007 – December 2013

Executive Summary

An increasing number of cell, tissue and organ transplant procedures take place each year in Canadian health care facilities, including procedures in clinics, physician and dentist offices. In 2012, 2,225 organ transplant procedures were performed in Canada – an increase of nearly 5% over 2011. In the same year, there were 41,252 Canadians living with end-stage kidney disease receiving some form of dialysis and 3,428 patients were on the waiting list.^{Footnote 1}In Canada, over 90,000 tissue allografts are distributed for transplantation, including musculoskeletal, vascular, skin, cardiac and corneal tissues.^{Footnote 2}

The Surveillance and Epidemiology Division (SED) of the Centre for Communicable Disease and Infection Control (CCDIC) at the Public Health Agency of Canada (the Agency) is responsible for leading the development of activities supporting the evolving Cell, Tissue and Organ Surveillance System (CTOSS).

The Agency works to protect the health and safety of Canadians through preventing and controlling chronic diseases and injuries and infectious diseases, in addition to preparing for and responding to public health emergencies. The Agency serves as a central point for sharing Canada's expertise with the rest of the world by applying international research and development to Canada's public health programs and strengthening intergovernmental collaboration on public health policy and planning.

The Agency is leading the development of CTOSS as a national system, with the objective of improving safety for Canadians receiving transplants by capturing and analyzing adverse event data and disseminating the resulting knowledge. Transplantation adverse event surveillance data is critical to our ability to improve patient safety by limiting and preventing transplant associated adverse events. Adverse event data is needed because the requirements for transplantation are expected to rise, and currently there is no surveillance data available to provide incidence rates for transplantation adverse events in Canada. "The need for organs is predicted to increase by 152 percent over the next two decades. Canada's aging population will require more and donate fewer organs, medical advances will enable more patients to benefit from transplantation and the demand for organs will increase significantly due to rising rates of chronic disease."^{Footnote 3}

The safety of both prospective and post-transplanted patients is the prime focus of CTOSS, as the data will support informed surgical consent and the potential avoidance of transplantation adverse events through the development of appropriate programs and policies.

Historically, Canada has not had a public health surveillance system in place for identifying adverse reactions from cell, tissue and organ (CTO) transplantation and no systematic way of identifying emerging issues and trends in public health threats arising from CTO transplants. The chronic disease trajectory including an anticipated increase in transplantation has highlighted the necessity of establishing a public health surveillance system for CTOs to ensure patient safety.

Data collection on adverse events related to human allograft tissue transplants began in April 2011 at five pilot sites: Alberta Health Services, Edmonton; Sunnybrook Hospital, Ontario; the province of Quebec; Horizon Health Network, New Brunswick; and the province of Nova Scotia. By December 2013, eight tissue transplantation adverse events have been reported, the majority of which involve corneal tissue.

Prior to the commencement of data collection, minimum data elements and definitions were established for tissues. The definitions were developed considering both the European Union's EUSTITE (European Union Standards and Training in the Inspection of Tissue Establishments) definitions and the U.S. Center for Disease Control's Transplantation Transmission Sentinel Network, in order to support international comparability. To date, these components have not yet been established for the cell and organ components; however they are the priority for the CTOSS program moving forward. The CTOSS initiative continues to support the Agency strategic objective of "protecting Canadians and empowering them to improve their health" by strengthening public health capacity in order to support public health decisions and actions relating to transplantation.

To obtain an electronic copy of the report, send your request to:

Centre for Communicable Diseases and Infection Control
Public Health Agency of Canada
100 Eglantine Driveway
Tunney's Pasture
Ottawa, ON K1A 0K9
E-Mail: ccdic-clmti@phac-aspc.gc.ca