Our hospital is the regional solid organ transplant centre for several provinces. We do all the heart transplants in western Canada (from the Superior lakehead to the Pacific and all points north), livers for Saskatchewan, Alberta and BC and kidneys for northern Alberta and parts of northern BC. We will be performing a pediatric lung transplant sometime in the nearish future. We're also one of three hospitals in the country that does multivisceral and islet cell transplants and we're the North American training facility for the Berlin heart. The provinces all have agreements in place for transferring patients out-of-province for care not available there. Our hospital is also the pediatric cardiac surgery regional centre for all of western Canada, although we've had kids from virtually every other province come to us for cardiac surgery because our surgeons are a rare breed and will attempt repairs no one else will consider. Our mortality rate is 2.5% for ALL PICU admissions so they must be doing something right. At the moment we have kids in the unit from Saskatchewan, BC and the Northwest Territories.
In 1988 my family was living in Manitoba (a have-not province) and our son needed a liver transplant. Manitoba sends their liver transplant recipients to London, Ontario. He and I spent five months there, from January until May 1989; Manitoba paid for the surgery and all his care (including 6 weeks in PICU), our transportation there and back (but not the ambulances) and helped with a small portion of our other out-of-pocket expenses. Now they also pay for accommodations, but in 1989, it was my responsibility. The system works reasonably well, and costs are contained by not putting MRIs, transplant centres, ECLS teams and other specialties in every hospital big or small. Oh, and it has a positive influence on outcomes because the specialty care providers are able to maintain and improve their skills by using them all the time.