In Focus

CANDAT

Building Canada’s vein-to-vein data infrastructure for safer, smarter transfusion medicine

Antoine Lewin

Héma-Québec, Québec, Canada

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In Canada, maintenance of an uninterrupted supply of lifesaving blood products to both large institutions and remote and underserved regions is a logistical challenge — one that goes beyond transportation.

Ensuring the sustainability and safety of the blood system in these areas also requires a robust data infrastructure to track inventory, monitor quality, support continuous quality improvement and coordinate timely distribution. The Canadian Donations and Transfusion Database (CANDAT) is a national initiative designed to create a comprehensive, vein-to-vein (V2V) data program updated in real-time1. This article outlines the rationale, structure, and vision for CANDAT, drawing on recent developments and international models. Vein-to-vein databases link donor, component, and recipient data to enable full traceability of transfusions. These systems support large-scale, real-world studies on transfusion effectiveness, safety, and complications. International examples, such as Scandinavian Donations and Transfusions (SCANDAT; Sweden and Denmark)2, Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P; USA)3, and the Dutch Transfusion Data warehouse (DTD; The Netherlands)4, support the potential of such systems in guiding policy decisions in transfusion medicine. Canada currently lacks a unified V2V system. Blood donation records are maintained by Héma-Québec and Canadian Blood Services, and transfusion recipient data reside in provincial health databases and/or hospital local electronic medical records. This fragmentation limits our ability to tackle the three major challenges confronting the Canadian blood system, namely infectious complications, non-infectious adverse events, and supply shortages1. An integrated V2V system would help address these issues by enhancing our ability to monitor trends, identify risks, and respond to emerging threats.

Canada is well-positioned to build CANDAT by leveraging and expanding existing databases. The General Medicine Inpatient Initiative (GEMINI) initiative pools data from over 35 hospitals in Ontario, including transfusion data and quality metrics5. The Institute for Clinical Evaluative Sciences (ICES) maintains longitudinal healthcare data for Ontario’s population, encompassing physician billings, lab results, and registries6. The Health Data Research Network (HDRN) connects organizations across Canada that hold linkable health data for entire populations7. Both Héma-Québec and Canadian Blood Services maintain extensive donor and product datasets. These include genotyping, seroprevalence studies, and biobank data. Past collaborations have demonstrated the feasibility of linking donor and recipient data for research purposes. CANDAT aims to build on these foundations to create a national, interoperable system. The vision for CANDAT1 is to establish a Canadian national platform that connects existing databases of blood donors and transfusion recipients in real time. Its primary goals are to improve transfusion safety and sustainability, enable research in transfusion medicine, and support data-driven policy and clinical decision-making. To achieve these goals, CANDAT will focus on several priorities.

Data quality is paramount, requiring rigorous validation and monitoring. Privacy and ethical considerations will be addressed through a centralized research ethics board and robust legal frameworks, such as the GEMINI research ethics board process, which is being expanded to support multi-provincial collaboration across three provinces in Canada. Rather than duplicating efforts, CANDAT will build on existing infrastructure, advocating for more detailed transfusion-related variables and direct linkages.

Successful implementation of CANDAT will require strategic planning, clear roadmaps, and stakeholder engagement. Governance structures must include legal and ethical oversight. Cybersecurity safeguards must be in place to protect data integrity and privacy. Training programs will be needed to develop skilled personnel and foster a culture of continuous improvement. Achieving project success also means navigating several challenges. These include data fragmentation, inconsistent coding, incomplete collection, and ethical-legal risks in cross-provincial linkages. Another key challenge to long-term success will be effectively engaging policymakers and funders. Moreover, overcoming provincial barriers will require interprovincial collaboration and harmonization, with leadership committed to building relationships and formalizing data agreements. Lastly, securing sustainable funding may prove challenging—but is essential to achieving long-term success. To demonstrate feasibility, CANDAT will launch a pilot project focused on immunoglobulin (Ig) usage. Ig products account for nearly a quarter of Canada’s blood manufactured blood product expenditures, and recent supply disruptions have highlighted vulnerabilities8. The project will integrate Ig inventory data from electronic health records (EHRs) and transfusion records with paper-based Ig request forms, which capture prescribing information and diagnoses not available in EHRs. Using advanced data mining and linkage techniques, the project will assess compliance with guidelines, identify high-utilization patterns, and develop predictive models for demand forecasting. This initiative will demonstrate how vein-to-vein data integration can improve system efficiency and help Canada better prepare for future Ig product needs.

International V2V databases offer valuable insights. SCANDAT in Sweden includes over 50 years of data and has enabled a number of studies on donor health and transfusion efficacy2. REDS-IV-P in the United States and Brazil includes comprehensive data from hospitals and blood centers, supporting research on donor genetics, pediatric transfusion, and sickle cell disease3. PETRA, a pan-European initiative, aims to standardize and link transfusion data across countries9. These models highlight the importance of standardized data collection, robust governance, and sustainable funding—lessons that CANDAT is actively incorporating. CANDAT is a bold step toward transforming transfusion medicine in Canada. By linking donor, product, and recipient data, it will enable monitoring, improve safety, and support equitable access to blood products. As we move forward, collaboration, innovation, and commitment will be key to realizing the full potential of this national initiative.

References

  1. Raza S, Callum J, Modi D, Sztainert T, Shih AW, Schull MJ, et al. Canadian donations and transfusion database (CANDAT): From blood donors to transfusion recipients. Transfusion. 2025;65:1187–95.
  2. Zhao J, Rostgaard K, Hjalgrim H, Edgren G. The Swedish Scandinavian donations and transfusions database (SCANDAT3-S) - 50 years of donor and recipient follow-up. Transfusion. 2020;60:3019–27.
  3. Birch RJ, Umbel K, Karafin MS, Goel R, Mathew S, Pace W. How do we build a comprehensive Vein-to-Vein (V2V) database for conduct of observational studies in transfusion medicine? Demonstrated with the Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric V2V database protocol. Transfusion. 2023;63:1623–32.
  4. van Hoeven LR, Hooftman BH, Janssen MP, de Bruijne MC, de Vooght KMK, Kemper P, et al. Protocol for a national blood transfusion data warehouse from donor to recipient. BMJ Open. 2016;6:e010962.
  5. Verma AA, Pasricha SV, Jung HY, Kushnir V, Mak DYF, Koppula R, et al. Assessing the quality of clinical and administrative data extracted from hospitals: the General Medicine Inpatient Initiative (GEMINI) experience. J Am Med Inform Assoc. 2021;28:578–87.
  6. Institute for Clinical Evaluative Sciences. Data Dictionary. Toronto: ICES.
  7. Health Data Research Network Canada. Data for Health & Health Equity. Cited 2025 Oct 1.
  8. Harmon M, Riazi K, Callum J, Arnold DM, Barty R, Sidhu D, et al. Immunoglobulin utilization in Canada: a comparative analysis of provincial guidelines and a scoping review of the literature. Allergy Asthma Clin Immunol. 2023;19:85.
  9. European Blood Alliance. Towards a Pan-European Transfusion Research infrastructure (PETRA). Cited 2025 Oct 1.
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