Liver transplantation with donation after medical assistance in dying: Case series and systematic review of the literature

Abstract

Medical assistance in dying (MAiD) has been a legally approved practice in Canada since 2016. Only recently have patients undergoing MAiD also been considered as donors for liver transplantation (LT). This study aimed to evaluate a case series of LT outcomes for recipients with MAiD donors and was paired with a systematic literature review of studies assessing the efficacy of MAiD-associated liver donation. A retrospective chart review of patients registered within the LT Registry at London Health Sciences Centre (LHSC) in London, Ontario, Canada, that had received MAiD donor LT was conducted to develop a case series. Descriptive statistics were produced based on available patient outcomes information. The systematic review included euthanasia due to MAiD being a term exclusive to Canada. Case series had a 100% 1-year graft survival rate, with 50% of patients experiencing early allograft dysfunction but having no significant clinical outcome. A single case of postoperative biliary complication was reported. Median warm ischemic time ranged from 7.8–13 minutes among case series and literature reviews. Utilization of donation after circulatory death allografts procured after MAiD appears to be promising. Mechanisms associated with potential impact in postoperative outcomes include relatively lower warm ischemic time relative to donation after circulatory death Maastricht III graft recipients.

Organ donation following medical assistance in dying, Part II: a scoping review of existing processes and procedures

“…We screened 341 full-text reports, and from those, 121 met the inclusion criteria. From the 121 included sources, 107 sources 2–4,6,7,18–119 are reported in this manuscript responding to research subquestions v and vi (details on the division of results can be found in the upcoming sections and in Figure 2).…”

“…It can take up to several minutes, which can result in prolonged functional WIT, compromise the quality of organs, and result in greater risk for recipients. 3,19,20,37,41,[48][49][50][51]53,[56][57][58]61,64,65,[67][68][69]77 MAiD, medical assistance in dying; OD, organ donation *Varies between countries; in some places the patient must start the conversation around OD; in others the health care professional may start this conversation. **Varies between countries and, in some places, the patient can make this arrangement prior to losing capacity to give consent before the procedure.…”

Reply: The urgent need for consensus around organ donation after assisted dying

“…Berry and Kotha raise ethical and geopolitical considerations related to transplantation from donation after MAiD. Encouraging discourse among stakeholders, including policymakers, the public, ethicists, legal experts, and the medical community, is crucial 1 …”

“…Encouraging discourse among stakeholders, including policymakers, the public, ethicists, legal experts, and the medical community, is crucial. [1] Jurisdictions practicing transplant after MAiD in Canada have undergone rigorous policy development. Public trust in transplantation is sacrosanct, warranting distance between transplant surgeons and donation decision-making.…”

Letter to the Editor: The urgent need for consensus around organ donation after assisted dying

“…Glinka et al’s review of liver transplantation after medical assistance in dying adds to the ever-growing literature from countries and states where voluntary assisted dying (VAD) or euthanasia is legal 1 . Outcomes are good, and warm ischemic times are short; clearly, it works.…”