Organ donation after assisted death: Is it more or less ethically-problematic than donation after circulatory death?

Abstract

A provocative question has emerged since the Supreme Court of Canada's decision on assisted dying: Should Canadians who request, and are granted, an assisted death be considered a legitimate source of transplantable organs? A related question is addressed in this paper: is controlled organ donation after assisted death (cDAD) more or less ethically-problematic than standard, controlled organ donation after circulatory determination of death (cDCDD)? Controversial, ethics-related dimensions of cDCD that are of relevance to this research question are explored, and morally-relevant distinctions between cDAD and cDCD are identified. In addition, a set of morally-relevant advantages of one practice over the other is uncovered, and a few potential, theoretical issues specifically related to cDAD practice are articulated. Despite these concerns, the analysis suggests a counterintuitive conclusion: cDAD is, overall, less ethically-problematic than cDCDD. The former practice better respects the autonomy interests of the potential donor, and a claim regarding irreversibility of cessation of the donor's circulatory function in the cDAD context can be supported. Further, with cDAD, there is no possibility that the donor will have negative sensory experiences during organ procurement surgery. Although the development of appropriate policy-decision and regulatory approaches in this domain will be complex and challenging, the comparative ethical analysis of these two organ donation practices has the potential to constructively inform the deliberations of relevant stakeholders, resource persons and decision makers.

Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy

“…Although there are potential concerns with first-person consent for organ donation after circulatory determination of death (including the permissibility of treatments administered to the dying donor solely for the health of the donated organ), 9 the informed, contemporaneous consent of a conscious and competent patient is the gold standard for decision-making in medicine. 10 Family concerns are important, and families must be supported throughout the donation, both for their own sake and to retain trust in the organ donation process. However, family refusals should not override persistent requests from capable patients to donate organs.…”

Organ donation following medical assistance in dying, Part I: a scoping review of legal and ethical aspects

“…Therefore, organizations should proceed with caution, as the availability of this process may increase or decrease the public trust in organ donation, MAiD, or both. 51 Despite the many debates around this process, the family members reported being pleased that their loved one had their final wish granted by donating their organs. 8,27,75 For patients who request MAiD, the availability of organ donation can help diminish their suffering at the end-of-life through a last altruistic act.…”

“…There is the potential that having the option of requesting organ donation following MAiD may either increase or decrease the public trust in these procedures. 51 This is because deceased organ donation, either from brain-dead donors or from donors with a circulatory determination of death, is already a socially accepted practice rooted in public trust in the health care system. 12,21,59,90 However a patient requesting to end their life through MAiD, regardless of whether it is followed by organ donation, remains a contentious, ethically charged issue in the public domain.…”

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

“…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.…”

“…4,20,24,25,27,37,[40][41][42][43]45,48,49,52,53,56,61,63,[71][72][73]76,78,80,81 The anesthetic regimen for organ donation following MAiD usually includes the administration of a coma inducer (eg, propofol, barbiturate thiopental, sodium pentobarbital) 4,20,24,25,27,37,43,45,53,56,61,63,72,76,80 with or without sedatives (eg, midazolam, fentanyl), 4,43,45,53,63,72 and neuromuscular blockers (eg, rocoronium bromide, atracurium besylate, cistracurium besylate). 4,20,24,...…”