Organ Donation After Euthanasia: A Dutch Practical Manual

Bollen, Jan; Jongh, Wim de; Hagenaars, Johanna A. M.; Dijk, G. van; Hoopen, Rankie ten; Ysebaert, Dirk; IJzermans, Jan N.M.; Heurn, Ernst van; Mook, Walther van

doi:10.1111/ajt.13746

Cited by 47 publications

(99 citation statements)

References 11 publications

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“…8 One of the main ethical problems that might arise is that the choice by the patient for euthanasia could be influenced by the possibility of organ donation. This in-hospital-committee deals specifically with complex end-of-life questions.…”

Section: A S E Rep Ortmentioning

confidence: 99%

Organ donation after euthanasia, morally acceptable under strict procedural safeguards

Dijk

Bruchem-Visser

Beaufort

2018

Clinical Transplantation

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In this paper, we will present a case of organ donation after active euthanasia (ODE) in the Netherlands from a patient who had his life ended at his explicit and voluntary request. The form of ODE we describe here concerns patients who are not unconscious and on life support, but who are conscious and want to have their life ended because of their hopeless and unbearable suffering, for instance due to a terminal illness such as Amyotrophic Lateral Sclerosis (ALS) or Multiple Sclerosis (MS). This form of ODE is of course only possible in jurisdictions where euthanasia is allowed. In these jurisdictions, organ donation after euthanasia is an option that may be considered. We believe ODE is worthwhile to pursue, as it can strengthen patient autonomy, can give meaning to the inevitable death of the patient, and be an extra source of much needed donor organs. To ensure voluntariness of both euthanasia and organ donation and avoid conflict of interest by physicians, ODE does need strict procedural safeguards however. The most important safeguard is a strict separation between the 2 procedures. The paper discusses several ethical issues such as who should broach the subject of organ donation and who should perform the euthanasia, and how a conflict of interest can be avoided.

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Section: A S E Rep Ortmentioning

confidence: 99%

Organ donation after euthanasia, morally acceptable under strict procedural safeguards

Dijk

Bruchem-Visser

Beaufort

2018

Clinical Transplantation

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“…One may question whether applying the DDR in the specific context of MAID or cessation of treatment is the optimal thing to do as suggested by Bollen et al 21 28. If organ donation were permitted following MAID, some would say it is counterproductive to provoke the death of the person with medication and then procure his or her organs.…”

Section: Cdcd In the Context Of A Conscious Decision To End Lifementioning

confidence: 99%

“…There is a dilemma surrounding the matter of informing patients of the possibility of donating organs after MAID 21 28. Not informing patients could prevent them from performing an act they would have wanted to do, while informing them could be seen as pressure to accept donation.…”

Section: Cdcd In the Context Of A Conscious Decision To End Lifementioning

confidence: 99%

“…Not informing patients could prevent them from performing an act they would have wanted to do, while informing them could be seen as pressure to accept donation. Bollen et al 21. places this dilemma on the physician's shoulders, with the attending physician having to decide whether to inform the patient requesting MAID.…”

Section: Cdcd In the Context Of A Conscious Decision To End Lifementioning

confidence: 99%

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Organ donation after medical assistance in dying or cessation of life-sustaining treatment requested by conscious patients: the Canadian context

Allard

Fortin

2016

J Med Ethics

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In June 2016, following the decision of the Supreme Court of Canada to decriminalise assistance in dying, the Canadian government enacted Bill C-14, legalising medical assistance in dying (MAID). In 2014, the province of Quebec had passed end-of-life care legislation making MAID available as of December 2015. The availability of MAID has many implications, including the possibility of combining this practice with organ donation through the controlled donation after cardiac death (cDCD) protocol. cDCD most often occurs in cases where the patient has a severe neurological injury but does not meet all the criteria for brain death. The donation is subsequent to the decision to withdraw life-sustaining treatment (LST). Cases where patients are conscious prior to the withdrawal of LST are unusual, and have raised doubts as to the acceptability of removing organs from individuals who are not neurologically impaired and who have voluntarily chosen to die. These cases can be compared with likely scenarios in which patients will request both MAID and organ donation. In both instances, patients will be conscious and competent. Organ donation in such contexts raises ethical issues regarding respect for autonomy, societal pressure, conscientious objections and the dead-donor rule. In this article, we look at relevant policies in other countries and examine the ethical issues associated with cDCD in conscious patients who choose to die.

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“…It should be acknowledged that since malignancy is a contraindication for organ donation, only a small—but still substantial—percentage of people who undergo euthanasia is eligible for organ donation 8. Of the 5306 times euthanasia has been performed in the Netherlands in 2014, in 1418 patients, suffering was not caused by malignancy 9.…”

Section: Introductionmentioning

confidence: 99%

Legal and ethical aspects of organ donation after euthanasia in Belgium and the Netherlands

et al. 2016

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Organ donation after euthanasia has been performed more than 40 times in Belgium and the Netherlands together. Preliminary results of procedures that have been performed until now demonstrate that this leads to good medical results in the recipient of the organs. Several legal aspects could be changed to further facilitate the combination of organ donation and euthanasia. On the ethical side, several controversies remain, giving rise to an ongoing, but necessary and useful debate. Further experiences will clarify whether both procedures should be strictly separated and whether the dead donor rule should be strictly applied. Opinions still differ on whether the patient's physician should address the possibility of organ donation after euthanasia, which laws should be adapted and which preparatory acts should be performed. These and other procedural issues potentially conflict with the patient's request for organ donation or the circumstances in which euthanasia (without subsequent organ donation) traditionally occurs.

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Organ Donation After Euthanasia: A Dutch Practical Manual

Cited by 47 publications

References 11 publications

Organ donation after euthanasia, morally acceptable under strict procedural safeguards

Organ donation after euthanasia, morally acceptable under strict procedural safeguards

Organ donation after medical assistance in dying or cessation of life-sustaining treatment requested by conscious patients: the Canadian context

Legal and ethical aspects of organ donation after euthanasia in Belgium and the Netherlands

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