Organ Donation After Euthanasia Starting at Home Is Feasible

Abstract

To the Editor Van Reeven et al 1 state in their article that the results of donation-after-circulatory-death liver transplant after euthanasia are good and may enlarge the organ donor pool. However, they also state: "Despite some previous cases in which the coma-inducing drug was administered to the patient at home, today the complete euthanasia procedure is highly recommended to take place in the hospital." 1 This statement, making reference to an article that we published, 2 is unsubstantiated and may even be considered damaging to this newly introduced, donor-friendly donation procedure. The authors appear to lack a correct understanding of the procedure of organ donation after euthanasia starting at home, which is described in our publications. [2][3][4][5] They state that the coma is induced at home, which is incorrect. The patient is only sedated at home, which marks the start of euthanasia in legal terms but is medically only intended to remove consciousness while vital functions are maintained and secured. Coma induction and the start of the agonal phase subsequently take place in the intensive care unit after farewells at home and transportation. With the 5 minutes "no touch," the total warm ischemia time until death decided was less than 7 minutes in this procedure. Suggesting that euthanasia must take place in the hospital disregards the deepest wishes of these donors: sick, hospital-weary human beings who have decided to end their pain in the comfort and privacy of their own home. Advocating the necessity for a hospital stay will alienate many potential donors. There is no conflict of interest, as may be suggested here. There is no need to play off the interests of transplant patients against the interests of euthanasia donors and vice versa. We can do better. Our patients deserve better.

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).…”

“…23 Additionally, the series of medications administered for the MAiD procedure varies across institutions. 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,…”

Practice and challenges for organ donation after medical assistance in dying: A scoping review including the results of the first international roundtable in 2021

“…Concerns have been expressed regarding the use of sedatives during mid‐procedure ODEH transport as, unlike propofol anesthesia, these do not guarantee complete loss of awareness. 88 , 118 …”

“…Concerns have been expressed regarding the use of sedatives during mid-procedure ODEH transport as, unlike propofol anesthesia, these do not guarantee complete loss of awareness. 88,118 Healthcare providers' conscientious objections are a familiar topic within MAiD care pathways, but less common in DCDD death pathways, typically performed with the less controversial withdrawal of life-sustaining therapy, and jurisdictions are developing protocols for this scenario. 59,77…”