Organ donation after euthanasia starting at home in a patient with multiple system atrophy

Abstract

Background A patient who fulfils the due diligence requirements for euthanasia, and is medically suitable, is able to donate his organs after euthanasia in Belgium, the Netherlands and Canada. Since 2012, more than 70 patients have undergone this combined procedure in the Netherlands. Even though all patients who undergo euthanasia are suffering hopelessly and unbearably, some of these patients are nevertheless willing to help others in need of an organ. Organ donation after euthanasia is a so-called donation after circulatory death (DCD), Maastricht category III procedure, which takes place following cardiac arrest, comparable to donation after withdrawal of life sustaining therapy in critically ill patients. To minimize the period of organ ischemia, the patient is transported to the operating room immediately after the legally mandated no-touch period of 5 min following circulatory arrest. This means that the organ donation procedure following euthanasia must take place in the hospital, which appears to be insurmountable to many patients who are willing to donate, since they already spent a lot of time in the hospital. Case presentation This article describes the procedure of organ donation after euthanasia starting at home (ODAEH) following anesthesia in a former health care professional suffering from multiple system atrophy. This case is unique for at least two reasons. He spent his last conscious hours surrounded by his family at home, after which he underwent general anaesthesia and was intubated, before being transported to the hospital for euthanasia and organ donation. In addition, the patient explicitly requested the euthanasia to be performed in the preparation room, next to the operating room, in order to limit the period of organ ischemia due to transport time from the intensive care unit to the operating room. The medical, legal and ethical considerations related to this illustrative case are subsequently discussed. Conclusions Organ donation after euthanasia is a pure act of altruism. This combined procedure can also be performed after the patient has been anesthetized at home and during transportation to the hospital.

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

“…As many patients prefer to undergo MAiD at home in a familiar environment, some organizations have started exploring the possibility of offering organ donation following MAiD at home to reduce the additional burden that the need for hospitalization may cause to these patients. 4,6,7,38,44,45,52,53,64,69,72,74,81 However, some logistical and financial implications of MAiD in the home need to be further explored. 6,53,63 Performing the MAiD procedure at home may provide more comfort and autonomy to patients, allowing them to be in a familiar HCPs, health care professionals; MAiD, medical assistance in dying Figure 2: Scoping review findings on organ donation following medical assistance in dying, and the division into 2 parts: i) legal and ethical aspects, and ii) processes and procedures environment and closer to family members and friends.…”

“…6,53,63 Performing the MAiD procedure at home may provide more comfort and autonomy to patients, allowing them to be in a familiar HCPs, health care professionals; MAiD, medical assistance in dying Figure 2: Scoping review findings on organ donation following medical assistance in dying, and the division into 2 parts: i) legal and ethical aspects, and ii) processes and procedures environment and closer to family members and friends. 4,7,64,69,72 We found detailed descriptions of the clinical pathway for organ donation following MAiD at home in 6 reports. 4,27,45,53,63,72 Five 4,27,45,63,72 out of the 6 reports described a process whereby the patient is sedated at home and then transferred to the hospital for MAiD and organ donation.…”

Feasibility of organ donation following voluntary assisted dying in Australia: lessons from international practice

“…These logistic requirements suggest that the patient should ideally undergo euthanasia in the hospital. However, organ donation after euthanasia commencing at home has been performed in the Netherlands and Canada 12 …”

Missed opportunities: saving lives through organ donation following voluntary assisted dying

“…When the dying process begins outside the clinical setting, a longer period of organ ischaemia and, hence, reduced viability for transplantation is likely. For some people, commencing the dying process at home may be an option under some VAD protocols 5,23,24 . Alternatively, a more home‐like environment may be established in the clinical setting in close proximity to operating theatres to support individuals in fulfilling all their end‐of‐life care goals.…”

“…For some people, commencing the dying process at home may be an option under some VAD protocols. 5,23,24 Alternatively, a more home-like environment may be established in the clinical setting in close proximity to operating theatres to support individuals in fulfilling all their end-of-life care goals.…”