Organ donation following euthanasia starting at home

Mulder, Johannes; Sonneveld, Johan P. C.

doi:10.1111/tri.13003

Cited by 23 publications

(79 citation statements)

References 3 publications

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“…We developed a procedure as one possibility to allow people who are ill and who would like to receive MAiD to fulfill their desire to donate their organs, with minimal disruption to the dignity of dying in their own home. 11,12 The key is temporizing MAiD by using an anesthesia bridge to separate the experience of dying at home from subsequent biological death and organ donation in hospital. The procedure was designed in cooperation with relevant stake holders, including the public prosecutor, and the ethics board and executive board of the participating hospital.…”

Section: What Is Organ Donation After Medical Assistance In Dying At mentioning

confidence: 99%

“…When the family physician is discussing endoflife options with the patient, organ donation after MAiD at home can be considered at the patient's explicit wish. 6,11,12 Organ donation should not be raised or discussed until the patient has determined that he or she wishes to receive MAiD, because these decisions must not influence each other. Furthermore, the patient must be fully informed of the prac tical consequences of adding organ donation.…”

Section: How Is Medical Assistance In Dying Delivered?mentioning

confidence: 99%

“…About 80% of patients requesting MAiD in the Netherlands have cancer and are ineligible for organ donation; other exclusion crite ria include serious infections and specific organ exclusions with kidney disease, pulmonary disease, liver cirrhosis and type 1 dia betes. 11,12 Patients with neurodegenerative diseases most com monly request the combination procedure in the Netherlands. 11…”

Section: Who Is Eligible?mentioning

confidence: 99%

“…Organ donation after MAiD at home has been per formed twice, resulting in the procurement of the same organs. 11,12 The procedure has been well received, in particular by the patient while conscious, the patient's family and the organizations involved. 8,11 The first case was accompanied by a broadcast (avail able at www.npostart.nl/alspatientdonateshisorgans after euthanasia/11052017/POMS_AT_8838678), in which the patient expressed positive views on the procedure.…”

Section: What Is the Evidence So Far?mentioning

confidence: 99%

“…11,12 The procedure has been well received, in particular by the patient while conscious, the patient's family and the organizations involved. 8,11 The first case was accompanied by a broadcast (avail able at www.npostart.nl/alspatientdonateshisorgans after euthanasia/11052017/POMS_AT_8838678), in which the patient expressed positive views on the procedure. The family physician, hospital staff and ambulance personnel evaluated the procedure as effective and rewarding because they witnessed the satisfaction of the patient and family.…”

Section: What Is the Evidence So Far?mentioning

confidence: 99%

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Organ donation after medical assistance in dying at home

Mulder

Sonneveld

2018

CMAJ

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Section: What Is Organ Donation After Medical Assistance In Dying At mentioning

confidence: 99%

Section: How Is Medical Assistance In Dying Delivered?mentioning

confidence: 99%

Section: Who Is Eligible?mentioning

confidence: 99%

Section: What Is the Evidence So Far?mentioning

confidence: 99%

Section: What Is the Evidence So Far?mentioning

confidence: 99%

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Organ donation after medical assistance in dying at home

Mulder

Sonneveld

2018

CMAJ

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Evaluation of Liver Graft Donation After Euthanasia

et al. 2020

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The option of donating organs after euthanasia is not well known. Assessment of the results of organ transplants with grafts donated after euthanasia is essential to justify the use of this type of organ donation.OBJECTIVES To assess the outcomes of liver transplants (LTs) with grafts donated after euthanasia (donation after circulatory death type V [DCD-V]), and to compare them with the results of the more commonly performed LTs with grafts from donors with a circulatory arrest after the withdrawal of life-supporting treatment (type III [DCD-III]). DESIGN, SETTING, AND PARTICIPANTSThis retrospective multicenter cohort study analyzed medical records and LT data for most transplant centers in the Netherlands and Belgium. All LTs with DCD-V grafts performed from the start of the donation after euthanasia program (September 2012 for the Netherlands, and January 2005 for Belgium) through July 1, 2018, were included in the analysis. A comparative cohort of patients who received DCD-III grafts was also analyzed. All patients in both cohorts were followed up for at least 1 year. Data analysis was performed from September 2019 to December 2019.EXPOSURES Liver transplant with either a DCD-V graft or DCD-III graft.MAIN OUTCOMES AND MEASURES Primary outcomes were recipient and graft survival rates at years 1, 3, and 5 after the LT. Secondary outcomes included postoperative complications (early allograft dysfunction, hepatic artery thrombosis, and nonanastomotic biliary strictures) within the first year after the LT. RESULTS Among the cohort of 47 LTs with DCD-V grafts, 25 organ donors (53%) were women and the median (interquartile range [IQR]) age was 51 (44-59) years. Among the cohort of 542 LTs with DCD-III grafts, 335 organ donors (62%) were men and the median (IQR) age was 49 (37-57) years. Median (IQR) follow-up was 3.8 (2.1-6.3) years. In the DCD-V cohort, 30 recipients (64%) were men, and the median (IQR) age was 56 (48-64) years. Recipient survival in the DCD-V cohort was 87% at 1 year, 73% at 3 years, and 66% at 5 years after LT. Graft survival among recipients was 74% at 1 year, 61% at 3 years, and 57% at 5 years after LT. These survival rates did not differ statistically significantly from those in the DCD-III cohort. Incidence of postoperative complications did not differ between the groups. For example, the occurrence of early allograft dysfunction after the LT was found to be 13 (31%) in the DCD-V cohort and 219 (45%) in the DCD-III cohort. The occurrence of nonanastomotic biliary strictures after the LT was found to be 7 (15%) in the DCD-V cohort and 83 (15%) in the DCD-III cohort. CONCLUSIONS AND RELEVANCEThe findings of this cohort study suggest that LTs with DCD-V grafts yield similar outcomes as LTs with DCD-III grafts; therefore, grafts donated after euthanasia may be a justifiable option for increasing the organ donor pool. However, grafts from these donations should be considered high-risk grafts that require an optimal donor selection process and logistics.

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Organ Donation After Euthanasia Starting at Home Is Feasible

Sonneveld

Mulder

2021

JAMA Surg

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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.

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Organ donation following euthanasia starting at home

Cited by 23 publications

References 3 publications

Organ donation after medical assistance in dying at home

Organ donation after medical assistance in dying at home

Evaluation of Liver Graft Donation After Euthanasia

Organ Donation After Euthanasia Starting at Home Is Feasible

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