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

Abstract

The procedure combining medical assistance in dying (MAiD) with donations after circulatory determination of death (DCDD) is known as organ donation after euthanasia (ODE). The first international roundtable on ODE was held during the 2021 WONCA family medicine conference as part of a scoping review. It aimed to document practice and related issues to advise patients, professionals, and policymakers, aiding the development of responsible guidelines and helping to navigate the issues. This was achieved through literature searches and national and international stakeholder meetings. Up to 2021, ODE was performed 286 times in Canada, the Netherlands, Spain, and Belgium, including eight cases of ODE from home (ODEH). MAiD was provided 17,217 times (2020) in the eight countries where ODE is permitted. As of 2021, 837 patients (up to 14% of recipients of DCDD donors) had received organs from ODE. ODE raises some important ethical concerns involving patient autonomy, the link between the request for MAiD and the request to donate organs and the increased burden placed on seriously ill MAiD patients.

Keywords: clinical research/practice; donors and donation: donation after circulatory death (DCD); guidelines; organ procurement; organ transplantation in general; patient safety; primary care; solid organ transplantation.

FIGURE 1

PRISMA‐ScR diagram. Three concepts are searched in four databases to satisfy the research aims: 1: all ODE literature between 1995 and 2022; 2: all review MAiD literature between 2017 and 2022; and 3: all review DCDD literature between 2017 and 2022. DCDD, donation after circulatory determination of death; MAiD, medical assistance in dying; ODE, organ donation after euthanasia

FIGURE 2

The ODE/ODEH modes. Steps 1–4 are the stages through which the patient progresses on the day when ODE/ODEH takes place: at home (1), transport to the hospital (2), hospital stay (3), and organ transplantation (4). The arrows mark the beginning and end of the MAiD and DCDD providers’ actions. For MAiD, this involves premedication, coma‐inducing medication, and finally, paralytics and, if applicable, cardioplegics. For DCDD, this involves attaching the monitor and observation, inserting lines, final assessments, and, once “permanent death” has occurred, commencing the transplantation procedure. The patient loses consciousness at stage 3 in procedure A and at stage 1 in other procedures. In B and E, the patient does not encounter the DCDD providers while conscious. Dutch‐II is identical to Dutch‐III except that transport is under sedation rather than anesthesia. DCDD, donation after circulatory determination of death; MAiD, medical assistance in dying; ODE, organ donation after euthanasia; ODEH, organ donation after euthanasia from home

FIGURE 3

Procured and transplanted organs originating from ODE. Procured and transplanted organs originating from ODE annually. Data provided by: Eurotransplant statistics analysis for ODE, 2012–2021, Nederlandse transplantatie stichting (Sonneveld), the Netherlands; Eurotransplant statistics analysis for DCD‐V, 2005–2021, Transplant Centre University Hospitals Leuven (Desschans), Belgium; Statistical analysis for OTDT after MAiD, 2005–2021 Canadian Blood Service (LaHaie), Canada (excluding Québec) and Transplant Québec (Dupras‐Langlais), Québec, Canada; Statistical analysis for ODE, 2021, Organización Nacional de Trasplantes (Pérez Blanco), Spain. DCD‐V, donation after circulatory death variant V; MAiD, medical assistance in dying; ODE, organ donation after euthanasia; OTDT, organ and tissue donation and transplantation