Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy

Abstract

First-person consent for organ donation after medical assistance in dying (MAiD) or withdrawal of life-sustaining measures (WLSM) should be an option in jurisdictions that allow MAiD or WLSM and donation after circulatory determination of death. • The most important ethical concern-that the decision for MAiD or WLSM is being driven by a desire to donate organsshould be managed by ensuring that any discussion about organ donation takes place only after the decision for MAiD or WLSM is made. • If indications for MAiD change, this guidance for policies and the practice of organ donation after MAiD should be reviewed to ensure that the changes have not created new ethical or practical concerns.

Facilitating the wishes of patients who choose both MAiD and organ donation

“…T he linked article by Downar and colleagues presents guidance for policy for managing deceased organ dona tion in conscious, competent donors who request med ical assistance in dying (MAiD) in the Canadian context. 1 Prepar ing guidance for policy in this area is not easy. Arriving at sound recommendations requires scrutiny of the procedure in terms of its desirability and due care, key principles in medical ethics (e.g., protection of autonomy and nonmaleficence), and safe guarding the rights of physician conscientious objectors not to be involved.…”

A request for directed organ donation in medical assistance in dying (MAID)

“…Their guidance states that directed donation should neither be offered nor encouraged. 12 Wellintentioned as this statement is, we already see by Ms. J and Ms. P that it perhaps lacks real-world applicability. Directed donation presents a unique challenge that must be dealt with carefully on an individual basis to maintain public trust and integrity in the system.…”

Visão dos enfermeiros sobre suas atribuições no setor de organização de procura de órgãos

“…O médico intensivista, socorrista, neurologista terão função de atestar a ME e comunicar a família. Só após o consentimento da família, o termo de autorização é entregue (Downar et al, 2019).…”

“…Ao longo desse tempo, o enfermeiro vem atuando principalmente na identificação de doadores, manutenção hemodinâmica, na constatação e comprovação de morte encefálica (Downar et al, 2019). Acredita-se também, que durante o processo de trabalho do profissional enfermeiro é necessário ser ardil e criar novas estratégias de esclarecimento para a comunidade leiga para que assim possa compreender melhor esse processo e contribuir para a sobrevida de milhares de pacientes (Tolfo et al, 2018).…”