Euthanasia through living organ donation: Ethical, legal, and medical challenges

Abstract

Euthanasia is categorically prohibited in almost all countries throughout the world. In Belgium and the Netherlands, combining euthanasia and subsequent organ donation in a so-called donation after circulatory-death (DCD) procedure is feasible on legal and medical grounds, and is increasingly gaining social and ethical acceptance. However, heart transplantation after DCD is currently not performed in Belgium and the Netherlands after euthanasia due to concerns surrounding the prolonged warm ischemia time associated with DCD and its effect on subsequent heart function. A number of patients who undergo euthanasia explicitly express their wish to donate their organs in a "living organ donation" procedure, which then causes death. Assuming that euthanasia is permitted, as expressed in Dutch and Belgian legislation, this exploratory article addresses whether it is legally and ethically sound to donate organs, especially the heart, as a living donor and to perform euthanasia in the same procedure in a patient who fulfills the due diligence requirements for euthanasia. Organ donation euthanasia (ODE) would then cause death by the associated surgical procedure, and in addition would improve the quality of the other donated organs, a procedure that would fully respect the patient's autonomy.

Waiting list mortality and the potential of donation after circulatory death heart transplantations in the Netherlands

“…Contraindications were scored according to the Papworth list of contraindications as published by Messer et al [6]. In addition to the inclusion criteria of Messer et al, both DCD type III donors (controlled DCD, donors awaiting cardiac arrest) and DCD type V donors (controlled DCD, donation after euthanasia) were included [9], as donation after euthanasia is allowed in the Netherlands [10]. All inclusion and exclusion criteria are listed in Tab.…”

“…DCD donation is already accepted for the kidney, liver, lung and pancreas, which could make the implementation of DCD HT more accessible [8]. Furthermore, donation after euthanasia is possible in the Netherlands [10], which could increase the number of heart donors even more. We believe that DCD HT (compared to other countries) could increase the number of HTs by 10-15 annually, increasing the number of HTs by 26-40% over the coming years.…”

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

“…An interesting piece outlines the ethical considerations pertaining to "living organ donor euthanasia" from the Netherlands, where a number of patients who have requested euthanasia wish to altruistically donate organs, including the heart and lungs. 26 Procurement. Procurement surgical techniques continued to evolve.…”

Québec health care professionals’ perspectives on organ donation after medical assistance in dying

“…OD after MAID raises many ethical issues as it combines two already ethically challenging procedures [ 6 – 12 ]. Combining MAID and OD raises concerns such as: (i) the importance of patients’ autonomy; (ii) the acceptability of directed donation in such a context, where pressure to save a loved one could push someone to choose MAID in order to donate organs; (iii) the possibility of death by donation in order to raise organ quality and enable heart procurement, which is not currently done through cDCD (i.e.…”

“…procuring vital organs under anaesthesia and thereby causing death, instead of going through the normal MAID procedure); and (iv) societal pressure, i.e. the possibility that by accepting OD after MAID society creates an underlying duty to choose MAID and donate organs when eligible [ 6 , 11 , 12 ].…”