Organ Donation After Euthanasia Starting at Home Is Feasible—Reply

Abstract

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.

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.…”

“…For all settings, organ donation following MAiD involves the allocation of resources and logistical challenges, 6,17,24,29,34,37,41,46,48,49,63,65,69,72,75,81,82 including the timing of the procedure, 65,75 mechanism of death, 65,75 availability of health care professionals for the procedure, 24,29,41,46,63 higher costs, 24,72 additional testing, 46,75,82 and administrative issues 34 (eg, only physicians or nurse practitioners with hospital privileges can be involved in the procedures). Also, some authors reported that MAiD, medical assistance in dying; OD, organ donation *Varies between countries; in some places the patient must start the conversation around OD; in others the health care professional may start this conversation.…”

“…23 Additionally, the series of medications administered for the MAiD procedure varies across institutions. 4,20,24,25,27,37,[40][41][42][43]45,48,49,52,53,56,61,63,[71][72][73]76,78,80,81 The anesthetic regimen for organ donation following MAiD usually includes the administration of a coma inducer (eg, propofol, barbiturate thiopental, sodium pentobarbital) 4,20,24,25,27,37,43,45,53,56,61,63,72,76,80 with or without sedatives (eg, midazolam, fentanyl), 4,43,45,53,63,72 and neuromuscular blockers (eg, rocoronium bromide, atracurium besylate, cistracurium besylate). 4,…”

“…A total of 48 reports addressed the MAiD donor and the different ways they can impact and be impacted by the procedures and processes. To optimize the possibility of donation and ensure adequate transplant outcomes, the MAiD donor may need to undergo diagnostic testing to be screened for eligibility 18,22,24,26,27,32,38 --41,43,46,49,54,55,64,70,72,73 ; receive non-therapeutic procedures and medications 3,65 ; be hospitalized despite their primary desire to receive MAiD at home 3,6,18,22,23,[27][28][29]33,35,[38][39][40]46,49,55,62,64,67,68,74,81,95 ; undergo something that negatively impacts their end-of-life experience (eg, spending their last hours in a "cold" environment for timely transfer to the operating room) 23,30,35,43,44,46,49,55,64,66,70 ; refrain from consuming recreational substances such as alcohol and cannabis 55 ; and face the stress related to the possibility that their organs will not be accepted during or after recovery. 49 Despite the many possible impacts on the endof-life experience, the MAiD donor is informed of all the requirements and interventions beforehand and agrees to them to achieve their ultimate goal of donating their organs.…”

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

“…The authors present a unique case of organ donation after euthanasia starting at home (ODAEH): a patient who requested to be sedated at home, and to die in the operating room (OR), in an attempt to minimize the warm ischemic time of the organs [4]. This request imposed medical, legal and ethical challenges for the health care professionals involved, which will be consecutively discussed.…”