Organ donation following medical assistance in dying, Part II: a scoping review of existing processes and procedures

Abstract

Objective: The objective of this review is to collate and summarize the current literature on what is known about organ donation following. For this part II of a 2-part series scoping review, the focus is on the existing procedures and processes for organ donation following MAiD. Introduction: Organ donation following MAiD is a novel and contentious issue worldwide. To give direction for future research and initiatives, a comprehensive understanding of the available evidence of existing procedures and processes for organ donation following MAiD is needed. Inclusion criteria: For this review, our population of interest included all individuals who underwent organ donation following MAiD; our concept was defined as procedures and processes involved in organ donation after MAiD; and the context was reports of organ donation following MAiD at home or in any health care setting worldwide. We considered quantitative and qualitative studies, text and opinion papers, gray literature, and unpublished material provided by stakeholders. Methods: This scoping review was conducted in line with JBI methodology. Published studies were retrieved from MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), PsycINFO (Ovid), Web of Science – Science Citation Index and Social Science Citation Index, and Academic Search Complete (EBSCOhost). Gray and unpublished literature included reports from websites and organ donation organizations in Canada, Belgium, and The Netherlands. Two independent reviewers screened all reports (both title and abstract, and full text) against the predetermined inclusion criteria, extracted data, and completed a content analysis. Any disagreements between the 2 reviewers were resolved through discussion or with another author. Results: We included 121 documents across the two-part series, and we are reporting on 103 in this part II. The majority of the 103 documents were discussion papers, published in English and in Canada from 2019 to 2021. In the content analysis, we identified 5 major categories regarding existing procedures and processes of organ donation following MAiD: i) clinical pathways for organ donation following MAiD; ii) organ donation following MAiD and the donor; iii) clinical practice tools for organ donation following MAiD; iv) education and support for health care providers involved in organ donation following MAiD; and v) health care providers’ roles and perceptions during organ donation following MAiD. Conclusions: Findings from this review can be used to provide support and guidance for improvements in procedures and processes, as well as a rich resource for countries currently planning to establish programs for organ donation after MAiD.

Organ donation following medical assistance in dying, Part I: a scoping review of legal and ethical aspects

“…In this first part of the 2-part review, we address 4 subquestions, with the remaining questions addressed in a separate paper. 9 This first part addressed the following subquestions:…”

“…2 However, for the context of this review, we will use the acronym MAiD to denote clinician-administered MAiD only, as organ donation is not currently possible after selfadministered MAiD due to the risk of damage to organs from prolonged warm ischemia time. 2,8,9 The history of organ donation following MAiD is relatively new, with the first case described in the literature in 2008 (from the first case performed in Belgium in 2005), and since then, there have been many ethical, legal, and moral debates and contradictory discussions concerning this process. 10,11 Organ donation following MAiD has raised concerns regarding patients' safety and autonomy, including debates around the determination of death, the dead donor rule, the impact on patients' end-of-life experience, acceptable procedures, public perception, and others.…”

Mapping the landscape of medical assistance in dying through exploring barriers and facilitators among providers in Canada

“…2(p.24) The rapidly changing MAiD legislation has implications for various practice guidelines and policies 3 as well as implications for health care providers and perceptions of their role in MAiD. 4,5 In Canada, physicians, NPs, and medical residents play a crucial role in the context of MAiD. These professionals ensure high-quality assessments, as well as decision-making and administration of MAiD.…”

Navigating crossroads: exploring organ donation following medical assistance in dying

“…This project resulted in a 2-part review published in this issue of JBI Evidence Synthesis. 11,12 In part I, 11 we synthesized the literature on the legal and ethical dimensions of the practice of organ donation following MAiD. Readers are able to review the existing legal definitions and legislation from jurisdictions where this novel procedure is permitted, and further explore the main points of debate and experts' opinion on ethical dilemmas and consensus, including patient consent and objection, as well as public perceptions and social acceptance of this practice.…”

“…Readers are able to review the existing legal definitions and legislation from jurisdictions where this novel procedure is permitted, and further explore the main points of debate and experts' opinion on ethical dilemmas and consensus, including patient consent and objection, as well as public perceptions and social acceptance of this practice. 11 In part II, 12 readers embark on a deeper exploration of the topic, particularly of the processes involved in organ donation following MAiD, and the roles and perceptions of the health care providers involved. We have included visual aids and detailed explanations of the different pathways used worldwide for organ donation processes following MAiD: the steps for organ donation following MAiD in the hospital setting; MAiD at the patient's home with organ retrieval in the hospital; and MAiD starting at home with completion in the hospital setting, followed by organ retrieval.…”