Sunday, August 7, 2016

Organ Donation after euthanasia, in the Netherlands

The American Journal of Transplantation discusses the fraught issue of patients who wish to end their lives with medical assistance, and then become deceased donors.

Organ Donation After Euthanasia: A Dutch Practical Manual

  1. J. Bollen1,*
  2. W. de Jongh2
  3. J. Hagenaars3,
  4. G. van Dijk4
  5. R. ten Hoopen5
  6. D. Ysebaert6
  7. J. Ijzermans7
  8. E. van Heurn8 and
  9. W. van Mook1
Version of Record online: 10 MAR 2016
DOI: 10.1111/ajt.13746
American Journal of Transplantation

American Journal of Transplantation

Volume 16Issue 7pages 1967–1972July 2016

Abstract: "Many physicians and patients do not realize that it is legally and medically possible to donate organs after euthanasia. The combination of euthanasia and organ donation is not a common practice, often limited by the patient's underlying pathology, but nevertheless has been performed >40 times in Belgium and the Netherlands since 2005. In anticipation of patients' requests for organ donation after euthanasia and contributing to awareness of the possibility of this combination among general practitioners and medical specialists, the Maastricht University Medical Center and the Erasmus University Medical Center Rotterdam have developed a multidisciplinary practical manual in which the organizational steps regarding this combined procedure are described and explained. This practical manual lists the various criteria to fulfill and the rules and regulations the different stakeholders involved need to comply with to meet all due diligence requirements. Although an ethicist was involved in writing this paper, this report is not specifically meant to comprehensively address the ethical issues surrounding the topic. This paper is focused on the operational aspects of the protocol."

"Introduction: In September 2013, an article addressing organ donation after active euthanasia was published in the Dutch Journal of Medicine (1). A patient suffering from a progressive neurodegenerative disease was able to donate his liver and both kidneys. Organ donation after euthanasia has been described previously, with excellent transplant outcome (2).

"Prior to December 2015, organ donation after euthanasia was performed 15 times in the Netherlands and resulted in donation of eight pairs of lungs, 13 livers, 13 pancreases and 29 kidneys. These developments necessitated the creation of a practical manual addressing the combination of both procedures because of the unique and complex legal and ethical issues, together with the appropriate medical care (3). This manual can be used as a framework for hospitals that wish to facilitate such successive procedures. The essential components of the practical manual, developed by the collaborative efforts of the Maastricht University Medical Center and the Erasmus Medical University Medical Center Rotterdam, are discussed below.

"Although the manual addresses euthanasia and organ donation in the Netherlands, many of the issues raised and discussed may be similar or comparable to those in any country that allows organ donation in the setting of euthanasia. A discussion of ethical considerations is not included in this paper, but this is not intended to dismiss the necessary ethical discussions to be held in this domain."

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