Monday, April 20, 2020

Organ donation after medically assisted dying, in Canada

In the New England Journal of Medicine, with many authors,
Organ Donation after Medical Assistance in Dying — Canada’s First Cases

February 6, 2020
N Engl J Med 2020; 382:576-577
DOI: 10.1056/NEJMc1915485

"In 2016, following the Supreme Court of Canada’s Carter Decision,1 medical assistance in dying (MAID) became possible with individual court orders. However, owing to the lack of a centrally coordinated Canadian response to the requests of some patients for voluntary euthanasia, as well as concern for individual repercussions, many Canadian providers of assisted dying operate largely independently. With 3 years now passed since euthanasia was approved, it is important to ensure our understanding of current practice for the purpose of quality assurance, provider education, and future research opportunities geared to improve patient-centered practice. Among the practices related to the legalization of euthanasia, organ donation raises challenging issues.

"We performed a historical cohort study of completed MAID organ-donation cases using data from three Canadian provincial organ-donation organizations (Trillium Gift of Life Network, Transplant Québec, and British Columbia Transplant) from June 2016 through January 2019 to describe the initial experience with euthanasia-associated organ donation. A total of 56 patients were referred as potentially eligible for organ donation after MAID on the basis of preliminary assessment by one of the three organ-donation organizations. The mean age was 61 years; 39% of the patients were female. The most common diagnosis was amyotrophic lateral sclerosis, followed by end-stage chronic obstructive pulmonary disease and Parkinson’s disease. Although the majority of Canadian euthanasia cases have involved patients with active cancer,1 our data showed that there is a substantial variety of conditions for which organ donation is a viable possibility. Among the 56 patients in the study, 30 were able to become donors and donated 74 organs. Twenty patients were single-organ donors, while 10 were multiorgan donors. 

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