Interest in organ donation with euthanasia is growing in Canada. Although it is still not legal or approved by medical authorities, leading experts in transplant medicine have published guidelines for administering it in the Canadian Medical Association Journal.
The authors include health professionals from Canadian Blood Services, the Canadian Critical Care Society, the Canadian Society of Transplantation and the Canadian Association of Critical Care Nurses. The panel was led by Dr James Downar, an critical and palliative care specialist and a supporter of medical aid in dying (MAID), Canada’s term for euthanasia and assisted suicide.
Below are the main points of the guidance:
Medically suitable, conscious and competent patients who provide first-person consent to end-of-life procedures should be given the opportunity to donate organs and tissues. Patients who seek MAiD or WLSM [withdrawal of life-sustaining measures] should not be prohibited from donating organs and tissue.
The patient must have the ability to provide first-person consent to MAiD or WLSM as well as to organ and tissue donation. The individual should be informed and understand that they may withdraw consent for MAiD or donation at any time, and that withdrawal of consent for donation does not affect their consent for, or access to, MAiD or WLSM.
The dead donor rule must always be respected. Vital organs can be procured only from a donor who is already deceased; the act of procurement cannot be the immediate cause of death.
To avoid any real or perceived conflict of interest, health care practitioners should separate the decision regarding WLSM or MAiD from discussions concerning donation. Providers who are assessing eligibility for MAiD should not be involved in donation discussions.
People with amyotrophic lateral sclerosis and patients with other nontransmissible neurodegenerative diseases should be offered the opportunity to donate organs after their death.
Health care professionals may exercise a conscientious objection to MAiD or WLSM specifically, but they should strive to accommodate the wishes of the donor by ensuring that their objection to MAiD or WLSM does not impede the ability of the patient to donate.
Michael Cook is editor of BioEdge.
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