The first international roundtable on “organ donation after circulatory death by medical assistance in dying” demonstrates increasing incidence of successful patient-driven procedure

Abstract

American Journal of TransplantationVolume 22, Issue 3 p. 999-1000 LETTER TO THE EDITOROpen Access The first international roundtable on “organ donation after circulatory death by medical assistance in dying” demonstrates increasing incidence of successful patient-driven procedure Johannes Mulder, Corresponding Author Johannes Mulder j.g.h.mulder@isala.nl orcid.org/0000-0003-0538-8238 Anesthesiologie-Intensive Care department, Isala Hospitals, Zwolle, The Netherlands Correspondence Johannes Mulder, Isala Hospitals, Zwolle, The Netherlands. Email: j.g.h.mulder@isala.nlSearch for more papers by this authorHans Sonneveld, Hans Sonneveld orcid.org/0000-0002-8013-6228 Anesthesiologie-Intensive Care department, Isala Hospitals, Zwolle, The NetherlandsSearch for more papers by this authorAndrew Healey, Andrew Healey orcid.org/0000-0002-4540-0425 Trillium Gift of Life donation, Toronto, Ontario, Canada Intensive care department, William Osler Health System hospitals, Brampton, Ontario, CanadaSearch for more papers by this authorDirk Van Raemdonck, Dirk Van Raemdonck orcid.org/0000-0003-1261-0992 Department of Thoracic Surgery, Transplant Centre University Hospitals Leuven, Leuven, BelgiumSearch for more papers by this author Johannes Mulder, Corresponding Author Johannes Mulder j.g.h.mulder@isala.nl orcid.org/0000-0003-0538-8238 Anesthesiologie-Intensive Care department, Isala Hospitals, Zwolle, The Netherlands Correspondence Johannes Mulder, Isala Hospitals, Zwolle, The Netherlands. Email: j.g.h.mulder@isala.nlSearch for more papers by this authorHans Sonneveld, Hans Sonneveld orcid.org/0000-0002-8013-6228 Anesthesiologie-Intensive Care department, Isala Hospitals, Zwolle, The NetherlandsSearch for more papers by this authorAndrew Healey, Andrew Healey orcid.org/0000-0002-4540-0425 Trillium Gift of Life donation, Toronto, Ontario, Canada Intensive care department, William Osler Health System hospitals, Brampton, Ontario, CanadaSearch for more papers by this authorDirk Van Raemdonck, Dirk Van Raemdonck orcid.org/0000-0003-1261-0992 Department of Thoracic Surgery, Transplant Centre University Hospitals Leuven, Leuven, BelgiumSearch for more papers by this author First published: 27 October 2021 https://doi.org/10.1111/ajt.16879Citations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat To the Editor: Organ donation after MAiD (medical assistance in dying) is a procedure requested by patients wishing to do good with the diseased body that also led them to request MAiD. It is endorsed by Eurotransplant and Canadian Blood Services. The first international roundtable on “organ donation after VAD/MAiD/euthanasia” (ODE) took place during the 26th WONCA (world conference of family doctors) 2021 in the Netherlands. The procedure is of increasing importance to physicians involved in end-of-life care, mainly family doctors, and the organ donation and transplantation community. The objective was to identify and discuss global ODE practice, connecting involved physicians and search for consensus. The topics, invited participants, and regional ambiguities were identified in advance by literature review and national preconference meetings. Sixteen euthanasia and/or organ donation experts, from the eight countries where euthanasia is legal, participated in the roundtable. They presented their country's practice followed by plenary discussions. Euthanasia was defined as “the act, legally undertaken by a third party, with the explicit intention of ending the patient's life, at the patient's voluntary, competent request.” Historical associations preclude using the term “euthanasia” in Canada (MAiD: medical assistance in dying), Australia (VAD: voluntary assisted dying), and New Zealand (AD: assisted dying). As of 2021, MAiD is legal in 10 jurisdictions (eight countries). Global euthanasia incidence in 2020 was 17 261 patients, including 5280 (31%) nononcological patients, a basic factor for eligibility for ODE (Table 1). Classic ODE (MAiD and donation both taking place in hospital) is provided in the Netherlands, Canada (British Colombia, Ontario, Quebec), and Belgium, regulated by national guideline (the Netherlands-2017), national guidance (Canada-2019), and regional manuals (Belgium).1-3 Provided 41 times in 2020, ODE is becoming a significant donor organ source (>5%) in the performing countries. Studies demonstrate excellent multi-organ donation results and transplant outcomes for kidneys, lungs, and livers. A different classification needs to be implemented in national registries, for example DCD-V, for the total transplant results to become clear. ODE(H) introduction is expected this year in Australia, New Zealand, and Spain. TABLE 1. Organ donation after MAiD Jurisdiction Legalization year National terminology Euthanasia death 2020/% of total registered death ODE ODE ODEH Total 2020 Total The Netherlands 2002 Euthanasie 6938/4.6% 74 (2012–2020) 11 3 Belgium 2002 Euthanasie 2444/2.2% 56 (2005–2020) 3 Luxembourg 2009 Euthanasie 25/<1% Canada 2015/2016 Medical assistance in dying 7595/2.5% 97 (2016–2020) 27 2 Australia/Victoria 2017, enacted 2019 Voluntary assisted dying 224/<1% Australia/Western Australia 2019, enacted 2021 Voluntary assisted dying NA Australia/Tasmania 2021, enacted 2023 Voluntary assisted dying NA Spain 2021 Eutanasia NA New Zealand 2021 Assisted dying NA Colombia 1997/2014 Eutanasia 35/<1% Abbreviations: ODE, organ donation after euthanasia; ODEH, organ donation after euthanasia from home; NA, not applicable. ODE with anesthesia initiated at home (ODEH) has occurred five times since 2017 in the Netherlands and Canada, by different modes.4, 5 These involve either single-organ donation ODEH with MAiD provided at the home of the patient and then body transportation to the hospital5 or multi-organ donation ODEH with MAiD protracted after anesthesia at the patient's home with subsequent transportation to the hospital followed by death and organ donation.4 A common factor was the MAiD-patient-driven development of ODE in the participating countries. Physicians are urged by their own patients to make ODE(H) possible. In most countries, healthcare professionals' reluctance to propagate the possibility and general familiarity was a limitation. Discussions about desirability revealed preferences for ODEH due to similarity with the private, more comfortable, MAiD procedure at the patient's home. However, patient values and regulations differ by country and participants agreed that all ODE(H) modes should be offered. Participants agreed that ODE(H) must remain a MAiD-patient-care-driven process, with maximum adaptation of donation processes and minimal intrusion into end-of-life care. DISCLOSURE The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation. REFERENCES 1Mulder H, Olthuis G, Siebelink M, Gerritsen R, van Heurn E. Richtlijn ‘Orgaandonatie na euthanasie’ [Guideline ‘Organ donation following euthanasia']. Ned Tijdschr Geneeskd. 2017; 161: D2135. CASPubMedGoogle Scholar 2Ball IM, Healey A, Keenan S, et al. Organ donation after medical assistance in dying – Canada's first cases. N Engl J Med. 2020; 382(6): 576- 577. CrossrefPubMedWeb of Science®Google Scholar 3 Donation after Circulatory Death (DCD). A Belgian Consensus, In: Evrard, ed. Les Éditions Namuroises, 2020. Google Scholar 4Mulder J, Sonneveld JPC. Organ donation after medical assistance in dying at home. CMAJ. 2018; 190(44): E1305- E1306. CrossrefPubMedWeb of Science®Google Scholar 5Healey A, Cypel M, Pyle H, et al. Lung donation after medical assistance in dying at home. Am J Transplant. 2021; 21(1): 415- 418. Wiley Online LibraryPubMedWeb of Science®Google Scholar Volume22, Issue3March 2022Pages 999-1000 AST and ASTS members - please log in via your Society website for full journal access.AST Members >> ASTS Members >> ReferencesRelatedInformation