Euthanasia is categorically prohibited in almost all jurisdictions. In the Netherlands, combining euthanasia and subsequent organ donation in a ‘donation after circulatory death’- procedure is feasible on legal and medical grounds, and is increasingly gaining social and ethical acceptance. It may seem strange to let a patient die first and then remove the organs. This causes oxygen deficiency in the organs, with a negative effect on quality. Some patients who underwent organ donation after euthanasia wanted to donate their organs while under anesthesia, and thus wanted to die as a result of the organ procurement. Not only would the donated organs be in better condition, it would also be possible to donate the heart. We investigated the medical, legal and ethical arguments for performing organ donation in an anesthetized patient. We have called this ‘organ donation euthanasia’ (ODE). The patient does not die as a result from the administered euthanasia drugs, but receives anesthesia before the organs, including the heart, are taken out, which then causes death. From a medical perspective, this procedure only seems to have advantages with regard to the quality of the organs and the number of organs donated. Since the patient is still alive when the organs are removed, this legally classifies a donating organs during life. If organ donation during life would affect the health of the donor, the Organ Donation Act would only allow it if the recipient of the organ is in danger to life, and if this danger cannot be averted adequately in another way. In current practice, this usually involves living kidney donation. ODE is thus currently prohibited under Belgian and Dutch legislation. Although ODE would fully meet the last wish of the patient, and therefore respect his autonomy, this procedure is currently still considered ethically a step too far. Moreover, the mental consequences of the procedure for all persons involved must not be underestimated. In addition to all the additional pressure that exists for both patient, relatives and healthcare professionals in the case of regular organ donation after euthanasia, in ODE it will be the surgeon who causes death of the patient by removing the organs, while he may not even know the patient. Regardless of a possible change in the law, it is crucial to avoid that the general public is given the impression that there is a “hunt” for organs, to take vital organs from a living patient. This goes against the current dead donor rule, which wishes to protect the interests of the donor. The above can be somewhat compensated by the knowledge that one contributes to fulfilling the last wish of the patient, and reducing the suffering of patients on the transplant waiting list. Those who underwent organ donation after euthanasia were very altruistic, and were very satisfied that their suffering could still have a positive effect on others.