Quebec researchers say organ donation appears to be increasing among people who received an assisted death, but they’re calling for greater collaboration to support those who choose to give, along with respect for their autonomy and dignity.
Researchers say 64 people in Quebec donated their organs after receiving medical assistance in dying (MAID) between 2018 and the end of 2022 and that donations from this group rose to comprise 14 per cent of all gifted organs in the final year of their study.
They analyzed data on all MAID recipients referred to Transplant Québec over the five-year study period for possible organ donation and found the number of donors climbed to 24 in 2022 – up from eight in 2018.
Of 245 people referred after MAID, 82 were retained. From those, 64 were found medically suitable and donated a total of 182 organs – mostly kidneys, but also the liver and lungs, in many cases. Those are the same organs usually retrieved through standard donation after someone has died.
Among the 163 referred patients who did not donate, 91 were deemed medically unsuitable and 21 withdrew from MAID entirely.
However, 34 patients – nearly 21 per cent – refused for unspecified reasons that demand further study, said lead author Dr. Matthew Weiss, medical director at Transplant Québec.
Dr. Weiss said some people may have decided not to donate after learning they would be required to receive MAID medications in hospital instead of at home, so that their organs could be retrieved quickly after their heart stopped beating.
“One of the things that we need to understand better is what are the barriers?” he said of MAID-related organ donation.
“I strongly suspect the fact that they can’t die at home is a major contributor, but I can’t say that with certainty right now,” Dr. Weiss said from Thun, Switzerland, where he was speaking about Canada’s ethical and clinical framework of MAID-related organ donation.
Switzerland does not allow such donations, unlike Belgium, the Netherlands and Spain.
Dr. Weiss said he hopes the research can help create a consortium of organ-donation organizations across Canada that standardizes data collection.
The study, published Monday in the Canadian Medical Association Journal, says that at the start of the research period, a total of 164 donors in Quebec gifted organs, with eight of them having undergone MAID. In 2022, a total 171 people donated their organs and 24 had received MAID.
The overall number of organ recipients in Quebec jumped significantly over the same time period – from 968 in 2018 to 3,663 in 2022 – following the lifting of COVID-19 restrictions.
There were no donations from MAID recipients between March and October, 2020, because of limited resources and concerns around donor-to-recipient transmission of the SARS CoV-2 virus, the study says. Eight people donated organs that year, compared with 24 in 2022.
During the study period, 10,124 people had MAID in Quebec, the study says.
In British Columbia, BC Transplant spokesperson Elaine Yong said 24 people donated their organs after receiving MAID between 2016 and 2022.
“The perspective of BC Transplant, and other organ-donation organizations across Canada, is that organ donation should be considered a normal part of quality end-of-life care, and every eligible person deserves the opportunity to be considered an organ donor, including someone choosing medical assistance in dying,” Ms. Yong said in an emailed statement.
Dr. Weiss said the coding system in Quebec’s database should be updated to include more details about why some people declined to donate their organs.
“This is such a new process that the databases weren’t even set up to code this type of donation,” said Dr. Weiss, also a pediatric critical care physician in Quebec City.
“If you have a patient who is undergoing MAID there’s no legal obligation to mention [donation] to that patient. And therefore there’s no organization that [records] the total number of patients who have been approached and who have or have not consented to donation.”
Patients who die in an intensive-care unit or emergency department are referred to a transplant organization for a donation eligibility assessment.
A MAID provider should be educated to discuss organ donation with eligible patients, excluding those who have metastatic cancer because of the risk of transmitting the disease to a recipient, Dr. Weiss said.
At that point, the provider could contact an organ-donation organization to assess whether the person is suitable to become a donor, he added.
However, he said patients’ autonomy and dignity must be respected by doctors and nurse practitioners who provide MAID, though the latter group is currently not permitted to work in that capacity in Quebec.
“Under no circumstances do we want to mix the decision of MAID and organ donation. We only want the mention of donation to even become a possibility after the decision to pursue MAID is finalized,” Dr. Weiss said.
“As you can imagine, the worst thing that could happen is the public thinks we are encouraging people to do MAID to get their organs.”
If MAID is legalized in Canada for people whose sole underlying condition is a mental illness, Dr. Weiss said they should initially be excluded from donating their organs.
“We’re going to wait because we want to make sure that system, independent of us, is well-established and accepted and functioning well without controversy before we add the additional controversy of organ donation.”
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