Organ donation after assisted dying

Organ donation after physician assisted dying has the potential to increase the availability of lifesaving organs while respecting the wishes of dying patients and their families. However, legal, regulatory, clinical, and ethical challenges need to be carefully navigated.

Belgium, the Netherlands, Canada, and Spain permit voluntary euthanasia through intravenous drugs administered by professionals and have the most experience of subsequent organ donation. Several hundred cases have been reported in practice developed in response to patient requests. Voluntary euthanasia was established in Belgium and the Netherlands decades ago, while in Canada, medical aid in dying (MAID) has expanded rapidly since it was legalised in 2016. In Quebec, organ donation after MAID increased from 4.9% of deaths to 14% between 2018 and 2022.1

In jurisdictions that allow donations after voluntary euthanasia, good medical outcomes have been reported for kidney,2 liver,3 lung,4 and, in one case, heart transplantation.5 Organ retrieval must occur in a controlled hospital environment, such as intensive care, within minutes of death being confirmed. Voluntary euthanasia usually occurs nearby in the hospital, although initial sedation at home before transfer to hospital is possible.6 …