‘Death by organ donation’: Doctors raise possibility of retrieving organs from MAID patients while they are still alive

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Most cases of organ donation involve people in intensive care who can’t provide first-person consent. Doctors have to rely on substitute decision makers and families “to help us understand their values and wishes,” Winberg said.

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“That’s a very different looking context than someone who drives in from home with a family member and is able to have a full conversation with you about their values and wishes.”

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With legalized euthanasia, organ donation has entered a “completely different landscape,” he said. “You have competent people asking and requesting their death. You have direct physician killing,” realities that didn’t exist when the dead donor rule was “stamped and defined in the literature.”

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Everyone agrees people shouldn’t be used for their organs, he said.

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“If the purpose of the death requirement is to maintain public trust and protect patients, can the spirit of that rule be done through other means? Our group would argue that it could be done through other means, if it was done thoughtfully in terms of upstream safeguarding with people who are competent and able to provide first-person consent.”

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“So, yes, broadly, we are asking whether retrieval could form part of the process that causes death, rather than always occurring only after death has been declared in this specific new context,” Winberg said.

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Today, more than 200 million people live in jurisdictions around the world with some form of legalized assisted death.

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Death by organ donation “is asking surgeons to take a living person into the operating room and to come out with a dead person, which I think is murder,” Lainie Friedman Ross, a University of Rochester bioethicist, told NPR.

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Bowman, the University of Toronto bioethicist who has been involved in many MAID cases, is troubled by the very practice of organ donation after euthanasia.

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“There’s a substantial cohort of patients that apply for medical assistance in dying who are approved, yet who choose not go go through with it. They take things day by day and they eventually die of their illnesses in other ways,” he said.

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But if they have already talked to people about organ donation they might be afraid to say they’ve changed their minds. “I would argue that really erodes the voluntary element of it.”

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People who seek MAID “tend to be really, really worn down by the reality and difficulties” of the illnesses they’ve been living with, he said.

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“Some have said to me, ‘I take more than I give. Everyone takes care of me. I don’t give anything back.’ I worry about the psychology of that, in a lot of ways.”

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Many clinicians also “really hold the desire to not want to waste organs,” Bowman said. “There can be subtle encouragement, definitely, to donate (and) societal praise.”

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The authors “are kind of saying the definition of death has evolved, so we don’t have to worry about that as much,” Bowman added.

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“You really do need some firewalls,” he said. “Clinicians, whatever they are, have got to put the patient in front of them first at all times. When a person is going to donate and it’s clinically advantageous for them to donate when they are still alive, one is pulling the other.”

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National Post

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