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A new publication in CMAJ (Journal of the Canadian Medical Association) is intended to help health care teams manage the clinical and ethical issues that arise when patients choose to donate organs or tissues after medical badistance in dying (MAiD) or withdrawal of life support measures .
Dead organ donation is a common practice that saves or improves lives worldwide and accounts for more than 3 out of 4 organs out of 4 in 2000 transplanted each year.
"The ability of donors to give first-person consent to both MAID or withdrawal of life-support measures and organ donation creates emotional and moral challenges for health professionals and raises unprecedented ethical and practical challenges for patients, their families, their institutions, and society, "says Dr. James Downar, senior author, palliative and critical care physician at the University of Ottawa.
In response to requests from patients across Canada, Canadian Blood Services, the Canadian Critical Care Society, the Canadian Society of Transplantation and the Canadian Association of Critical Care Nurses collaborated with medical, legal and other experts. Ethical guidelines to develop recommendations for organ and tissue donation decision makers in patients who choose medical badistance in dying or withdrawal from life-sustaining measures. The patient partners provided valuable information and unique perspectives to help guide this work.
Main recommendations:
- Patient Protection – The decision to use medical badistance in the event of death or withdrawal of life support measures should be made before any discussion about organ donation. This alleviates the risk that the desire to donate organs will affect the type of end-of-life care the patient is asking for.
- Choice – Medically-minded, competent and medically competent patients who give first-person consent to end-of-life procedures should be given the opportunity to donate organs and tissues.
- Consent – the patient must be able to give consent to the first person and be able to withdraw it at any time.
- Donor Testing – Physicians, transplant teams, and other staff members should try to minimize the impact and disruption of donations, such as testing, to the patient.
- Determination of death – the "dead donor rule" must be respected, which means that vital organs can only be taken from deceased donors after death has been determined in accordance with accepted criteria.
- Conscientious objection – health professionals may choose not to participate in the AMDI or withdrawal of life support measures, but they must work to meet the patient's wishes for donations.
To help health care teams, the publication includes an easy-to-read chart with full recommendations.
"We hope that these directions and recommendations will be essential tools for health care teams, so that they can provide quality care to end-of-life patients, manage medical, legal and ethical issues, and honor patients." the patient's wish to become an organ donor, "says Dr. Downar.
"[T]The explicit target should focus on the patient who has a DID. To maintain public trust, policies must clearly aim to protect the patient who has chosen MAiD treatment, "writes Dr. Johannes Mulder, affiliate of the Dutch Association of Family Physicians and the Dutch working group on the donation of organs after euthanasia, Zwolle Overijssel, the Netherlands, in a related commentary.
"Policy-related advice represents an important step in the creation of a Canadian guideline to help health care workers in the interest of the patient who chooses organ donation after a MAID" he concludes.
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