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Table 1 Clinical vignettes

From: Québec health care professionals’ perspectives on organ donation after medical assistance in dying

Vignette 1
Mr. A, 39 years old, suffers from an advanced-stage neurodegenerative disease. His pain has become unbearable, and he requests MAID. Given the advanced stage of his disease, he is considered to be at the end of life. His doctor tells him that his request for MAID will be examined and also lets him know that organ donation is a possibility after MAID. Up to that point, Mr. A had not signed his organ donation card nor had he really considered his position on organ donation. However, he is enthusiastic about it and expresses a desire to donate his organs. His MAID request is accepted in accordance with the law
His doctor reports the organ donation offer to Transplant Québec. He has no medical contraindications to organ donation
In your opinion, should Transplant Québec (i.e., the provincial organ donation organization) agree to retrieve Mr. A’s organs? If yes, why? If no, why not?
Are there any other factors that might have altered your decision?
What do you think about the doctor having informed the patient about the possibility of organ donation?
 
Vignette 2
Ms. B lives in a jurisdiction where MAID for reasons of unbearable suffering is legal outside of the end-of-life context
Ms. B, 48 years old, suffers from severe intractable depression. All known treatments have been tried with no improvement in her condition. She no longer wants to live with the suffering and requests MAID. Her doctor, believing she has truly tried every possible option, supports her decision. Her social network is very limited, but her loved ones also support her. Her MAID request is examined and granted. Ms. B expresses a desire to help other sick people by donating her organs after her death. She has no medical contraindications to organ donation
Do you think the local organ donation agency should accept Ms. B as an organ donor? If yes, why? If no, why not?
Are there any other factors that might have altered your decision? (physical disease vs. psychiatric disease, end of life or not)
 
Vignette 3
Mrs. C, 57 years old, suffers from a neurodegenerative disease. She is considered to be at the end of life. She has often expressed the desire to choose the moment of her death and has decided that this moment has come. A niece of Mrs. C suffers from renal failure and is actually on the waiting list to receive a kidney. Mrs. C gathered information on the possibility of donating organs after MAID; she is aware that this process would require her to undergo different medical tests and that she would have to die in the operating room. Mrs. C is willing to go through this process if she is guaranteed that her niece will receive one of her kidneys. If she is compatible with her niece, she agrees to donate the other kidney and other organs (if possible) to patients on the waiting list. If she is not compatible, she renounces organ donation and prefers to die in her room surrounded by her family
Her MAID request has been examined and granted in accordance with the law. She has no contraindications to organ donation
Do you think Transplant Québec should accept Mrs. C’s organ offer? Why?
Are there any factors that could have modified your decision?
 
Vignette 4
Mr. D, 53 years old, has a degenerative disease. He plans to request MAID once his suffering becomes unbearable. He has thought about organ donation after MAID but does not like the idea of dying in an operating room. This led him to consider making a living donation before MAID. Since his disease is relatively advanced, he would like to be approved quickly as a living donor so that he can donate a kidney (or maybe even both kidneys, if he can be placed on dialysis for a few weeks) and part of his liver. He is aware that these surgeries could be extremely painful, but he would like to be alive to find out that his organs have saved people, and that they are doing well thanks to him. He thinks this would alleviate his suffering. He also feels that it’s the only useful contribution in years that he’d be able to make to society, so he’d prefer to do it while still alive
He has no medical contraindications to organ donation
Do you think the living donations team should agree to assess this donor as quickly as possible and proceed with retrieving his organs?
What other factors that might have altered your decision?
 
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