Table 3 Comparison of recommendations on different issues and HCPs’ perspectives
From: Québec health care professionals’ perspectives on organ donation after medical assistance in dying
Canadian Blood Services [13] | Transplant Québec Ethics Committee [18] | CEST(19) | Dutch national guidelines [20] | Participants’ perspectives | |
|---|---|---|---|---|---|
Informing potential donor | All eligible, medically suitable patients should be given an opportunity to consider organ and tissue donation Discussions concerning donation should happen only after patients have been found eligible for MAID by 2 independent assessments | 2016: Respond only to patient-initiated requests 2018: All MAID patients eligible for OD should be informed about the possibility of donating organs Discussions concerning OD should take place after MAID request has been accepted. OD as a motivation for MAID has to be assessed by the physician assessing the MAID request | All patients eligible for MAID should be informed of the possibility of donating organs after MAID and of the effects on their end of life Strict separation of discussions about MAID and OD | Physicians should not inform potential donors. Requests for organ donation should be initiated by the patient who asked for euthanasia Separation of discussions is not mentioned. The treating physician is responsible informing the patient about OD and ensuring that the autonomy of the patient is safeguarded | In favour of informing all MAID patients who are eligible for OD Discussions concerning OD should take place after MAID request has been granted. OD as a motivation for MAID has to be assessed |
Directed donation | Should not be offered or encouraged, but should be examined on a case-by-case basis if a patient insists | Not mentioned Transplant Quebec has accepted deceased directed donation before MAID was practised | Not mentioned | Not mentioned as it is not permitted in the Netherlands | In favour after comparing with living donation |
Living organ donation before MAID | Should not be offered or encouraged, but should be examined on a case-by-case basis if a patient insists | Not mentioned | Not mentioned | Not mentioned | Divided positions. Some participants against because of added suffering and minor benefits. Others in favour of assessing the case |
Death by donation | The dead-donor rule must always be respected. Vital organs can be procured only from a deceased donor; the act of procurement cannot be the immediate cause of death | Recommendation to follow the normal cDCD procedure and respect the dead-donor rule | Not openly mentioned, but strict separation of the procedures and teams to preserve public trust is mentioned | Not mentioned | Most participants were either against the practice per se or in order to protect public trust in OD |
Conscientious objection | HCPs can object to MAID but their objection should not impede the ability of the patient to donate. Participation of HCPs should be voluntary when possible | Not mentioned | Possible moral distress of HCPs is mentioned without taking a position on the will to participate in the procedure | Hospitals should deal prudently with care professionals not wishing to become involved in euthanasia as a matter of principle, and replace them with colleagues who want to be involved in the procedure on a voluntary basis | All but one participants were in favour of respecting conscientious objection and deploying only willing HCPs |
OD and MAID without the end-of-life criteria | Recommendations would have to be reviewed if indications for MAID changes | Not mentioned | Not mentioned | Already practised, no difference mentioned | Participants are divided about OD in this context |