Skip to main content

Organ donation after euthanasia starting with anesthesia at home is legal in The Netherlands, Belgium, Canada and Spain

Matters Arising to this article was published on 29 May 2023

The Original Article was published on 06 September 2021

Abstract

We would like to respond to the article “Organ donation after euthanasia starting at home in a patient with multiple system atrophy Tajaâte et al., [2021] 22:120” on organ donation after euthanasia from home [ODEH]. Although we welcome the performance of ODEH, we would like to make some critical comments regarding the article, both in relation to factual inaccuracies and in terms of the vision expressed on this subject. In this letter we stress the protection of autonomy of vulnerable euthanasia patients, we contradict the assumption of illegality, we question if the anesthesia method utilized is optimal and correct a mistake in regard to an article to which is referred of ourselves.

Peer Review reports

Letter to the editor/correspondence

Dear Editor

We welcome the article of Tajaâte et al. on organ donation after euthanasia from home [ODEH] which will continue to raise awareness of the opportunity for a specific group of euthanasia patients to pass life as a gift [by donating organs] to others while they lay down their lives [1]. This is the third publication on ODEH, following publications by Healey et al. and Mulder et al. [2, 3]. The classical “Organ donation after euthanasia [ODE]” procedure offered over 200 patients who wished for ODE, the option in a careful, legal and considered manner [4,5,6]. ODEH accommodates the significant objection of ODE for the patient to go to hospital in a conscious state by allowing the patient to enter complete loss of consciousness in the comfort of their own home [7]. During the recent first ODE[H] conference held in 2021 this advantage was recognized and supported by all participants from performing countries [6].

We have some comments on the article by Tajaâte et al. The abstract states that “patients are nevertheless willing to help others”. It implies that suffering euthanasia patients are actively asked to cooperate with organ donation. Supported by the Dutch and Canadian guidelines, we take the view that the ethical principle must be that the addition of organ donation to euthanasia must be patient-initiated for protection of autonomy reasons with the vulnerable euthanasia patients [4, 8, 9]. Consequently, it would be better to say that patients are asking, rather than willing, to help others.

The assertions concerning the legality of ODEH are concerning and likely to give rise to unnecessary disquiet. Under Dutch law, the euthanasia provider must be convinced that the due diligence requirements (also known as appropriate care or due care requirements) are satisfied prior to the start of the euthanasia procedure. The procedure itself consists of the elements premedication, medical coma induction and muscle relaxation, as stated in the Dutch euthanasia guideline. Claiming that due diligence requirements are no longer satisfied once the euthanasia procedure has started, irrespective of the time frame, is irrational. This is also confirmed in the three ODEH cases by the Dutch Regional Euthanasia Review Committees [10, 11].

We also question the described sedation method “general anesthesia was induced with 15 mg midazolam, 10 mg piritramide (a synthetic morphine analog, equal to 7,5 mg morphine) and 100 mg rocuronium”, following which intubation, ventilation, transportation, abdominal ultrasound examination, intra-arterial line insertion took place before the euthanasia procedure was concluded. Despite the reference to “general anesthesia”, this method does not appear to include an anesthetic [such as propofol/thiopental etc.], even though the risks of awareness [while the patient is fully paralyzed] where only a sedative is used are well-known [12].

It is also stated that the difference between their procedure and an earlier ODEH case was that death took place close to the operating theatre “for the best organ quality”, accompanied by a reference to Mulder et al. [3]. This is also incorrect. The referred to, first ODEH case from 2017 was also concluded close to the operating theatre, with a warm ischemia time of only 7 min for optimal organ quality [3, 11].

Finally, although it is correct that the official ODE guideline [11] has not yet adopted a formal position on ODEH, the national Health Council has stated its position at the request of the Minister of Health: “The committee regards the procedure in principle as a viable route, provided that it does not impede a careful establishment of death” [13]. This is also true for Canada were the first ODEH cases are performed [2]. Furthermore, the option is mentioned in the 2022 revised version 3 of the ODE guideline [14].

Availability of data and materials

Not applicable.

Abbreviations

ODE:

Organ donation after euthanasia

ODEH:

Organ donation after euthanasia from home

References

  1. Tajaate N, Dijk N, Pragt E. Organ donation after euthanasia starting at home in a patient with multiple system atrophy. BMC Med Ethics. 2021;22:120.

    Article  Google Scholar 

  2. Healey A, Cypel M, Pyle H, et al. Lung donation after medical assistance in dying at home. Am J Transplant. 2021;21(1):415–8.

    Article  Google Scholar 

  3. Mulder J, Sonneveld JPC. Organ donation following euthanasia starting at home. Transplant Int. 2017;30(10):1075–6.

    Article  Google Scholar 

  4. Mulder H, Olthuis G, Siebelink M, Gerritsen R, van Heurn E. Multidisciplinary national guideline 'Organ donation following euthanasia"; Practice manual and core document. Ned Tijdschr Geneeskd. 2017;161:D2135.

    Google Scholar 

  5. Trillium Gift of Life Network. Organ and tissue donation following medical assistance in dying: Program development toolkit. Available from: https://www.giftoflife.on.ca/en/professionals.htm

  6. Mulder J, Sonneveld H, Healey A, Van Raemdonck D. The first international roundtable on “organ donation after circulatory death by medical assistance in dying” demonstrates increasing incidence of successful patient-driven procedure. Am J Transplant. 2022;22:999–1000. https://doi.org/10.1111/ajt.16879.

    Article  Google Scholar 

  7. Mulder J, Sonneveld JPC. Organ donation after medical assistance in dying at home. CMAJ. 2018;190(44):E1305–6.

    Article  Google Scholar 

  8. Downar J, Shemie SD, Gillrie C, et al. Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy. CMAJ. 2019;191(22):E604–13.

    Article  Google Scholar 

  9. Mulder J, Sonneveld J, Van Raemdonck D, Downar J, Wiebe K, Domínguez-Gil B, Healey A, Desschans B, Neyrinck A, Pérez Blanco A, Dusseldorp I, Olthuis G. Practice and challenges for organ donation after medical assistance in dying: a scoping review including the results of the first international roundtable in 2021. Am J Transplant. 2022. https://doi.org/10.1111/ajt.17198.

    Article  Google Scholar 

  10. Royal Dutch Medical Association (KNMG). Guidelines for the Practice of Euthanasia and Assisted Suicide, 2021. https://www.knmg.nl/download/knmg-knmp-richtlijn-uitvoering-euthanasie-en-hulp-bij-zelfdoding.htm

  11. Mulder JGH, Sonneveld JPC. Orgaandonatie na euthanasie vanuit de thuissituatie [Organ donation following physician-hastened death at home]. Ned Tijdschr Geneeskd. 2017;161:D1779.

    Google Scholar 

  12. Myles PS. Prevention of awareness during anaesthesia. Best Pract Res Clin Anaesthesiol. 2007;21(3):345–55.

    Article  Google Scholar 

  13. Health Council of the Netherlands. Vaststellen van de dood bij orgaandonatie na euthanasie [Determining death in with organ donation after euthanasia]. 2018; publication no. 2015/13 https://www.gezondheidsraad.nl/binaries/gezondheidsraad/documenten/adviezen/2018/12/12/vaststellen-van-de-dood-bij-orgaandonatie-na-euthanasie/advies-Vaststellen-van-de-dood-bij-orgaandonatie-na-euthanasie.pdf. Accessed 1 Oct 2021.

  14. : Organ donation following euthanasia, practice manual V3 2022, https://www.transplantatiestichting.nl/files/2022-02/richtlijn-ogaandonatie-na-euthanasie-versie-3-februari-2022.pdf?25f4690774

Download references

Acknowledgements

Not applicable.

Funding

None.

Author information

Authors and Affiliations

Authors

Contributions

JM and HS performed: Conceptualisation, writing, review and editing.

Corresponding author

Correspondence to Johannes Mulder.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This comment refers to the article available online at https://doi.org/10.1186/s12910-021-00686-4

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mulder, J., Sonneveld, H. Organ donation after euthanasia starting with anesthesia at home is legal in The Netherlands, Belgium, Canada and Spain. BMC Med Ethics 24, 34 (2023). https://doi.org/10.1186/s12910-023-00906-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12910-023-00906-z

Keywords