Canadian Doctors worry how organ donations will be affected by...assisted suicide

[Clark]

http://news.nationalpost.com/health/doctor-assisted-dying-organ-donations-ethics#__federated=1

Doctors worry how organ donations will be affected by Supreme Court ruling on assisted suicide
Sharon Kirkey

As the nation awaits legalized doctor-assisted death, the transplant community is grappling with a potential new source of life-saving organs — offered by patients who have chosen to die.

Some surgeons say every effort should be made to respect the dying wishes of people seeking assisted death, once the Supreme Court of Canada ruling comes into effect next year, including the desire to donate their organs.

But the prospect of combining two separate requests — doctor-assisted suicide and organ donation — is creating profound unease for others. Some worry those contemplating assisted suicide might feel a societal pressure to carry through with the act so that others might live, or that it could undermine struggling efforts to increase Canada’s mediocre donor rate.

“Given the controversy and divided opinion regarding physician-assisted suicide in Canada, I don’t think we are anywhere near being ready to procure the organs of patients who might choose this path,” said Dr. Andreas Kramer, medical director of the Southern Alberta Organ and Tissue Donation Program in Calgary.

Dr. Atul Humar, medical director of the multi-organ transplant program at the University Health Network in Toronto, said donation after assisted death is highly complex and would require careful consideration by the transplant community, national and provincial organ-donation agencies and the public.

“If we were ever to consider this type of practice, all the decisions around assisted death should be kept separate from the discussions around organ donation,” he said. “And that whole piece should be kept separate from the transplant group and the transplant physicians.”

However, “My own thoughts on it are that we should always make all efforts we can to respect the patient’s wishes.

“If one of those wishes is to be an organ donor, we would try, as we would for any end-of-life situation, to respect that wish,” he said.

Organ harvesting after doctor-assisted death is already a reality in Belgium, which became the second country in the world, after the Netherlands, to legalize voluntary euthanasia in 2002.

In 2011, Belgian surgeons reported the first lung transplants using lungs recovered from four donors put to death by lethal injection. All — two patients with multiple sclerosis, one with a neurological disorder and the other a mental illness — explicitly and voluntarily expressed their wish to become an organ donor after their request for euthanasia was granted, the team reported.

“We now have experience with seven lung donors after euthanasia,” Dr. Dirk van Raemdonck, a surgeon from University Hospitals Leuven, told the National Post. “All recipients are doing well.”

Lungs, as well as kidneys and livers, have been retrieved and transplanted from a total of 17 euthanasia donors, Dr. van Raemdonck said. The results will be presented next week at the annual meeting of the Belgian Transplantation Society in Brussels.

In Canada, 4,612 people were waiting for an organ in 2012; 230 died waiting.

While demand for organs is growing as the population ages, only about a third of potential donors become actual donors in this country, a recent Canadian Institute for Health Information report found.
As well, fewer people who suffer severe head injuries are progressing to “brain death” — historically the major source of organs for transplant — largely because of advances in treating head trauma.

Now, with organs in scarce supply, doctors are expanding donors to include “donation after cardiac death,” or DCD — procuring organs from people whose hearts have stopped beating.

DCD involves patients on life support who are thought to have no chance of recovery. If a decision is made with the family to stop life support, the organs can be retrieved five minutes after the heart has stopped beating. Two doctors declare death, separate from the transplant team.

The same guidelines could be applied to assisted-dying donors, says bioethicist David Shaw, of the Institute for Biomedical Ethics at the University of Basel in Switzerland.

In a recently published paper in the journal Transplantation, Dr. Shaw argues organ donation after assisted suicide could reduce transplant wait-list deaths “in any country that permits assisted dying.”

Organs are already retrieved from people who commit “unassisted” suicide, if they are taken to hospital while they are still alive or soon after death, Dr. Shaw said in an interview.

“It’s strange that we would take organs after very sad, violent, self-suicides but refuse to do it when people are part of a process of assisted dying that involves lots of planning, and they can make a competent decision about it,” he said.