Warning: Graphic content Several doctors are reopening the debate over “death by organ donation” in a new paper published in a medical journal. They argue that the growing acceptance of voluntary euthanasia and advances in life-sustaining technology have opened the door to considering the merits of the practice. Death by organ donation, which is illegal in Canada, involves harvesting organs from still-living patients who have chosen assisted dying. Clinicians currently follow the “Dead Donor Rule” (DDR), which means donated organs can only be retrieved after patients die, and extracting their organs must not cause their death. But in the paper, titled “Contextualizing the Dead Donor Rule in an Era of Voluntary Euthanasia” and published in the New England Journal of Medicine earlier this month, the co-authors argue that with more than 200 million people today living in places that allow assisted death, a discussion around organ donations is warranted. “Voluntary euthanasia creates a new ethical context, complicating the DDR and established approaches to organ donation: patients are not yet dead, but their death is imminent and results directly from voluntary medical intervention,” co-authors Dr. Ian Ball, Dr. Carter Winberg and Dr. Robert Truog wrote in the paper. “In death by organ donation, the patient’s authorization, experience, and outcome are not altered by whether death occurs moments before or during organ retrieval,” the doctors added. In 2016, the federal government passed legislation to allow adults to apply for medical assistance in dying, or MAID. The process of applying for MAID involves a medical practitioner helping patients end their life, which the federal Criminal Code allows under “very specific circumstances and rules.” MAID patients must meet eligibility criteria and medical practitioners must meet “safeguards.” Some medical and legal experts are raising concerns about death by organ donation. “I find it troubling in the sense that … it crosses a very important symbolic line that we have always emphasized in the context of the practice of organ transplantation, which is the need to absolutely separate the dying process from the retrieval of organs,” Trudo Lemmens, a professor in health law and policy at the University of Toronto, said in an interview with CTVNews.ca on Friday. Lemmens said the paper suggests that society should further cross the line. “But I would say the most troubling part for me is that they do indeed fundamentally cross the line between the dying process and the retrieval of organs,” he said. “They recommend that even organ transplant teams can be involved or have to be involved in that process of (MAID), which really allows conflict of interest and professional interest in retrieving of organs to potentially influence (MAID) procedures.” Kerry Bowman, a bioethicist and assistant professor at the University of Toronto, said that “death by organ donation” is “very problematic.” “I think the public reaction will be very negative,” Bowman said in a Zoom interview with CTVNews.ca on Friday. “I’ve spoken to several religious leaders about this topic … there’s a lot of deep religious concern that if the cause of death is actually organ donation, from a religious point of view, it would be considered very problematic.” He said even non-religious people would find death by organ donation “very worrisome.” “We have enough challenges in this country right now with (MAID) …,” he added. “I would argue this is an unnecessary distraction at a difficult time.” If you or someone you know is in crisis, here are some resources that are available. Canada Suicide Crisis Helpline (Call or text 988) Crisis Services Canada (1-833-456-4566 or text 45645) Kids Help Phone (1-800-668-6868) If you need immediate assistance, call 911 or go to the nearest hospital.
