A new research paper is pushing for "death by organ donation" when retrieving organs from MAiD patients while they are still alive.Reported by the National Post, the paper from the prestigious New England Journal of Medicine, argues the dead donor rule (DDR) which is the current law requiring donor patients to be dead when physicians extract their organs, should not apply to patients already consenting to death.The DDR means that doctors cannot kill a patient by means of collecting their organs.However, the authors contend, the DDR is complicated by euthanasia where the doctors are legally allowed to kill a patient under "circumscribed situations" with the patient's consent..They argue the quality of donor organs are better when they're removed from living donors, "potentially saving many lives.”According to University of Toronto (UofT) bioethicist Kerry Brown, this act would erode public trust in MAiD and organ donation.“I think a lot of the public would be fairly horrified by it.”The paper's authors claim they do not wish to abandon the DDR, but instead reassess the rule in its application to MAiD..They also claim this would protect people from being killed just for their organs and help preserve the public trust.The two critical care doctors and Harvard Medical School bioethicist wrote in the paper voluntary euthanasia “creates a new ethical context.”The “categorical constraint on physician killing, for its part, is legally and ethically circumvented by voluntary euthanasia.”“The current legal reality of voluntary euthanasia provides a new context for interpreting the Don’t Kill Rule.”.They say in cases where euthanasia donors “are not dead yet, but their death is imminent,” these cases are “ethically arbitrary” because they require a formal declaration of death before organs are retrieved. They continue that the outcome isn't different "whether death occurs moments before or during organ retrieval."Thus, the ethical focus should be on "shift[ing] away from identifying a precise moment of biologic death and toward respecting patients’ autonomous decisions, ensuring that safeguards against coercion and exploitation are robust and advocating for a transparent and publicly accountable process."Under guidance developed by Canadian Blood Services, the decision to receive MAiD must precede the decision to donate organs, so people don't feel pressured to do either..The option for organ donation can be made after a patient has already decided on euthanasia and their request has been granted. One study found Canada performs more organ donations after MAiD than any other country that practices legal euthanasia.Between 2019, the first year organ donation after MAiD was available, and 2021, Canada performed 136 organ donations after euthanasia. In 2021 alone, Canada had 41 such cases, compared to 20 in Belgium, the Netherlands, and Spain combined..How the process actually works, the MAiD patient is taken to hospital and given life-ending drugs. Next, the organ donation protocol follows, blood pressure is monitored via a line inserted into the small artery in the wrist to determine when the person's heart has stopped beating.Then doctors wait another five minutes, called the "no touch" period to confirm the patient is dead before extracting the organs. One of the paper's authors Dr. Carter Winberg, a Canadian critical care doctor completing his master's in bioethics at Harvard Medical School, said it "would look in some ways similar, and in some ways very different.".Here's how it would look: the MAiD patient would be taken to hospital, and given the same sedatives they would be given during euthanasia, which would knock them completely unconscious.Then, surgery would commence, while the patient is alive but unconscious, and the cause of death would be the removal of vital organs.The only other organ removal surgery of this nature is performed on living bodies who are brain-dead, while they're legally and medically dead, their hearts are still beating, and ventilators keep the oxygen flowing to the heart and other organs until organs can be retrieved. It was made legal twenty years ago for physicians to remove organs from "controlled circulatory deaths" those who are on death's door, but like MAiD patients, they aren't dead, but recovery is so grim and unlikely they decide to withdraw life support..Organs can be damaged while donors are dying, and the mandated waiting periods after death add to the lack of blood flow and oxygen organs need.The longer the time elapsed without blood flow, known as ischemia, the greater risk organs are put under, which might make them unable to function properly.Therefore, ischemia time for organs donated by MAiD patients would be shortened and so would the amount of risk to the organs. Currently, no jurisdiction is considering implementing this "death by donation" scheme for MAiD patients; however, the authors say the idea should be subject to "open, transparent dialogue.".Death by organ donation is "asking surgeons to take a living person into the operating room and to come out with a dead person, which I think is murder," Lainie Friedman Ross, a University of Rochester bioethicist told NPR.Bowman, a UofT bioethicist, is troubled even with the concept of organ donation after euthanasia."There’s a substantial cohort of patients that apply for medical assistance in dying who are approved, yet who choose not to go through with it. They take things day by day and they eventually die of their illnesses in other ways," stated Bowman. If they have already talked about organ donation, they might feel afraid or pressured not to change their minds.."I would argue that really erodes the voluntary element of it."Lots of the time, people who seek MAiD "tend to be really, really worn down by the reality and difficulties" of the illness they have, observed Bowman.“Some have said to me, ‘I take more than I give. Everyone takes care of me. I don’t give anything back.’""I worry about the psychology of that, in a lot of ways.”.He adds that clinicians often "really hold the desire to not want to waste organs.""There can be subtle encouragement, definitely, to donate (and) societal praise." The authors "are kind of saying the definition of death has evolved, so we don’t have to worry about that as much."Bowman adds there must be restrictions for organ donation and euthanasia in place.Otherwise, "Clinicians, whatever they are, have got to put the patient in front of them first at all times. When a person is going to donate and it’s clinically advantageous for them to donate when they are still alive, one is pulling the other.”
