According to the legalization of medical assistance in dying (MAiD) and increased requests for organ donation by conscious, competent donors who decide on the withdrawal of life-sustaining measures (WLSM), Canadian practitioners requested the development of updated Canadian policies for managing donation after circulatory determination of death. This report was published in the Canadian Medical Association Journal.
Canadian Blood Services devised a guidance development panel — including relevant medical, legal, and ethical experts and patients considering MAiD and organ donation — to analyze and refine a series of recommendations that consider organ and tissue donation in conscious, competent patients.
Recommendations for Deceased Organ Donation in Conscious and Competent Patients
Consenting patients who seek MAiD or decide on WLSM should have the opportunity to donate deceased organs and tissues; physicians should discuss all end-of-life options before getting their patient’s consent.
Recommendations for Organ Donation Organization Referrals
Physicians should evaluate a patient’s eligibility to donate before proceeding with WLSM or determining MAiD eligibility, as referral to the organ donation organization is recommended as soon as is practical after the patient WLSM decision.
Recommendations for Conversations About Donation
The decision to donate should be separate from the decision to proceed with MAiD or WLSM, and physicians should discuss how donation may affect end-of-life care processes and options. It is recommended that organ donation organizations facilitate these conversations by developing checklists and discussion guidelines.
Pending regional referral legislation, all medically suitable patients should be given the option to consider organ and tissue donation, and families should be provided with standardized information resources. These discussions should happen early and center around the patient to ensure patient autonomy.