Recommendations for Consent
The patient must be able to provide first-person consent to MAiD or WLSM procedures and to organ and tissue donation; if patients decide to withdraw consent for donation, it does not affect their consent or access to MAiD or WLSM.
Physicians and donation teams should avoid any risk for coercion or undue influence on the patient’s decision; they should further help resolve any conflict between the patient’s wishes and family disagreement.
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If a patient loses decisional capacity after consenting to donate after WLSM, a strong case can be made for proceeding with donation; if decisional capacity is lost before proceeding with MAiD, MAiD can no longer be carried out. The donation team must report MAiD deaths according to the laws and policies of their jurisdiction.
Recommendations for Donor Testing and Evaluation
Donation teams and transplant surgeons should coordinate to minimize the impact and inconvenience of donation on the patient, including scheduling home visits for blood draws and minimizing hospital visits for necessary investigations (x-rays, ultrasound).
The potential impact of unanticipated results — such as previously undiagnosed infectious diseases — on both the patient and on public health should be routinely discussed among donor teams.
Recommendation for Determination of Death
Vital organ procurement can only be from a donor who is already deceased; death must be determined by the absence of a palpable pulse in conjunction with the absence of anterograde circulation via arterial monitoring, carotid perfusion ultrasound, Doppler monitoring, aortic valve ultrasound, or isoelectric electrocardiogram. A second physician must confirm death after a “no touch” period of continuous observation.
Recommendation for Protection for Patients
To avoid real or perceived conflicts of interest, it is strongly recommended that a clear separation of decisions be made concerning donation and WLSM or MAiD; in addition, separation of roles between care practices should be maintained among end-of-life care, donation, and transplant teams.
Directed deceased donation, conditional donation, or living donation is recommended against and should not be offered or encouraged; a request for directed deceased donation should only be considered on a case-by-case basis. During allocation, MAiD should not be disclosed to potential recipients; however, the donor’s underlying disease may be disclosed depending on exceptional distribution policies.
Recommendations for ALS and Neurodegenerative Diseases
Patients with amyotrophic lateral sclerosis (ALS) or a nontransmissible neurodegenerative disease should have the opportunity to donate deceased organs and tissues. Allocation of these donations should be done with caution; transplant professionals should balance the benefits of the transplant against any potential harm of receiving an organ from a donor with a neurologic disease.
Although neurologic monitoring is not recommended for transplant recipients of organs from a donor with neurodegenerative disease, these cases should be reported to Health Canada to determine associations between donor illness and transplant outcomes.
Reference
Downar J, Shemie SD, Gillrie C, et al; Canadian Blood Services, the Canadian Critical Care Society, the Canadian Society of Transplantation, and the Canadian Association of Critical Care Nurses. Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy. CMAJ. 2019;191(22):E604-E613.
