Call for organ donation to be linked with voluntary assisted dying

Deakin University Law School Associate Professor Neera Bhatia said Australia had a shortage of people donating their organs after death.

“If a person wishes to donate their organs after VAD there is no compelling reason why they should not be able to,” she said.

Currently, patients who choose VAD in Belgium, the Netherlands, Spain and Canada can participate in organ donation after circulatory death, but it is not available in Australia.

Associate Professor Bhatia said the combined practice had received limited attention in Australia up until now.

“Organ donation after VAD is available in other countries, so why not here? They are two separate medical practices, but they should, and could, be easily connected together,” she said.

In the MJA paper, Associate Professor Bhatia and co-authors Dr Jan Bollen and Associate Professor James Tibballs determine that the combined process has no legal obstructions and is clinically feasible in Australia.

“While voluntary assisted dying and organ donation are practically, legally and ethically sound, both procedures should remain clearly separated, to avoid any undue influence on the patient to participate in this procedure,” Associate Professor Bhatia said.

Internationally, the process is essentially the same as donation of organs after circulatory death by patients in the intensive care unit following withdrawal of life-sustaining therapy. However, in the case of organ donation after euthanasia, there are a number of additional considerations and processes that are followed.

“We do consider that permission of next of kin would be required in Australia. Not only does this conform with current practice in organ donation, but there are legal precedents that establish ownership of the body of a deceased person,” Associate Professor Bhatia said.

“In any case, the societal ethical concept of gifting organs rather than taking organs would be preserved by this practice.”

The paper recommends the development of Australian guidelines comprising four key elements:

1. adherence to the legal definition of death
2. adherence to each state-based VAD legislation
3. adherence to the national guideline for organ donation after circulatory death and
4. consent of the closest relative.

Data from countries that currently allow the combined procedures show approximately 10 per cent of patients who underwent euthanasia were assessed as potentially medically eligible for organ donation. And organs transplanted after euthanasia were found to function adequately in recipients.

“While the potential number of patients who may be eligible for VAD and suitable for organ donation may be limited, those who do meet the criteria for both should be facilitated to donate their organs after VAD,” Associate Professor Bhatia said.

“Following other countries that already facilitate organ donation after euthanasia, we recommend the development of national best practice guidelines for this combined procedure in the Australian context.

“This would also raise awareness among health care professionals – mainly general practitioners – about the possibility of organ donation after voluntary assisted dying, so they know how to refer patients.”