In 2022, 14% of organ donations in Quebec came from people who requested medical assistance in dying. And of the 3,663 people who received medical assistance in dying during the same year, only 3% of them offered their organs for transplantation to Québec. A study published on January 29 in Journal of the Canadian Medical Association (CMAJ), however, shows that their number has increased between 2018 and 2022 and points to factors limiting their progression.
The study authors reviewed the files of 245 people who, after receiving approval for their request for medical assistance in dying (MAID), offered to donate their organs to Transplant Québec — the organization that coordinates the organ donation process — between January 2018 and December 2022. They noted , that the number of these people increased from 21 in 2018 to 109 in 2022.
Of these 245 candidates, 181 (or 74%) were not selected, mainly because of poor organ function or medical history, but also because they refused to receive MAID in hospital rather than at home, or because they had given up on the idea of having MAID, or because they had died before , before they got MAID.
Organs were eventually harvested from 64 patients, 8 in 2018 (representing 5% of all donors) and 24 in 2022 (14% of all donors). These donors were on average 60 years old (between 40 and 76 years old) and were predominantly male (64%). The majority suffered from a neurodegenerative disease (84%), most commonly from amyotrophic lateral sclerosis or chronic pain syndrome or spinal cord injury (9% for both).
On average, three organs were harvested from each of the 64 donors for a total of 182 organs, including 116 kidneys, 20 livers and 46 lungs. This average of three organs harvested from one donor is similar to that of all other donors.
The majority of patients applying for MAID between 2018 and 2022 had metastatic cancer, and approximately 10% had neurodegenerative or cardiopulmonary disease. “Patients with metastatic cancer are not eligible for organ donation because there is a risk of cancer transmission to the person who receives their organs,” D clarifies.year Matthew Weiss, medical director of Transplant Québec and first author of the article.
Among the reasons given by patients for refusing organ donation is the fact that the MAID process must be carried out in a hospital. “After the MA injection, once the heart stops beating, the organs must be removed very quickly because they are no longer supplied with blood and oxygen. If the delay is too long, organs can no longer be transplanted. If MAID were administered at home, the transport time to the hospital would compromise the quality of the organs,” explains Dr.year Weiss.
“Starting the process at home could be technically possible, but for now the logistical organization would be too burdensome for our currently under-resourced health system. But we should explore the possibilities of how to do this, especially if there are many patients who ask for it,” he says, before clarifying that the hospital does everything possible to respect the patient’s wishes as much as possible. family.
“Family presence, music, dimmed lighting and required rituals are allowed in the hospital. The family is there when death is pronounced, but quickly afterwards the person will be taken to the operating theatre. However, there is a possibility that the body may be returned to the family after the organ harvesting is completed. »
Although there was no formal assessment of the quality of organs harvested from people who received MAID, transplant specialists consulted D.year Weiss says the condition of these patients’ organs is similar to, if not better than, organs from other donors. “People with neurodegenerative disease often die from a serious infection that makes them very sick or from trauma, whereas in MAID the organs are not stressed, so they are transplanted almost ideally,” he notes.
It goes without saying that Transplant Québec would like to see an increase in the number of donors among people requesting MAID. “We would like all patients who are eligible to donate organs and would like to do so to have the opportunity to discuss this with the doctor administering MAID, (when their decision to use MAID is confirmed) and if they are willing to do so. a gift,” says D.year Weiss, while stressing that Transplant Québec in no way interferes with the assessment of patients’ eligibility for MAID.
The fact that in 2022 Transplant Québec received only 109 requests among 3,663 patients who received MAID “suggests that there are eligible patients who were not referred to us,” he notes. Physicians are not required to discuss this with their patients and are not required to refer patients who agree with us.” In the absence of regulations, Transplant Québec teams conduct educational campaigns, particularly during palliative care and MAID conferences, to inform physicians.