In 2022, 14% of organ donations in Quebec came from people who requested medical assistance in dying. And among the 3,663 people who received medical assistance in dying during that same year, only 3% of them offered their organs to Transplant Québec. A study published on January 29 in the Journal of the Canadian Medical Association (CMAJ), however, shows that their number increased between 2018 and 2022, and it highlights the factors that limit their progression.
The authors of the study reviewed the files of 245 people who, after receiving approval of 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 noticed 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 due to the poor functioning of their organs or their medical history, but also because they refused to receive MAID at the hospital. rather than at home, or because they had given up on the idea of having MAID, or because they had died before receiving MAID.
Organs were ultimately 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 aged 60 years (between 40 and 76 years) and were predominantly men (64%). Most suffered from a neurodegenerative disease (84%), most commonly amyotrophic lateral sclerosis, or chronic pain syndrome or spinal cord injury (9% for both).
On average, three organs were removed 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 collected per donor is similar to that recorded for all other donors.
Most patients who requested 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 transmitting the cancer to the person who will receive their organs,” specifies the Dr Matthew Weiss, medical director at Transplant Québec, and first author of the article.
Among the reasons given by patients who decline organ donation is the fact that the MAID process must absolutely be done in hospital. “After the MA injection, as soon as the heart stops beating, the organs must be removed very quickly, because they are no longer perfused and no longer receive oxygen. If the delay is too long, the organs can no longer be transplanted. If MAID were administered at home, the transport time to the hospital would compromise organ quality,” explains Dr.r Weiss.
“Starting the process at home might be technically possible, but for now the logistical organization would be too burdensome for our health system, which currently does not have the necessary resources. But we should explore the possibilities of doing so, especially if there are many patients who request it,” he says before specifying that, at the hospital, everything is done to respect the wishes of the patient as much as possible. the person and their family.
“In the hospital, the presence of family, music, dim lighting and desired rituals are permitted. The family is there when the death is pronounced, but, quickly afterwards, the person will be taken to the operating room. However, the option is offered that the body can be returned to the family once organ harvesting is completed. »
Even though there has been no formal assessment of the quality of the organs removed from people who received MAID, the transplant specialists consulted by Dr Weiss says the condition of these patients’ organs is similar to that of other donors’ organs, if not better. “People with a neurodegenerative disease often die from a serious infection that makes them very ill or from trauma, while with MAID, the organs are not stressed, so they are transplanted in almost ideal,” 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 for organ donation and who would like to do so to have the opportunity to discuss it with the doctor administering the MAID, [une fois que leur décision d’avoir recours à l’AMM est confirmée] and if they show themselves willing to make such a donation”, affirms the Dr Weiss while emphasizing that in no case does Transplant Québec intervene in the evaluation of patients’ eligibility for MAID.
The fact that in 2022, Transplant Québec only received 109 submissions among the 3,663 patients who received MAID, “indicates that there are eligible patients who have not been referred to us,” he notes. Doctors are not required to discuss this with their patients and they are not required to refer patients who agree to us.” In the absence of regulations, Transplant Québec teams carry out educational campaigns, particularly during conferences on palliative care and MAID, in order to inform doctors.