Voluntarily Withdrawing From Life Through Organ Donation

"Although some patients may want to be sure that organ procurement won't begin before they are declared dead, others may want not only a rapid, peaceful and painless death, but also the option of donating as many organs as possible and in the best condition possible."
"Following the dead donor rule could interfere with the ability of these patients to achieve their goals. In such cases it may be ethically preferable to procure the patients' organs in the same way that organs are procured from brain-dead patients [with the use  of general anesthesia to ensure the patient's comfort]."
"Because voluntary euthanasia creates organ-donation opportunities that differ from existing pathways, it may be necessary to develop new protocols specific to these patients."
Dr. Ian Ball, Western University, Dr. Robert Truog, Harvard Medical School bioethicist/pediatrician, New England Journal of Medicine

Grotesque and ghoulish to many, the very thought of live organ donation geared toward resulting in immediate death on retrieval of organs such as the heart. Two medical specialists have speculated on the utility of frankly taking advantage of Canada's three-year-old euthanasia law to go a little further and allow the option to patients seeking medically-assisted suicide, adding to the process a unique new protocol they have named "euthanasia by organ donation".

During which the removal of critical organs, as many as conceivable, would act as a death sentence to those whose medical/health condition would legally qualify them for the procedure. Instead of receiving a lethal injection of a life-ending dose of drugs prescribed by a doctor, the mode of death would be the harvesting of the organs to benefit those awaiting organ transplants.

"And so, if the patient says, 'I want two things: I want to have a good death, I want to die peacefully, I don't want to suffer', we can do that."
"And then if the patient also says, 'I'd also like to be an organ donor'. Well, if you said to me, what is the optimal way to accomplish both of those things, it's to put the patient to sleep so they won't have any discomfort, and there won't be air hunger, there won't be any anxiety or fear, and then take their organs out."
Dr. Michael Shapiro, professor of general surgery, New Jersey Medical School/Rutgers

"It is a legitimate question in a society that has said it's OK to bring about death -- euthanasia."
"Why does it matter to bring it about one way versus the other?"
Jennifer Chandler, bioethicist, University of Ottawa

So far, since "medical assistance in dying" (MAID) became a legal option in Canada, some thirty people have coupled their euthanasia with the donation of kidneys or other organs. In Ontario, 168 people donated tissues such as corneas, skin, veins, tendons and ligaments. Transactions harvesting tissues that can survive and be harvested up to 24 hours following death.

Organs cannot be procured until donors are declared dead under the long-standing "dead donor rule", whereby five minutes must pass after the declaration that death has occurred, before organs can be taken; five minutes after the heart stops beating; moreover under present rules organ retrieval must not lead to the donor's death. This new proposed regimen would effectively reverse that caution, a rule meant to avoid collusion between those removing someone from life support to determine death and transplant surgeons awaiting an organ for someone desperately needing one to prolong life.

Not everyone in the medical profession will be enthralled at the prospect of hastening death by removal of vital organs. Just as the idea will fail to resonate with many people in the general population, much less those who see themselves as candidates for medically assisted euthanasia, nor their family members who might regard the prospect with less than generous applause.

"Death by donation would, at present, be considered homicide to end a life by taking organs", was Dr. E.Wesley Ely's reaction, professor of medicine at Vanderbilt University School of Medicine.

That visceral distaste for the prospect of 'killing one bird by removing a stone' will not be shared by everyone. There are some who argue that organs are at present recovered from people whom medical science prescribes as irreversibly dead because they are comatose and appear unconscious to everything happening around them, yet time and medical advances could conceivably resuscitate them; uniquely revivals have been known to occur spontaneously, albeit rarely.

Traditionally transplant organs have been retrieved from people declared brain dead and of more recent vintage has been the acceptance of "donation after circulatory death": (DCD) where people on life support with a bleak prognosis decides the withdrawal of life support. When the heart stops beating and the "hands off" period of five minutes elapses, organ procurement commences. But -- death can take up to two or three hours and organs like the heart and lungs deteriorate rapidly.

The ischemic time, the length of time when blood flow to the organs is uninterrupted, can be achieved through euthanasia by organ donation. That is the plus in the proposed scenario. It has the unqualified support of Dr. Shapiro in that doctors could not only fulfill a patient's wishes but in so doing provide an organ in maximal condition for a desperately waiting recipient.