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Organ retrieval after euthanasia

Organ retrieval after euthanasia has been reported for Belgium (57 cases since 2005), the Netherlands (86 cases since 2012), Canada (136 cases since 2019) and Spain (7 cases in 2021), that is a total of with 286 known cases between 2005 and 2021.1

Organ retrieval after euthanasia follows the protocols for organ retrieval after circulatory determination of death. This requires confirmation that circulation has “permanently” ceased by a mandatory wait time – 5 minutes in the four countries currently reporting organ retrieval after euthanasia but just 3 minutes in Australia and New Zealand.

In all jurisdictions permitting euthanasia most cases are related to a diagnosis of cancer. Persons with cancer are clearly not potential sources for organ retrieval for transplantation. In 2020, of the 17,217 reported cases of euthanasia internationally 4,319 (25.5%) were for conditions other than cancer.

Belgium is the jurisdiction  with the longest experience with organ retrieval after euthanasia.

The first four cases (2005-2007) involved persons who were not in the terminal phase of a terminal illness but who had a “debilitating neurologic disease, either after severe cerebrovascular accident or primary progressive multiple sclerosis”.2 

In 2011 a report was published on four cases of lungs for transplant taken from persons who were euthanased between 2007 and 2009.  The cases each involved “an unbearable non-malignant disorder”, including two cases of multiple sclerosis. 

Astoundingly, one case involved a 52 year old woman with a mental disorder manifested by repeated automutilation – cutting to cause self-harm.  Her consent to euthanasia and having her organs removed  was accepted despite this particular mental illness.3

In a paper delivered to the 21st European Conference on General Thoracic Surgery held in Birmingham in May 2013, Dirk Van Raemdonck and his colleagues reported on a total of six lung transplants following death by cardiac arrest brought on by the administration of euthanasia carried out in Belgium between January 2007 and December 2012.  Of the six cases, three of them had neuromuscular disorders and three had neuropsychiatric disorders.  The authors conclude “More euthanasia donors are to be expected with more public awareness.”4

There seems to be no awareness of the exploitation involved in accepting consent to euthanasia followed by organ retrieval from patients with mental illness.

The 2018-2019 biennial report notes that 18 people who were euthanased donated their organs. These people suffered either from a disease of the nervous system or from a mental and behavioral disorder. The majority of them were Dutch speakers, in the age group 50 to 69, female and death was not expected soon. There were 3 cases reported for 2020 and 2021 – all males, aged 33, 73 and 76.

Dominic Wilkinson and Julian Savulescu have expressed support for retrieving organs prior to causing death by cardiac arrest following a decision to perform euthanasia.5 In this case death would be caused by exsanguination following surgical incisions to remove organs while the heart was still beating for the purpose of organ transplantation.

1 Mulder J et al, “Practice and challenges for organ donation after medical assistance in dying: A scoping review including the results of the first international roundtable in 2021, American Journal of Transplantation, 2022;22:2759-2780, read more.

2 D Ysebaert et al. “Organ Procurement After Euthanasia: Belgian Experience”, Transplantation Proceedings, 2009, 41: 585–586, read more.

3 D Van Raemdonck et al., “Initial experience with transplantation of lungs recovered from donors after euthanasia”, Applied Cardiopulmonary Pathophysiology , 2011, 15: 38-48, read more.

4 D Van Raemdonck et al., “Lung transplantation with grafts recovered from euthanasia donors”, Abstracts, 21st European Conference on General Thoracic Surgery, Birmingham, 26-29 May, 2013, Abstract O-099, p, 137, read more.

5 Wilkinson D, Savulescu J. Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation. Bioethics. 2012 Jan;26(1):32-4 read more.