Organ Harvesting From Donor Killed By Euthanasia May Undermine Public Trust In Transplantation

Buturović-Ponikvar, Jadranka and Buturović-Bradarić, Željka (2019) Organ Harvesting From Donor Killed By Euthanasia May Undermine Public Trust In Transplantation. In: 5th ELPAT Congress – Developing Dialogue, Pioneering Practice. Krakow, Poland, April 26-29, 2019. European Society For Organ Transplantation, Krakow, Poland, pp. 67-68.

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Abstract

Ethical controversies in transplantation are mainly the consequence of organ shortage. Organ trading and use of organs from executed prisoners are condemned by transplant community. However, in align with euthanasia legalization and expansion, there is a growing interest in another controversial issue, organ harvesting from donors killed by euthanasia. Eurotransplant has embraced use of organs from euthanasia donors more than a decade ago. In 2012 ethicists from Oxford has proposed a step further compared to Eurotransplant approach: instead of first killing the patient by euthanasia, declare death and then harvest the organs, they have suggested to put euthanasia candidate into general anesthesia, start organ harvesting while the patient is still alive, harvest the heart as the last organ and actually perform euthanasia by harvesting the heart. Such approach requires abandonment of a long-standing principles of transplantation ͞dead-donor rule͟ meaning that the person should be declared dead before vital organ is removed. Calls for abandoning dead-donor rule are fully mainstreamed with a recent article in New England Journal of Medicine arguing that number and quality of organs will be maximized if harvesting begins while the donor is still alive (Ball IM et al, NEJM September 6,2018 ) and implying that suicidal thoughts about being more valuable dead than alive should be encouraged rather than treated. At the same time, criteria for euthanasia is becoming ever more lax and more expansive. While initially advertised as a procedure for the sickest of the sick, euthanasia is now available to psychiatric patients, disabled and children. It was reported that a significant number of euthanasia procedure in Belgium is performed without signed consent (Smets T et al, BMJ October 5, 2010). In short, euthanasia may rapidly become a tool for getting rid of the weak, confused and expensive. Transplant community should not ignore alternatives like regenerative medicine, artificial organs, xenotransplantation and prevention of end-stage organ failure. Slovenian ethics committee in 2012 has declared against the use or organs from euthanasia donors. Slovenian model of transplantation, assuring enough organs from brain dead donors with acceptable waiting time, focused on quality and long-term survival is a proof that transplantation program can be sustained without resorting to ethically controversial practices. Harvesting organs from euthanasia donors and abandoning dead-donor rule will not solve the problem of organ shortage and may open Pandora's box.

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