The heart is of sufficient quality for transplantation after euthanasia

People who die from euthanasia sometimes donate their organs. But not the heart, because in the Netherlands only people who die of a brain and heartbeat can donate this. At UMCG, doctors have shown that the heart can also be used for transplantation after circulation has stopped due to euthanasia.

In the Netherlands there are two types of organ donation: live donation, for example a person donating a kidney, and deceased donation. The last group can be divided into what is today Donate after circulatory death (DCD) is called en Donation after brain death (DBD), for example in severe traumatic brain injury following a motorcycle accident. These groups were indicated as yes or no Heartbeat. Both groups can donate organs such as the lungs, kidneys, liver, and pancreas, but only people who undergo surgery for brain death can also donate their hearts (DBD).

10% potential donor

Co-training anesthesiologist Jean Pauline co-wrote the article in Transplantation Direct. He received his PhD in 2019 on organ donation after euthanasia. This is the category Donate after circulatory deathFor the Netherlands: the organs, not the heart. Three quarters of people who undergo euthanasia cannot donate because oncology is on the way. Only 10 percent of the more than 6,000 people per year are potential donors. For example patients with ALS, MS and other muscle diseases. As of December 2020, there were already 72 procedures for organ donation after euthanasia, Pauline says. There was a heart that could have been donated, which did not happen, although this desire was strong in the donor at times. Patients sometimes request that they be allowed to donate their hearts under anesthesia rather than undergoing euthanasia. But this is not possible with the current legislation.

Morally charged

In Australia and England, heart transplantation is already common after circulation has stopped, but in the Netherlands it is imminent. But euthanasia is not permitted in these countries. Cardiothoracic surgery Annius Vincent van Soylen requested permission to have the heart removed twice for examination after euthanasia. At UMCG, the authors examined two donated hearts after euthanasia using a perfusion machine. Van Suylen, Bollen and others published in Transplantation Direct at the end of February that donated hearts that have stopped working are suitable for transplantation. The guideline for organ donation after euthanasia now states that donating a heart “is not (yet) possible,” but is therefore not due to the quality of the heart after removal. Pauline says it’s a challenge, because the heart always has some ischemia. It is also ethically charged. You have to explain to the family that someone died because their heart stopped beating, but then the heart is used to make another person work.

A final wish

Pauline says organ donation after euthanasia is a delicate matter anyway. “It is important for an independent decision that the request comes from the patient.” It asserts that this is not a procedure to shorten the transplant waiting list. It relates to the last wish of the patient receiving euthanasia. And it is very nice that patients want to contribute to shortening the waiting list. They come to the hospital more to undergo checks that are not actually in their best interest. They cannot die at home, which is what most people would like to do. After the euthanasia, we bring them to the operating room as quickly as possible and remove their organs. This, in turn, is stressful for the family out there. All this while these people are seriously ill from euthanasia.

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