Ethical line is crossed as pressure on ill to die mounts
Doctors in the Netherlands are working on a scheme to increase the number of life-saving organs available for transplant – by harvesting them from people who want to be euthanased.
Erasmus Medical Centre in Rotterdam and the University Hospital of Maastricht have already written national guidelines which are being studied by the Dutch Transplant Foundation.
If the procedures are approved, they would be binding on hospitals and doctors throughout the country.
Spurring on this study is the feeling among transplant surgeons that healthy organs are sometimes wasted when patients are euthanased. In the words of a medical ethics expert with the Royal Dutch Medical Association (KNMG), Gert van Dijk, “An estimated 5 to 10% of people who are euthanased could be considered for organ donation. Five percent does not seem like much, but this still means 250 to 500 potential organ donors every year.” He believes that Dutch doctors could even double the number of organs available for life-saving procedures.
Technically, linking euthanasia and organ transplants has many advantages. It is a “living donation”, so the organs are fresher and more viable than if they are taken from someone who has suffered brain death and is being kept alive artificially. And unlike most living donations, all the organs – both kidneys, both lungs, the whole liver, the heart, the corneas etc – will become available. This way of crossing the bar could also give donors the consolation of knowing that they are saving lives even if they themselves are about to die.
Up to now, there have only been six case of organ donation after euthanasia in the Netherlands. More have been done in neighbouring Belgium, where euthanasia is also legal.
While getting euthanasia patients to donate organs might sound like a snap, in practice there are a number of difficulties. Most euthanasia patients have cancer and so their organs are not suitable for donation. The most suitable patients are those with neurodegenerative diseases like ALS or multiple sclerosis, who constitute only a small fraction of the total number of Dutch who are euthanased every year. Even though they are afflicted with creeping paralysis, their organs are healthy.
There are administrative issues as well. Most hospitals are adverse to allowing doctors to perform euthanasia if they are not staff members. Many euthanasia patients want to die at home, but if they want to donate their organs, they have to die in an operating theatre, away from their loved ones. It will be a lonely and clinical death, very different from the one most of them have envisaged.
The protocol will probably create some firm guidelines to ensure that patients are not killed for their organs, thus fulfilling the gloomiest of prediction about legalised euthanasia.
- Procedures for euthanasia and organ donation must be completely separate. Only if a person fulfils all the criteria for euthanasia would he be eligible for organ donation.
- The idea of donating organs must come from the patient, not the doctor.
- Only a doctor who is not involved in the organ donation can confirm the patient’s eligibility for euthanasia.
- The euthanasia doctor must sign a statement indemnifying the hospital against future lawsuits.
This is not a new idea. It was seriously proposed in 2010 by Oxford bioethicist Julian Savulescu and a colleague, Dominic Wilkinson in an article in one of the leading bioethics journals, Bioethics. They wrote:
“Organ Donation Euthanasia would conflict with the dead donor rules, and the injunction against physician killing. Yet it would not (if appropriate safeguards were provided) lead to the death of any patients who would otherwise live. … if we can save even one life, that is something of great moral importance. Many lives could be saved even if only a small percentage of people opted for ODE… We should encourage and support such altruistic desires.”