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1.
Allard  J, Fortin  MC.  Organ donation after medical assistance in dying or cessation of life-sustaining treatment requested by conscious patients [published online December 29, 2016].  J Med Ethics. doi: 10.1136/medethics-2016-103460.PubMedGoogle Scholar
2.
Bollen  J, de Jongh  W, Hagenaars  J,  et al.  Organ donation after euthanasia: a Dutch practical manual.  Am J Transplant. 2016;16(7):1967-1972. PubMedGoogle ScholarCrossref
3.
Van Raemdonck  D, Verleden  GM, Dupont  L,  et al.  Initial experience with transplantation of lungs recovered from donors after euthanasia.  Appl Cardiopulm Pathophysiol. 2011;15:38-48. http://www.applied-cardiopulmonary-pathophysiology.com/fileadmin/downloads/acp-2011-1_20110329/05_vanraemdonck.pdf. Accessed February 1, 2017.Google Scholar
4.
 Federal monitoring and evaluation committee on euthanasia, seventh report to the legislative chambers (2014-2015), August 9, 2016 [in Dutch]. http://overlegorganen.gezondheid.belgie.be/sites/default/files/documents/7_euthanasie-verslag_2014-2015-nl.pdf. Accessed March 6, 2017.
5.
Eurotransplant International Foundation.  Eurotransplant website. http://www.eurotransplant.org/cms/. Accessed February 1, 2017.
Research Letter
April 11, 2017

Potential Number of Organ Donors After Euthanasia in Belgium

Author Affiliations
  • 1Department of Intensive Care Medicine, Maastricht University Medical Center, the Netherlands
  • 2Surgery, Maastricht University Medical Center, the Netherlands
  • 3Health Law, Maastricht University, the Netherlands
  • 4Pediatric Surgery, Academic Medical Center, Amsterdam, the Netherlands
  • 5Transplant Surgery, University Hospital Antwerp, Antwerp, Belgium
 

Copyright 2017 American Medical Association. All Rights Reserved.

JAMA. 2017;317(14):1476-1477. doi:10.1001/jama.2017.0729

Organ donation after euthanasia involves patients whose request to undergo euthanasia has been granted and who voluntarily want to donate their organs after death. It requires patients to undergo euthanasia in the hospital, and organ donation is performed after circulatory death. The practice is controversial and currently only allowed in Belgium and the Netherlands. Even in these countries, it is rarely performed; as of August 2016, 43 patients undergoing euthanasia had donated organs.1 Organ donation after euthanasia has been described in a practical manual, which addresses the medical, ethical, and legal aspects of performing euthanasia and donation after circulatory death.2

Donation after euthanasia could potentially help ease the shortage of organs for transplantation. It is unknown how many of these patients would be medically suitable to donate organs.3 We examined the number of patients undergoing euthanasia in Belgium who could potentially donate at least 1 organ.

Methods

The Belgian Control and Evaluation Committee granted permission to access deidentified data of all persons undergoing euthanasia in 2015. To calculate the number of potential organ donors, we excluded patients older than 75 years because this is the maximum age for acceptance of donor kidneys, lungs, and pancreas islets after circulatory death within the Eurotransplant region. Patients with cancer were excluded as the majority of malignancies are a contraindication for organ donation. Patients with multiple or infectious pathologies like human immunodeficiency virus (HIV) were excluded because their organs would be unlikely to be accepted.

In addition, the number of potential donors of individual organs was calculated. For kidney donation, patients with renal disease were excluded. For lung donation, patients with lung disease were excluded. For liver donation, patients with liver disease or who were 60 years and older were excluded, as this is the maximum age for liver donation. For whole pancreas donation, patients 50 years and older were excluded, being the maximum age for whole pancreas donation.

Results

In 2015, 2023 patients underwent euthanasia in Belgium (total population 11 million).4 Two patients were excluded because of insufficient data in the euthanasia reports; 926 patients (45.8%) could not donate because they were older than 75 years of age; 1372 patients (67.8%) had a malignancy; 3 patients (0.15%) had HIV; and 239 patients (11.8%) had multiple or other pathologies. Of all patients who underwent euthanasia, 204 (10.1%) were potential donors with at least 1 suitable organ for donation.

Four patients with kidney disease were excluded for kidney donation, resulting in 400 possible kidney donations. Twenty-five patients with pulmonary disease were excluded, leaving a potential 179 lung donors. There were 125 patients between age 60 and 75 years and 4 with liver disease, leaving 75 potential liver donors. For whole pancreas donation, 174 patients between age 50 and 75 years were excluded, resulting in 30 potential pancreas donors. Thus, 684 whole organs could potentially be donated.

Discussion

In 2015, 1288 people were on the Belgian organ transplantation waiting list.5 An estimated maximum of 10.1% of all patients undergoing euthanasia could potentially donate at least 1 organ, with 684 organs potentially available for donation. In 2015, 260 deceased donor kidneys were donated5; if 400 kidneys were donated by patients undergoing euthanasia, the potential number of kidneys available for donation could more than double. Of 104 total donations after circulatory death, 4 were performed after euthanasia (written communication, January 3, 2017, Dirk Ysebaert, MD, PhD, University Hospital, Antwerp, Belgium).

However, medical suitability only implies that a patient is a possible organ donor. Whether the patient is also willing to donate, and is willing to die in hospital, must be carefully ascertained.

Even if only a small percentage of the patients undergoing euthanasia donated an organ, donation after euthanasia could potentially help reduce the waitlists for organ donation. Nevertheless, it is essential that the primary goal of organ donation after euthanasia remains the same as for any patient donating an organ—to enable patients to carry out their last will of donating organs to help other people, after their own death.

Section Editor: Jody W. Zylke, MD, Deputy Editor.
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Article Information

Corresponding Author: Jan Bollen, LLM, MD, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands (jan@janbollen.be).

Author Contributions: Drs Bollen and van Smaalen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Bollen, van Smaalen, ten Hoopen, van Heurn, Ysebaert.

Acquisition, analysis, or interpretation of data: Bollen, van Smaalen, Ysebaert, Van Mook.

Drafting of the manuscript: Bollen, van Smaalen.

Critical revision of the manuscript for important intellectual content: van Smaalen, ten Hoopen, van Heurn, Ysebaert, Van Mook.

Statistical analysis: Bollen, van Smaalen.

Administrative, technical, or material support: Bollen.

Supervision: ten Hoopen, van Heurn, Ysebaert, Van Mook.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

References
1.
Allard  J, Fortin  MC.  Organ donation after medical assistance in dying or cessation of life-sustaining treatment requested by conscious patients [published online December 29, 2016].  J Med Ethics. doi: 10.1136/medethics-2016-103460.PubMedGoogle Scholar
2.
Bollen  J, de Jongh  W, Hagenaars  J,  et al.  Organ donation after euthanasia: a Dutch practical manual.  Am J Transplant. 2016;16(7):1967-1972. PubMedGoogle ScholarCrossref
3.
Van Raemdonck  D, Verleden  GM, Dupont  L,  et al.  Initial experience with transplantation of lungs recovered from donors after euthanasia.  Appl Cardiopulm Pathophysiol. 2011;15:38-48. http://www.applied-cardiopulmonary-pathophysiology.com/fileadmin/downloads/acp-2011-1_20110329/05_vanraemdonck.pdf. Accessed February 1, 2017.Google Scholar
4.
 Federal monitoring and evaluation committee on euthanasia, seventh report to the legislative chambers (2014-2015), August 9, 2016 [in Dutch]. http://overlegorganen.gezondheid.belgie.be/sites/default/files/documents/7_euthanasie-verslag_2014-2015-nl.pdf. Accessed March 6, 2017.
5.
Eurotransplant International Foundation.  Eurotransplant website. http://www.eurotransplant.org/cms/. Accessed February 1, 2017.
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