2024-01-29 06:57:59
The number of Quebecers who agree to donate organs following obtaining medical assistance in dying is increasing, according to data published Monday morning in the Canadian Medical Association Journal (New window).
Between January 2018 and December 2022, during the first five years of the legalization of medical assistance in dying (MAID) in Quebec, Transplant Québec received 245 references from a potential donor in the context of MAID.
Note that the data analyzed concerns living donations (lungs, hearts, kidneys), and not tissue donations following death (which are managed by Héma-Québec).
Among the 245 cases referred, 163 were excluded; 56% due to health problems, 21% refused because they did not want to die in hospital (a criterion for organ donation); 13% chose to no longer use MAID and 4% died before being able to make a decision.
According to Dr. Matthew Weiss, who led the analysis and is medical director of organ donation at Transplant Québec, approximately 10% of people who request MAID would be eligible to donate.
Patients with metastatic cancers are not eligible because we do not want to transmit cancer. [Ceux qui peuvent faire un don] have diseases such as ALS, Parkinson’s or a neurodegenerative disease, explains Dr. Weiss, who is also an associate researcher at the CHU de Québec-Université Laval Research Center and a pediatric intensivist at the CHU in Québec.
Among the 82 files retained by Transplant Québec, 64 Quebecers were able to donate organs in the context of MAID between 2018 and 2022.
In total, 182 organs (116 kidneys, 20 livers, 46 lungs) were transplanted, or 2.9 organs per donor.
The number of people who were able to donate organs increased from 8 in 2018 to 24 in 2022. Thus, in 2022, 14% of all Quebec organ donors following death were people who used the AMM.
There was a plateau during the pandemic, because we were making fewer donations of all kinds. But the proportion is increasing. With the number of people using MAID increasing, it’s not surprising that the number of donations following MAID is also increasing, says Dr. Weiss.
Start of widget. Skip the widget?
End of widget. Return to start of widget?
From 2018 to 2022, the number of Quebecers who used MAID increased from 968 to 3,663.
Start of widget. Skip the widget?
End of widget. Return to start of widget?
The average age of donors in the context of MAID was 60 years and most were men.
In more than 80% of cases, the diagnosis was a neurodegenerative disorder, most commonly amyotrophic lateral sclerosis (ALS). Other donors include people with terminal heart or lung conditions, chronic pain syndromes and spinal cord injuries.
Start of widget. Skip the widget?
End of widget. Return to start of widget?
A still recent and little-known practice
Open in full screen mode
Dr Matthew Weiss, pediatric intensivist at the CHUL of the CHU de Québec-Université Laval and medical director of organ donation at Transplant Québec
Photo: Radio-Canada / Pierre-Alexandre Bolduc
Besides Canada, only the Netherlands, Belgium and Spain carry out organ donation in the context of MAID. Switzerland is considering this medical practice.
In 2021, 8% of 734 organ donors in Canada used MAID. In 2020, in the Netherlands, 4% of 255 donors used MAID.
The first donations in Canada following MAID took place in 2016; those in Quebec, in 2017.
Before 2018, doctors were discouraged from mentioning the possibility of organ donation to their patients seeking MAID. Moreover, the first organ donations in the context of MAID were carried out at the request of people at the end of their lives.
We never wanted to give the impression that Transplant Québec encourages MAID just for organ donation. Over time, Transplant Québec judged that MAID was better accepted and better understood by society. We were then more comfortable talking regarding the possibility of this type of donation, explains Dr. Weiss.
Today, doctors who offer MAID are encouraged to broach the subject with their patients, but they are not obliged to do so.
Dr Weiss reminds us that a protocol exists. The discussion surrounding organ donation only begins when a person has had confirmation of their eligibility for MAID. The decision to donate organs has no impact on access to MAID and patients can change their mind at any time.
According to Dr. Weiss, it is difficult to know whether all doctors provide information to patients. This is why he believes that many people who would be eligible are not even aware of their options.
If the patient doesn’t know this is a possibility, that person doesn’t even have the opportunity to independently say yes or no.
If all eligible people were identified and directed to Transplant Québec, the number of donations in the context of MAID might be higher, he believes.
Dr. Weiss says we also need to find ways to respect the patient’s wishes at the end of life by reducing barriers to donations, such as the need to receive MAID in hospital.
The main reason is that once the heart stops, the window for harvesting organs is very short, says Dr. Weiss, adding that the Netherlands and Belgium have tried home donation, but that everything remains very complex to put in place.
Dr Weiss adds that we must not forget the positive impact that a decision to donate organs can have on the patient at the end of life.
I think the benefit that is most important is the benefit for the donor. People who are able to incorporate this altruistic gesture into their last moments mean a lot to them. These people were very proud to have the opportunity to make a donation. It is a gesture of solidarity.
1706537556
#organ #donors #Quebec #medical #assistance #dying
