Featured Image

Specialists from several Dutch medical schools have prepared a document that is to serve as official guidelines for organ donation after euthanasia, and aims to facilitate the procedure. Doctors expect the legal framework to step up the number of organ donations, which up to now have been few and far between: 6 cases in 16 years, less than in neighboring Belgium. It will help people who choose euthanasia to give a “meaning” to their death, the guidelines’ authors suggest.

Up until now, organ donation after euthanasia has been a very marginal practice for several reasons, the first being that killing of the patient usually takes place in the home at the hands of the family doctor, with the family in attendance. Organ donation requires hospital surroundings, as the vital organs must be harvested within minutes of cardiac arrest. Moreover, after death, a specialized doctor must see the body and check that the procedure has taken place in accordance with legal requisites before giving an all-clear for the death certificate.

The medical condition of the patient is also important: cancer patients are not acceptable donors and they form the largest population of euthanized patients in the Netherlands. But neurological disorders, multiple sclerosis, ALS, and other illnesses that do not damage vital organs are acceptable conditions and the number of acts of euthanasia on patients suffering from these is on the rise.

Roughly a month ago a woman aged 61 received a good deal of media attention and acclaim for having combined euthanasia with organ donation. As a multiple sclerosis sufferer, she was found able to donate her kidneys, lungs, pancreas, and liver, and she fought hard with her husband and two daughters to obtain permission for the procedure. “Woman dies while saving five lives,” went one newspaper headline.

Dicky Ringeling’s story either prompted the writing of the new guidelines, or served as a welcome bait in the media, making the idea of “using” people’s deaths seem normal and even praiseworthy. Whatever the timeline, the result is the same: the Netherlands is heading to establish an official link between so-called “mercy killing” and using human beings as “spare parts” reservoirs, albeit under rigid conditions.

Dr. Gert van Dijk, a medical ethicist from the Erasmus medical school in Rotterdam, and Hanneke Hagenaars, who coordinates organ transplantation in that hospital, worked with Jan Bollen of the Academy Hospital of Maastricht to define these conditions that have yet to be validated by the Netherlands Transplant Foundation, before becoming compulsory. Meanwhile doctors are already allowed to use them.

It is interesting to note that no questions were asked about the moral acceptability of coupling euthanasia with organ donation: it was more a question of how to do it.

The guidelines require hospitals to accept that the donor’s family doctor acts within their precincts to perform the euthanasia: many have been wary up till now about allowing a non-resident doctor to act within their walls. As a counterpart, the family doctor will be required to take full legal responsibility and liability for the act. A hospital doctor, not linked in any way to the hospital’s transplantation department, must also be present to verify full compliance with euthanasia guidelines. As soon as death has occurred, a third doctor representing the national justice department must verify the death and give the all-clear for the body to be transferred immediately to have the organs removed: this means that contrary to “normal” euthanasia, legal authorities are warned beforehand. Once the organs are harvested, the body can be returned to the family to “say goodbye.”

Another condition for coupling organ donation with euthanasia has also been established by the “ethicists”: the two must be clearly disassociated in order to avoid that the patient would choose euthanasia in view of giving his or her organs. Patients must meet all requirements for euthanasia and a doctor specialized in the valuation of euthanasia requests must have given the go-ahead together with the family doctor. It is only at this point that the organ donation can be taken into account, provided the patient has “spontaneously” offered to donate and that the family doctor has abstained from suggesting the possibility to the patient.

In 2013, 273 persons actually donated their organs in the Netherlands. The guidelines’ authors underscore that in the same year, 4,800 declared cases of legal euthanasia took place. “Even if a small percentage of euthanasia patients choose to donate their organs after death, we could be seeing the doubling of post-mortem donors,” said van Dijk.

Whether they are in fact post-mortem donations is another point altogether: while in the case of euthanasia there is no question of “clinical death,” which poses many ethical problems in ordinary organ donation, on the other hand the hasty harvesting of organs within minutes of cardiac arrest, in a context of intended killing, poses ethical problems of its own.

Besides, however “strict” the guidelines and however careful the disassociation between the decision to ask for death and the one of giving one’s organs may seem, the frontiers will be flimsy. “Strict” procedures for euthanasia itself in the Netherlands have themselves widened over the years.