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Organ Donation Euthanasia

by Dominic Wilkinson and Julian Savulescu

There are 8000 patients on transplant waiting lists in the UK. Every year 400 patients die while waiting for an organ to come available.
We are all far more likely to be in need of an organ transplant than to be a donor. Most of us expect that if we needed a transplant that someone would donate one. On the basis of the ethical golden rule – do unto others as you would want them to do for you, we should all think seriously about whether and how we could donate our organs if we no longer need them.

One important way to do this is to sign the organ donation register and to let loved ones know that you would like to donate after your death. 16 million people in the UK are on the register for organ donation. Donating your organs is one of the most important ways that we can help others. After all there are not many times when you can save the life of up to 9 other people at no personal cost.
But most people who would like to donate their organs are not able to.

Donation of organs like the heart, lungs, and liver is only possible when patients die in controlled circumstances in hospital. Most patients who die in hospital do not meet “brain death” criteria and are not able to donate their organs even if they would have wanted to.

However, there is another potential way of donating organs that we should consider. When patients are seriously ill in intensive care and not likely to recover doctors and families often decide to stop life support and let the patient die. 5000 patients in the UK per year die in these circumstances.

This is a proposal for those 5000 patients each year who will have their life saving treatment stopped. We can give them the option in advance to donate their organs if they are ever going to have their treatment limited because their prognosis is deemed hopeless. If the person agreed in advance to be such an organ donor, and an independent committee confirmed that the patient’s prognosis was hopeless and treatment should be stopped, the patient could be taken to an operating theatre in controlled circumstances, given a general anaesthetic and have their organs removed. The surgical procedure would be a form of euthanasia. We could call it “organ-donation euthanasia”. This option would give people the best chance of ensuring that their organs do not go to waste after their death. It would also prevent the patient from suffering after life support was withdrawn. It would harm noone, and would potentially benefit a number of seriously ill patients in organ failure.

At present it is sometimes possible to donate organs after life support is stopped (so called Donation after Cardiac Death). Doctors take away the machines and wait for the patient’s heart to have stopped beating for 10 minutes before declaring them dead. Then their organs can made available for transplant. But it often takes some time after machines are withdrawn for the heart to stop. This leads to damage to the organs and makes donation impossible for many.

Importantly, what we are proposing is to give people a choice about how they die and whether they can donate their organs. Organ donation euthanasia would only be available to patients having life support stopped on grounds of futility. It would only apply to patients who are going to die anyway. It would only apply to patients who have specifically asked for this option during life, when they were competent and understood what was being offered.

What would you prefer – if you were in intensive care and going to have life support stopped? Would you prefer to have the machines taken away and to die slowly, with a strong likelihood that your organs would be damaged and therefore unavailable to help anyone else? Or would you prefer to be given an injection and a guarantee that you would not suffer any pain while dying, and that your organs would be available to save up to 9 other people?

This option may not be for everyone. Some people would not want the option of organ donation euthanasia. They should not be forced to. They may still want to be on the organ donor register and to donate their organs in case of brain death. But what we are proposing is that people who do want this option be given the choice. Deciding to donate your organs is one of the best decisions that we can make. We should support people who want to donate. We should give them the choice of organ donation euthanasia.

Wilkinson D, Savulescu J, Should we allow organ donation euthanasia? Bioethics 2010 (forthcoming) (full article available free – html, pdf)

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