This is from the Canadian Medical Association: Deceased organ and tissue donation after medical assistance in dying: 2023 updated guidance for policy
"In a case in Ontario, the patient received the MAiD procedure at home.16 When the family was ready, the patient was transferred to an ambulance, where death was confirmed. Intubation was performed and an orogastric tube was secured [This is to empty the contents of the stomach of the dead person] before the patient was placed prone on the ambulance stretcher. The rest of the protocol for lung protection during the absence of circulation was applied before the patient was transferred to the hospital for organ recovery.17“
(16. Organ donation after medical assistance in dying (MAID) has only been possible for patients having the MAID procedure performed at a hospital facility due to prohibitive warm ischemic times. Herein, we describe a protocol for lung donation following MAID at home and demonstrate excellent postoperative outcomes. Lung donation following MAID at home is possible and should be considered by transplant programs.)
Note these troubling remarks in the guidelines:
"This guidance does not address the ethics of MAiD, questions regarding eligibility or assessment for MAiD, or provision of MAiD. It focuses on organ donation for those patients who have been assessed and found eligible for MAiD through established processes in Canada." (emphasis added)
And this:
"international experience with donation after MAiD is limited, and therefore, we found limited data to inform our recommendations. There was potential bias among forum participants, given that they were generally supporters of the current deceased donation and transplantation system, as well as donation after MAiD. (emphasis added)
Of course there was bias in this exercise, since everyone involved were MAID supporters, including MAID patients and family partners who were included as participants for the forum.
Yet strangely, the authors actually do mention the ethical challenges of organ donation after MAID:
"The purpose of this updated guidance is to continue to inform the development of policies and practices of donation after MAiD. This will help clinicians navigate the medical, legal and ethical challenges that arise when they support patients pursuing donation after MAiD."
So how do we manage to kill someone at home, and successfully extract their lungs for transplant? Well, we have a flow chart for that:
1) First we kill the patient. Make sure patient is dead.
2) Paramedics transfer (dead) patient to the ambulance.
3) Next we pump the (dead) patient's stomach to remove messy contents. Reconfirm (dead) patient is dead.
4) Inflate lungs.
5) Reconfirm (dead) patient is dead. (Do this multiple times. Just to make sure dead patient is truly dead. Just to be sure.)
6) Transfer (dead) patient to hospital.
7) Recover lungs at hospital.
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