November 26, 2022

Is the NEJM pushing organ donation after euthanasia?

We need a debate, suggests a recent article

The latest issue of the New England Journal of Medicine contains an engaging appeal to consider the possibility of organ donation after euthanasia in the United States. Drawing on experience from Canada, where this is legal, Dr Lisa Rosenbaum, a cardiologist and a regular contributor to the NEJM, argues that the issue should be open for debate.

Nowhere in the US is euthanasia legal, so at the moment it is just a talking point. But the article suggests that a number of physicians are talking about it as a way to boost the supply of organs and to give meaning to the lives of their dying patients.

The obvious objection to combining euthanasia with organ transplants is that the patient might feel pressured into agreeing to the controversial procedure. Dr Bill Wong, an anaesthetist at the University of Toronto who has overseen three of these procedures, acknowledges this. But he says that the Canadian system provides adequate safeguards. The danger of pressure to undergo euthanasia is greater than the danger of euthanasia plus organ donation.

Dr Rosenbaum appears to feel that too much caution involves its own dangers: “In protecting patients who might not want to donate organs … the process may thwart the wishes of those who do.”

Since euthanasia is not possible in the US, she explores “imminent death donation”, a procedure in which a terminally-ill patient donates an organ like a kidney – and dies not long afterwards. This also has drawbacks. To the public this might look like doctor-vultures circling around a dying patient.

Even in Canada, she points out, organ donation after euthanasia is conducted only after the patient is pronounced dead. Often the organs are unusable because too much time has elapsed between death and retrieval. Her unspoken message seems to be that the ultimate solution will be euthanasia by organ donation – in which the patient dies when his organs are removed.

The big obstacle to any and all of these solutions is public perception. Legal obstacles will not disappear unless the public approves. Dr Rosenbaum is optimistic that voters will see the wisdom of the euthanasia with organ donation combo. The physicians she interviews believes that the medical profession is more conservative than the public. “Patients are far more open than the medical community is to questioning ethical boundaries,” one of them tells her.

Dr Rosenbaum’s muffled advocacy of organ donation euthanasia suggests that the editors of the NEJM, the most influential medical journal in the world, are keen to keep this ball in the air. In 2018 it published an article by Harvard Medical School’s Robert Truog and colleagues which extolled its virtues. It was no surprise to see that Dr Rosenbaum cites him.