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Letter to the Editor: The urgent need for consensus around organ donation after assisted dying

Letter to the Editor: The urgent need for consensus around organ donation after assisted dying Received: 24 May 2023 Accepted: 24 May 2023 DOI: 10.1097/LVT.0000000000000260 LET T ER TO TH E E D I TOR Letter to the Editor: The urgent need for consensus around organ donation after assisted dying To the editor, AUTHOR CONTRIBUTIONS Glinka et al’s review of liver transplantation after Philip Berry and Sreelakshmi Kotha: Conceptualization medical assistance in dying adds to the ever-growing and writing the manuscript. literature from countries and states where voluntary [1] assisted dying (VAD) or euthanasia is legal. Out- CONFLICTS OF INTEREST comes are good, and warm ischemic times are short; The authors have no conflicts to report. clearly, it works. However, opinions are likely to be as divided as those pertaining to the ethics of VAD itself. Philip Berry For hepatologists, the discussion is further layered by a Sreelakshmi Kotha compelling need to expand the donor pool and prolong the lives of patients with liver failure. Department of Gastroenterology, Guy’s and St Thomas’ Ray and Martin have reported that in 2020, 4% Foundation Trust, London, UK of donations followed euthanasia or VAD in the [2] Netherlands and Canada. This expansion is highly Correspondence significant and is no longer theoretical. It is occurring Sreelakshmi Kotha, Department of Gastroenterology, across the globe by degrees, but society chairs, Guy’s and St Thomas’ Hospital, London, SE1 7EH, UK. thought leaders, and journal editors have not yet Email: [email protected] opined, leaving somethin g of a moral and ethical vacuum for clinicians who must now decide what stance to take. ORCID Although this is not the place to rehearse all the Philip Berry https://orcid.org/0000–0003–0104–4737 arguments for and against organ donation after VAD, Sreelakshmi Kotha https://orcid.org/0000–0003– the “dead donor rule” tends to dominate the discus- 3144–503X sion. This mandates that organs are only taken from the dead, protecting individuals from harm and society [ ] from a dystopian end point. The boundary between REFERENCES life and death becomes blurred when death is brought 1. Glinka J, Sachar Y, Tang E, Brahmania M, Hwang J, Waugh E, et al. Liver transplantation with donation after medical assistance in about by the removal of vital organs that are to be [4] dying: Case series and systematic review of the literature. Liver donated (so-called organ donation euthanasia). Transpl. 2023;29:618–25. It has been argued that patient autonomy should 2. Ray R, Martin D. Missed opportunities: Saving lives through not extend this far due to the wider societal organ donation following voluntary assisted dying. Intern Med J. [5] consequences. 2023;53:861–5. This is but one example of many challenging ethical 3. Smith AP. Abandoning the dead donor rule. J Med Ethics. 2023; 49:707–17. debates that the transplant community must work 4. Andersen DB. May I give my heart away? On the permissibility through in advance of a growing phenomenon. If of living vital organ donation. Bioethics. 2021;35:812–9. guidance, structures, and safeguards are not put in 5. Rubin J. Autonomy to a fault: The confluence of organ place, we will see variation in practice—a sure sign that donation, euthanasia, and the dead donor rule. Bioethics. 2023; risks of injustice and inequity exist. 37:374–8. Abbreviation: VAD, voluntary assisted dying. ------------------------------------------------------------------------------------------------------- Copyright © 2023 American Association for the Study of Liver Diseases. E44 www.ltxjournal.com Liver Transplantation. 2023;29:E44–E44 © 2023 American Association for the Study of Liver Diseases. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article prohibited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Liver Transplantation Wolters Kluwer Health

Letter to the Editor: The urgent need for consensus around organ donation after assisted dying

Berry, Philip; Kotha, Sreelakshmi
Liver Transplantation , Volume 29 (12) – Dec 26, 2023
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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2023 American Association for the Study of Liver Diseases.
ISSN
1527-6473
eISSN
1527-6465
DOI
10.1097/lvt.0000000000000260
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Abstract

Received: 24 May 2023 Accepted: 24 May 2023 DOI: 10.1097/LVT.0000000000000260 LET T ER TO TH E E D I TOR Letter to the Editor: The urgent need for consensus around organ donation after assisted dying To the editor, AUTHOR CONTRIBUTIONS Glinka et al’s review of liver transplantation after Philip Berry and Sreelakshmi Kotha: Conceptualization medical assistance in dying adds to the ever-growing and writing the manuscript. literature from countries and states where voluntary [1] assisted dying (VAD) or euthanasia is legal. Out- CONFLICTS OF INTEREST comes are good, and warm ischemic times are short; The authors have no conflicts to report. clearly, it works. However, opinions are likely to be as divided as those pertaining to the ethics of VAD itself. Philip Berry For hepatologists, the discussion is further layered by a Sreelakshmi Kotha compelling need to expand the donor pool and prolong the lives of patients with liver failure. Department of Gastroenterology, Guy’s and St Thomas’ Ray and Martin have reported that in 2020, 4% Foundation Trust, London, UK of donations followed euthanasia or VAD in the [2] Netherlands and Canada. This expansion is highly Correspondence significant and is no longer theoretical. It is occurring Sreelakshmi Kotha, Department of Gastroenterology, across the globe by degrees, but society chairs, Guy’s and St Thomas’ Hospital, London, SE1 7EH, UK. thought leaders, and journal editors have not yet Email: [email protected] opined, leaving somethin g of a moral and ethical vacuum for clinicians who must now decide what stance to take. ORCID Although this is not the place to rehearse all the Philip Berry https://orcid.org/0000–0003–0104–4737 arguments for and against organ donation after VAD, Sreelakshmi Kotha https://orcid.org/0000–0003– the “dead donor rule” tends to dominate the discus- 3144–503X sion. This mandates that organs are only taken from the dead, protecting individuals from harm and society [ ] from a dystopian end point. The boundary between REFERENCES life and death becomes blurred when death is brought 1. Glinka J, Sachar Y, Tang E, Brahmania M, Hwang J, Waugh E, et al. Liver transplantation with donation after medical assistance in about by the removal of vital organs that are to be [4] dying: Case series and systematic review of the literature. Liver donated (so-called organ donation euthanasia). Transpl. 2023;29:618–25. It has been argued that patient autonomy should 2. Ray R, Martin D. Missed opportunities: Saving lives through not extend this far due to the wider societal organ donation following voluntary assisted dying. Intern Med J. [5] consequences. 2023;53:861–5. This is but one example of many challenging ethical 3. Smith AP. Abandoning the dead donor rule. J Med Ethics. 2023; 49:707–17. debates that the transplant community must work 4. Andersen DB. May I give my heart away? On the permissibility through in advance of a growing phenomenon. If of living vital organ donation. Bioethics. 2021;35:812–9. guidance, structures, and safeguards are not put in 5. Rubin J. Autonomy to a fault: The confluence of organ place, we will see variation in practice—a sure sign that donation, euthanasia, and the dead donor rule. Bioethics. 2023; risks of injustice and inequity exist. 37:374–8. Abbreviation: VAD, voluntary assisted dying. ------------------------------------------------------------------------------------------------------- Copyright © 2023 American Association for the Study of Liver Diseases. E44 www.ltxjournal.com Liver Transplantation. 2023;29:E44–E44 © 2023 American Association for the Study of Liver Diseases. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article prohibited.

Journal

Liver Transplantation – Wolters Kluwer Health

Published: Dec 26, 2023

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