Organ Donation After Medical Aid in Dying: An Ethical Overview.

Organ Donation after Medical Aid in Dying (OD-MAiD) is currently practised in four countries: Belgium, Canada, the Netherlands, and Spain. While OD-MAiD shares some similarities with MAiD (absent the possibility of organ donation) and with standard organ donation protocols, the combination of OD and MAiD involves unique circumstances that present novel ethical challenges. These challenges revolve around donors' consent and protection, the dead donor rule, and organ allocation. This paper explores these moral challenges and proposes strategies to ensure ethical safeguards in the context of OD-MAiD. An underlying question is whether OD-MAiD, if permitted, should follow the ethical guidelines of living donation or deceased donation, as these two practices commonly operate under distinct moral paradigms. While the living donation paradigm is centred on the protection of donors' interests and emphasises individual choice by allowing donors to decide who receives their organs, the deceased donation framework places more emphasis on enabling recipients to benefit from transplant, and organ allocation is typically based on impartiality. OD-MAiD also raises ethical concerns about how the possibility of donation could influence a patient's decision to seek euthanasia and/or interfere with optimal end-of-life care. Proposing organ donation to individuals considering MAiD could conceivably create pressure to proceed with euthanasia, either to realise a social good or to satisfy the needs of loved ones (if a family member requires an organ). This may undermine the patient's autonomy or well-being at the end of life.