Organ donation after euthanasia for mental suffering

Growing group in cases of mental suffering

Organ donation after euthanasia (ODE) has existed in the Netherlands since 2012 and has been increasing in recent years: in 2025, it occurred 34 times.

A striking shift is occurring within this group: while between 2012 and 2022 about 30 percent underwent euthanasia due to mental suffering, NTS administration shows that this now accounts for about two-thirds of ODE procedures.

According to psychiatrist and SCEN physician Richard Oude Voshaar, this is easily explained. 'In patients with a psychiatric basis, there are less often medical contraindications for organ donation.' As a result, a wish to donate can relatively often be fulfilled.

At the same time, he observes that many healthcare providers are still insufficiently familiar with the possibilities and procedures of ODE in this context. That lack of knowledge can lead to the subject not being discussed, or being discussed too late.

Two separate trajectories

An important principle of ODE is that euthanasia and organ donation always remain two separate procedures. Both the assessment and the execution must take place strictly separately. 'The rule is that the donation procedure can only be started once the euthanasia procedure has been fully completed. Competency is also assessed separately for both decisions.'

In practice, this means that healthcare providers must be constantly alert to possible influence. The wish to donate organs must never play a role in the decision to request or proceed with euthanasia. In cases of mental suffering, both trajectories often take longer because of this. There is an extensive review of whether all treatment options have been exhausted. 'You often see that people who are considering or requesting euthanasia on psychiatric grounds have been thinking about it for a long time, while the practitioner still has to get used to the idea. Because of that longer timeframe, there is sufficient room to also discuss organ donation, even if the donation procedure cannot be started yet.'

When do you discuss organ donation?

In practice, this requires a careful assessment. When is the patient sufficiently certain of their choice? And when can information about donation be provided without exerting influence?

The current guideline is cautious: the initiative to discuss organ donation should preferably lie with the patient. This is to prevent the subject from being perceived as coercive. Oude Voshaar has reservations about this. 'Once the euthanasia procedure is finalized, I find it very normal for the GP or psychiatrist to bring it up. According to the Donor Act, you check the Donor Register to see if someone is a donor at the moment death is imminent, and then you discuss potential organ donation. With patients who choose euthanasia due to mental suffering, you know that death is approaching, and you also know whether someone is in principle open to organ donation.'

According to Oude Voshaar, timing is key here. 'When it is clear that the patient has no (further) doubt about their wish for euthanasia, you can provide information about the possibility of ODE.'

Vulnerability and ‘entrapment’

Oude Voshaar observes that some people who request euthanasia due to mental suffering are very firm in their decision, but there is also a group that experiences a certain ambivalence. ‘They are essentially saying they don’t want to die, but they also cannot sustain life in its current form. Especially with this group, who still have some doubt, organ donation is a difficult topic of conversation. You have to be very careful that the choice for organ donation does not influence the choice for euthanasia. Many of these patients have a poor self-image and feel that by donating their organs, they can still mean something positive for others. They also often find it difficult to make their own choices, and the danger is that they do not dare to reverse their decisions.’

This is also known as ‘entrapment’: the feeling of being stuck in a decision once it has been made. That is why it is crucial that patients know they can always go back on their choice.

Positive experiences

Oude Voshaar has guided ODE for several patients. Although every situation was different, his experience has generally been very positive. It can even contribute to the grieving process. He advocates for informing patients about the possibility of organ donation early in the euthanasia process. ‘Through more attention and awareness, ODE following mental suffering could increase even further.’

This article is from Transparant magazine (no. 97).
Curious about more stories and background? Read the full magazine here.