Organ donation after euthanasia from home: where do we stand now?

Alternative

Until recently, a patient had to go to the hospital for organ donation after euthanasia (ODE). After all, organ retrieval can only take place there. But many patients and their loved ones prefer to say goodbye at home. Therefore, many patients decide against organ donation. As a result, many valuable organs and tissues are lost to others. Organ donation after euthanasia from home (ODEH) is a new alternative.

How does the ODEH procedure work?

With ODEH, the patient is sedated at home. They are then transported to the hospital in a Mobile Intensive Care Unit (MICU). The general practitioner administers the actual euthanasia medication there. After death is confirmed, the organs are retrieved.

In the Netherlands, this procedure has now taken place about five times. ODEH also exists in other countries, but it is sometimes organized differently. In Canada, for example, the actual euthanasia medication is already administered at home.

Include ODEH in the guideline?

The ODE working group is meeting to discuss adding the home-based procedure to the national guideline. ODEH has been in the media often over the past year, and parliamentary questions have been asked. The current ODE guideline has since been adjusted regarding euthanasia for early-stage dementia and psychiatric issues. And there is already a regional protocol for ODEH, with the Isala Hospital as the center. Nevertheless, it seems that the way is not yet clear for inclusion in the national guideline for the time being.

Obstacles and unanswered questions

Transplant coordinator Wim de Jongh from Maastricht mentions obstacles such as a cardiac arrest that could occur at home, but also the fact that hospital staff may refuse to cooperate. 'I had to lobby a lot to make the procedure possible at our facility,' says De Jongh. 'Many parties are involved within the hospital. You have to get everyone on the same page, from the board of directors to the nurses.'

Unanswered questions

Nichon Jansen, policy advisor at the NTS, confirms this. 'There are still many unanswered questions.

Is an intensivist-anesthesiologist willing and allowed to go to a patient at home? Is this legally permitted? But also: does the board of directors give a doctor permission to go to a home setting for a donation procedure? And who pays for the MICU?

In many respects, ODEH falls outside the frameworks of current healthcare. The existing ODE guideline was approved by twenty parties, and that was already a major undertaking. It would be very good if it were possible to draw up a guidance document for ODEH. This could support hospitals that receive a request regarding ODEH. A full-fledged guideline will come later.'