Organ donation: a hidden factor in support for euthanasia

The role of organ transplantation in expanding euthanasia legislation has often been underappreciated. While popular and ethical discussion regarding legalization often focus on the issues of autonomy, right to die and dignity, an interest for euthanasia among medical professionals and decision-makers may be driven by more pecuniary and practical considerations. This is especially true for the transplant community which prioritizes quick harvesting of organs from euthanasia patients while barely engaging with the ethical issues and their own incentives regarding euthanasia. Thus, following a recent legalization of euthanasia in Quebec the most pressing concern expressed among professionals engaged in transplantation appears to have been the ways to swiftly proceed with organ harvesting without hurting family. (Achille M. Using Canadian code of ethics for psychologists to determine acceptability of organ donation following medical assistance to die. In: Massey et al, eds. Ethical, legal and psychosocial aspects of transplantation. Global challenges. Pabst Science Publishers, Lengerics 2017; 113-122 ) Similarly, a discussion at a recent ELPAT congress in Rome 2016 was focused mainly on logistics of harvesting organs from euthanasia patients without acknowledgment of the role that incentive to obtain organs might play in their own attitudes toward euthanasia. As discussed elsewhere transplant community has been myopically focused on increasing the supply of organs, recently suggesting abandonment of such long standing postulates as dead donor rule (Nair-Collins M, JME 2014), and embracing ever widening indications for euthanasia (e.g. mental disorders, Alzheimer disease), all while often ignoring numerous promising alternatives to transplantation such as regenerative medicine, artificial and bioartificial organs. Recently, organ donation euthanasia procedure was suggested, consisting in euthanasing the candidate, remove all organs from the person while he is still alive, with heart removal concluding the procedure (Wilkinson, Savulescu, Bioethics 26: 1: 32-48). None of this is necessary. Slovenian ethics committee in 2012 has declared against the use or organs from donors killed by euthanasia. Slovenian model of organ transplantation is a living proof that an adequate transplantation program can be sustained without resorting to ethically controversial practices