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Organ donation after euthanasia in children: Belgian and Dutch perspectives
  1. Jan A M Bollen1,
  2. Rankie ten Hoopen2,
  3. Mark A H B M van der Hoeven10,
  4. David Shaw11,12,
  5. Joe Brierley3,
  6. Dirk Ysebaert4,
  7. L W Ernest van Heurn5,
  8. Walther N K A van Mook1
  1. 1 Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
  2. 2 Department of Health Law, Maastricht University, Maastricht, The Netherlands
  3. 3 Departments of Critical Care and Paediatric Bioethics, Great Ormond Street Hospital, London, UK
  4. 4 Department of Transplant Surgery, University Hospital Antwerp, Edegem, Belgium
  5. 5 Department of Pediatric Surgery, Academic Medical Center, Amsterdam, The Netherlands
  6. 10 Department of Neonatology, Maastricht University Medical Center, Maastricht, the Netherlands
  7. 11 The Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
  8. 12 Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
  1. Correspondence to Dr Jan A M Bollen, Department of Intensive Care, Maastricht University Medical Center, Maastricht, 6202AZ, The Netherlands; jan{at}janbollen.be

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Introduction

Organ donation after euthanasia has been performed more than 70 times in Belgium and the Netherlands combined (personal communication, Jan Bollen, 2018). These two countries allow for euthanasia in minors as well, while Luxembourg, Colombia and Canada only allow adults to undergo euthanasia. A Dutch guideline on organ donation after euthanasia focuses on mentally competent adults, with a predominance of neurodegenerative diseases.1

The question arises whether organ donation after euthanasia should be possible in children and adolescents, and what are the legal, medical and ethical conditions for the combined procedure.

Organ donation after euthanasia

When all due diligence requirements for euthanasia have been fulfilled and no contraindications for organ donation are identified, it is possible for an adult to ask his physician to donate his organs as well. The patient undergoes several preparatory investigations to identify which organs are suitable for donation. Subsequently, euthanasia is performed by injection of a coma inducer and muscle relaxant. After 5 min ‘no touch time’ the organs are recovered in the operating room analogous to a donation after circulatory death (DCD) procedure. Lungs, liver, pancreas (islets) and kidneys can be donated and—if applicable—tissues as well. The preliminary transplantation results are promising, and organ donation after euthanasia is is thus clearly of benefit to patients awaiting transplantation.2 3 Organ donation euthanasia in children and adolescents, where the patient is anaesthetised and his organs removed in a heart-beating procedure,4 is beyond the scope of this article.

In this article, the legal aspects of euthanasia and organ donation are elaborated, after which the medical and ethical dilemmas of the combined procedure are addressed, followed by a comprehensive discussion of these aspects in children and adolescents.

The authors argue neither in favour of nor against euthanasia and organ donation from children; we merely aim to increase awareness regarding the possibilities and …

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