Organ Donation After Medical Assistance in Dying (MAiD): A Global Overview of Short- and Long-Term Clinical Outcomes

Introduction: Organ donation after MAiD has developed as an emerging practice internationally, but due to its relatively recent implementation, there is a need to understand the relative safety and efficacy of organ donation after MAiD compared to traditional deceased donation methods, such as donation after death by neurological criteria (DNC) and death by circulatory criteria (DCC). Our objective was to synthesize the available global evidence for clinical outcomes following MAiD organ donation through a systematic review.
Methods: The systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ovid MEDLINE; Ovid Embase; Cochrane Database of Systematic Reviews (Ovid); and Cochrane Central Register of Controlled Trials (Ovid) were used to obtain relevant studies. All studies were screened by two independent reviewers. Risk of Bias was conducted using the JBI Critical Appraisal Checklists for the relevant study type. Disagreements throughout the process were resolved via discussion or by a third reviewer.
Results: 600 articles underwent title and abstract screening, and 16 articles met our inclusion criteria.
Heart: There were 2 case studies of heart transplantation after MAiD. While both patients had complicated post-operative courses, they showed significant improvement in cardiac function post-transplant.
Islet Cell: There were 2 case studies highlighting clinical outcomes from islet-cell transplantation after MAiD. All patients in both studies experienced a successful decrease in insulin requirement. Metabolic outcomes were no worse in MAiD recipients than in DCC recipients.
Lung: There were no significant differences seen between the MAiD and control groups in any of the 4 studies in either short- or long-term outcomes.
Liver: Results across 5 studies suggest that early allograft dysfunction (EAD) may be lower in MAiD recipients compared to DCC recipients. While length of hospital and ICU stay were longer in MAiD recipients, there were no significant differences in other short- or long-term outcomes between the MAiD and DCC groups.
Kidney: Results across 3 studies indicate that rates of delayed graft function (DGF) are significantly lower in the MAiD group than DCC group, and were comparable to the DNC group. There were no significant differences in long-term outcomes at any time point.
Conclusion: Overall, the available literature suggests that clinical outcomes for patients receiving organs from organ donation after MAiD have comparable outcomes to DNC and DCC donation. However, some organ groups, particularly heart and islet cell, require more large-scale research to confirm the findings of smaller studies. MAiD organ donation remains a viable option to both expand the donor pool and honour the generosity and autonomy of patients undergoing MAiD.