Outcomes of Kidney Transplantation From Organ Donation After Medical Assistance in Dying (MAiD): The University Health Network Experience

Introduction: Medical assistance in dying (MAiD) has been practiced in various countries for several decades, but it is only recently that some countries, including Canada, have started practicing organ donation after MAiD. Canada is, at present, one of the world leaders in this practice, performing more transplants from MAiD donors than any other country in the world. However, the data to support this type of donation in Canada is limited. This study investigates the outcomes of kidney transplants from donation after MAiD at the Ajmera Transplant Centre, University Health Network (UHN), Toronto, Canada, in comparison to other forms of deceased donation.
Methods: This is a retrospective single centre cohort study comparing kidney transplantation outcomes using kidneys donated after MAiD compared to donation after death determination by neurologic criteria (DNC) and donation after death determination by circulatory criteria (DCC), from January 1, 2018 to June 30, 2025. Recipient demographics, medical history, and clinical outcomes were obtained from UHN electronic patient records. Donor information was obtained from the Trillium Gift of Life Network (organ donation organizatino for the province of Ontario). Patients were followed until September 30, 2025. Logistic and Cox proportional hazards regression was used for analyses. A two-sided p-value < 0.05 was considered statistically significant.
Results: A total of 930 transplants from MAiD donors (n=61), DCC donors (n=269), and DNC donors (n=600) were included in the study cohort. After adjusting for various recipient, donor factors, and transplant factors, patients receiving MAiD kidneys were 76% less likely to experience delayed graft function than the DCC group (OR=0.24 [95% CI: 0.12, 0.48]; p < 0.001). There was also better kidney function at 1 and 3 months, with a mean eGFR's of 10.9 and 8.1 mL/min/1.73 m² greater in recipients of MAiD vs. DCC kidneys, respectively. There were no statistically significant differences in early hospital readmissions within 30 days, acute rejection within one year post-transplant, eGFR at 6 and 12 months, or the incidence of graft failure, among recipients of MAiD vs. non-MAiD kidneys.
Conclusion: The findings suggest that clinical outcomes for patients receiving kidneys from organ donation after MAiD have comparable outcomes to DNC and DCC donation. Thus, MAiD organ donation remains a viable option to not only expand the donor pool, but also honour the generosity and autonomy of patients undergoing MAiD at the end of their lives.