MAID in Canada: Donation

after Medical Assistance in

Dying Today and TomorrowMatthew Weiss, Medical Director of Donation, Transplant Québec

Pediatric Intensivist CHU de Québec

CCCF Donation Symposium, Toronto

November 11, 2019

Disclosures

• No conflicts with for-profit entities

• Paid consultant as medical director of

Transplant Québec

• Researcher with interests in donation

science and KT

• Full time pediatric intensivist

https://ici.radio-canada.ca/nouvelle/1147969/don-organes-aide-medicale-a-

mourir-mauricie-shawinigan-transplant-quebec

Marcel Boucher

Trillium

Overview: MAiD - DCD

donation

• Administration of MAiD cocktail, not WLSM

• Assured of rapid death

5-10 minutes 5-10 minutes

Generally Short

Warm Ischemia

MAiD DeathRecoverySurgery

MAiD With and Without Donation

Standard MAiD• Location at choice of

patient – often at home

• No limit on number of loved ones at time at death

• One or few providers present

MAiD with donation• In hospital – in or near OR

• Multiple exams prior to donation

• Family present but may be limited

• Coordination of multiple providers and teams – may limit choice of date or time

Elsewhere

1. Bollen 2016 Am j of Trans 2. Gilbo N 2019 JAMA.

15 Donors in the Netherlands

prior to December 2015 (1)

11 Liver Donors in Single Center

in Belgium 2009-2015 (2)

Trillium Gift of Life Network

* Includes consent for 8 cases, that were later rescinded

Referrals ApproachesConsents Donors

Organ Tissue Organ Tissue

Organ and Tissue DonationApproaches before Death

1092 414 69* 240 30 202

Tissue OnlyReferrals/Approaches after Death

103 39 - 18 - 17

Total 1195 453 69 258 30 219

Organ and Tissue Donation

after Medical Assistance in Dying

To refer your patient or discuss suitability, contact the Provincial Resource Centre:1-877-363-8456

To date, 64 lives have been saved through the gift of organ donation and 219 tissue donors enhanced lives through the gift of eye and tissue donation.

Source: iTransplant - 01 July 2016 to 30 September 2019

Donation after MAID in Québec

References Consent Cancelled Actual

Donors

Organs*

2017 7 5 3 2 4

2018 23 10 2 8 24

2019

(june)21 16 1 10 32

Totals 30 15 5 20 60

• 40 kidneys, 10 livers, 4 double lungs

• All donors had neurodegenerative diseases (13 ALS, 5 Parkinson, 1 multiple

sclerosis, 1 cortico-basilar degeneration

Emerging Issues

Death Determination Method and Warm

Ischemic Time

Emerging Issues

Require Art Lines?

Change

MAID Cocktail?

NEJM 2018

“Following the dead donor rule could

interfere with the ability of these

patients to achieve their goals.”

Questions?matthew-john.weiss@chudequebec.ca