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Organ donation after medical assistance in dying or cessation of life-sustaining treatment requested by conscious patients: the Canadian context
  1. Julie Allard1,2,
  2. Marie-Chantal Fortin1,2,3
  1. 1 Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
  2. 2 Bioethics Program, Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
  3. 3 Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
  1. Correspondence to Dr Marie-Chantal Fortin, Nephrology and Transplant Division, Hôpital Notre-Dame, 1560 Sherbrooke Street East, Montreal, QC H2L 4M1, Canada; marie-chantal.fortin{at}


In June 2016, following the decision of the Supreme Court of Canada to decriminalise assistance in dying, the Canadian government enacted Bill C-14, legalising medical assistance in dying (MAID). In 2014, the province of Quebec had passed end-of-life care legislation making MAID available as of December 2015. The availability of MAID has many implications, including the possibility of combining this practice with organ donation through the controlled donation after cardiac death (cDCD) protocol. cDCD most often occurs in cases where the patient has a severe neurological injury but does not meet all the criteria for brain death. The donation is subsequent to the decision to withdraw life-sustaining treatment (LST). Cases where patients are conscious prior to the withdrawal of LST are unusual, and have raised doubts as to the acceptability of removing organs from individuals who are not neurologically impaired and who have voluntarily chosen to die. These cases can be compared with likely scenarios in which patients will request both MAID and organ donation. In both instances, patients will be conscious and competent. Organ donation in such contexts raises ethical issues regarding respect for autonomy, societal pressure, conscientious objections and the dead-donor rule. In this article, we look at relevant policies in other countries and examine the ethical issues associated with cDCD in conscious patients who choose to die.

  • Donation/Procurement of Organs/Tissues
  • Euthanasia
  • Suicide/Assisted Suicide
  • Vital organ donation

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  • Contributors JA is the primary author. She wrote the draft and final versions of the article. M-CF commented and revised all versions.

  • Funding Fonds de Recherche du Québec—Santé (Doctoral training grant).

  • Competing interests M-CF is a member of the Transplant Québec ethics committee. JA is the secretary of the Transplant Québec ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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