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* Includes consent for 8 cases, that were later rescinded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.”