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Letters to the Editor

Response to Bernat and Delmonico

Weiss, Matthew J. MD, FRCPC1,2; Chaudhary, Prosanto MD, MSc, FRCSC3,4

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doi: 10.1097/TP.0000000000003184
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We read with interest the recent commentary by Bernat and Delmonico1 entitled “Restoring Activity of Pig Brain Cells After Death Does Not Invalidate the Determination of Death by Neurologic Criteria or Undermine the Propriety of Organ Donation After Death.” We were particularly interested in the algorithm that outlines the entirety of donation progress possibilities (Figure 11 of that publication). While we feel that this algorithm offers a generally comprehensive and cohesive overview of donation pathways, we would like to suggest 1 addition. As first pioneered in Belgium and the Netherlands, and later in Canada, there is an additional entry point onto the donation after circulatory determination of death pathway: donation after medical assistance in dying (MAID)—often referred to as voluntary euthanasia.2,3 In our province of Québec, we have increasingly incorporated this pathway to donation into end–of–life care, with over 20 completed cases of donation after MAID since 2017 resulting in 64 transplanted organs (internal Transplant Québec reports). This currently represents 5%–10% of our total donation activity. This practice has been met with general acceptance from stakeholders including MAID providers, donation professionals, and the general public, including several favorable media reports.4 As other countries consider MAID legislation, it is important not to forget that this pathway can provide a source of transplanted organs while fulfilling the patient’s intent to help others at the end of their own life. We thus suggest that this pathway be added to future editions of your otherwise extremely informative algorithm.


1. Bernat JL, Delmonico FL. Restoring activity of pig brain cells after death does not invalidate the determination of death by neurologic criteria or undermine the propriety of organ donation after death. Transplantation. 2019; 103:1295–1297. doi:10.1097/TP.0000000000002782
2. Downar J, Shemie SD, Gillrie C, et al.; for Canadian Blood Services, the Canadian Critical Care Society, the Canadian Society of Transplantation and the Canadian Association of Critical Care NursesDeceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy. CMAJ. 2019; 191:E604–E613. doi:10.1503/cmaj.181648
3. Bollen J, Ten Hoopen R, Ysebaert D, et al. Legal and ethical aspects of organ donation after euthanasia in Belgium and the Netherlands. J Med Ethics. 2016; 42:486–489
4. Bouchard M-P. Un ultime don avant de mourir [Radio-Canada Website]. 2019. Available at–organes–aide–medicale–a-mourir–mauricie–shawinigan–transplant–quebec. Accessed December 12, 2019
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