American man gets heart from 38-year-old Ontario ALS patient who died by MAID

An American man dying of heart failure received the heart of a Canadian man with ALS who chose a medically assisted death in what is being described as a landmark case of a heart transplant following euthanasia.

Organs have been donated after MAID before, involving liver, kidney or lung transplants.

“Here we report the first case of a successful cardiac transplantation after MAID,” a team of doctors from The University of Pittsburgh Medical Center and The Ottawa Hospital report in the Journal of Heart and Lung Transplantation .

The case involved a 59-year-old man with rapidly worsening heart failure who wasn’t expected to survive more than a month without a new heart.

Ten days after his status on a transplant waitlist was upgraded, “a suitable donor was identified: a 38-year-old male with ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease) who was to receive MAID and wished to donate his organs,” the team reported.

“Provision of MAID and death determination occurred in keeping with Canadian standards,” they said.

With organ donation after MAID, life-ending drugs usually must be administered in a hospital near an operating room because organs are recovered immediately after death is called. Time is of the essence to shorten the ischemic time — the elapsed time without blood flow to the organs before they can be transplanted into someone else.

“Death was declared within seven minutes of initiating the MAID protocol,” the team wrote.

The dead donor’s heart was removed, attached to a special machine that “reanimates” or restarts hearts to keep blood flowing through the organs while keeping them warm, and then transported to Pittsburgh, where the transplant took place.

The time from retrieval to transplant was five hours and 28 minutes.

After some initial complications, the Pittsburgh patient was discharged home 20 days post-op, “in good condition and remains well at most recent follow up,” the team wrote in their case report published in June.

“While longer term data and data on additional cases will be required, this case suggests that safe cardiac transplantation can be performed after MAID,” they said, potentially expanding the pool of donor hearts.

Organ donation after voluntary euthanasia has been called the ultimate act of altruism, a gesture that could bring a profound sense of psychological comfort and solace to those seeking assisted death.

However, the combination of organ donation and assisted dying is ethically fraught. Concerns have been raised that vulnerable people might feel pressured to proceed with MAID, even if they’re having a change of heart, if they know people are waiting for their organs.

Canada is already a world leader in ODE — organ donation after euthanasia — according to a review published by Dutch researchers that found of the 286 instances identified up to and including 2021, 136 were Canadian.

Since 2021, at least 235 people who have died by MAID have consented to donating their organs, typically kidneys, livers or lungs, according to the Canadian Institute for Health Information data.

Of 894 deceased donors in 2024, seven per cent donated following MAID.

Five per cent of a total of 3,212 organ transplants performed last year used organs donated after MAID.

Organs are allocated to the person in most need, and the best match.

Organs from Ontario donors are first allocated to Ontario or Canadian residents on a waitlist, Ontario Health, which oversees the province’s organ and tissue donation organization, said in an email to National Post.

If the organs aren’t matched or accepted by a transplant program in Ontario or other Canadian program, they’re then offered to the U.S through the United Network for Organ Sharing.

“Ontario has partnerships and reciprocity agreements with other Canadian provinces and UNOS to share donated organs,” Ontario Health said.

“This practice ensures that as many people benefit as possible, a family’s donation wishes are fulfilled and all viable organs are used, thereby maximizing the generous gift provided by donors and their families.”

In 2024, 13 organs were exported to the U.S.; 63 were imported, according to CIHI.

Several authors of the Pittsburgh transplant team did not respond to requests for an interview. The MAID provision and procurement of the donor heart did not occur at The Ottawa Hospital, according to spokesperson. Ontario Health would not confirm if the donor was an Ontario patient, citing provincial privacy legislation.

The same principles that have existed for decades around organ donation, including the “dead donor” rule, also apply in cases of MAID.

“The dead donor rule stipulates that organ donation should not cause or hasten death, and that an individual must be pronounced dead before organ procurement,” according to a review by Canadian authors of the legal and ethical aspects around organ donation after MAID.

After death occurs, and after a five-minute “no touch” waiting period to confirm death is irreversible, only then may organs be removed.

Guidance developed by the Canadian Blood Services makes clear the decision for MAID has to precede, and be separate from, the decision to donate organs, and that people should be made fully aware that they can withdraw their request for either procedure at any time.

However, how, and when, to approach people requesting MAID about organ donation is controversial and varies in Canada, according to the review paper. Organ donor organizations in Ontario and British Columbia recommend that people who request MAID “are approached and informed about the possibility of organ donation.” In others, like Alberta and Manitoba, people aren’t asked about organ donation unless they start the conversation themselves.

“Not informing patients about the possibility of donation can prevent them from exploring the opportunity to donate their organs and negatively impact their autonomy, while informing them of this possibility may cause undue societal pressure for donation, and the desire to become a donor may be a driver for the MAID request,” the review authors wrote.

However, the decision to donate organs after MAID “by a patient who has nothing to gain from it should be considered an act of altruism, and such an act should not be impeded,” they said.

“The capacity to fulfill the last wish of these patients to diminish their suffering should be the main, and only, reason to advocate for organ donation following MAID.”

Still, “some patients may feel they are a burden to their family and friends and feel motivated to undergo MAID to relieve this burden,” the authors wrote.

Stories have accumulated of people being driven to MAID primarily because of poverty, or a lack of adequate health care or social supports.

MAID assessors and providers should be attentive, the researchers said, “to potential indicators that the patient may somehow be feeling pressured to proceed with MAID or MAID and organ donation.”

While most people who choose MAID have cancer, which typically makes their organs unsuitable for transplant, 25 to 30 percent have neuromuscular or neurological diseases or other conditions that don’t preclude donation.

It’s not clear when the Pittsburg heart transplant was performed.

Two years ago, researchers in Belgium reported what they described as the first case of a heart donated, and then transplanted, after euthanasia, using different donor heart reperfusion and transplant techniques.

National Post

• Obese woman, grieving widower among Canada's latest MAID patients
• New MAID dilemma: Will people be 'unduly influenced' to die if they can gift their organs to loved ones?

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