Leave it to the Dutch
F. Amos Bailey, MD Dec 29, 2020
I have never been to the Netherlands; I know a few people who are of Dutch heritage but no one who is Dutch. However, the image in my mind is of a clean, highly educated tidy country of highly rational people.
The Dutch, with a few other European countries, have pioneered, Hastened Death for people with a terminal illness and intractable suffering. This seems to be working for them as a country.
This month in JAMA, authors from the Netherlands published an article regarding outcomes for 47 individuals who, as part of their decision for euthanasia, donated their liver for transplant. In short, the outcomes were positive for those receiving the organs.
It is unlikely that this is coming soon to the USA. It does cause me to reflect on my experiences with Palliative Care and organ donation. I have gone to the OR on several occasions to assist with the extubation of a person who was dying from a head injury/stroke. The families had decided after careful consideration to transition to comfort-focused care but also for DACD (Donation After Cardiac Death). In one case the young man died within minutes after extubation with his family at his side. Two minutes later they had left the room so the organs could be removed for transplant. In another care, the woman lingered for more than an hour and the organ donation was not possible. She returned to the Palliative Care Unit and died within a few hours. Her family grieved her death but also that she could not be a donor.
More recently, a patient with a progressive neurological condition asked about both Hastened Death and organ donation. We discussed how this was not possible at this time. Later I would hear on NPR a story of a similar situation.
Now the Dutch, always rational, share their experiences with EOL, hastened death, and organ donation.
I doubt that this will change practices here in the US very much anytime soon since we are divided on these difficult ethical issues. This is not an easy topic to talk about, and decisions are not easy to make. It is good to take time but to think of all the potential options.
Learn more here about the Dutch experience.
https://jamanetwork.com/journals/jamasurgery/fullarticle/2769118