Introduction: Expanding the Donor Pool with MAiD Livers
Organ donation after medical assistance in dying (MAiD) is a relatively new but increasingly discussed practice in North America and beyond. A recent study published in the Journal of Hepatology provides the first large-scale Canadian comparison of liver transplants using donors who gave organs after MAiD (donation after circulatory death following MAiD) with those from standard donation after circulatory death. The findings indicate that patient survival and overall outcomes are comparable between the two groups, suggesting MAiD as a viable way to broaden the donor pool and save more lives.
Study Overview: What Was Compared?
The Canadian study analyzed 313 liver transplants performed across six transplant centers between 2016 and 2023. Participants were divided into two groups: standard donation after circulatory death (type 3) with 257 liver transplants, and donation after circulatory death following MAiD (type 5) with 56 liver transplants. The researchers focused on postoperative outcomes, patient survival, and graft function to determine whether MAiD livers could be integrated safely into current transplantation practices.
Key Findings: Survival and Outcomes Comparable
The results showed excellent outcomes in both groups, with similar survival rates and graft performance. This parallel in outcomes mirrors previous international work from Belgium and the Netherlands, reinforcing the idea that MAiD can be a meaningful source of high-quality organs without compromising patient prognosis.
Implications for Policy and Practice
As of 2025, only a handful of countries—Australia, Belgium, Canada, Spain, and the Netherlands—have legalized organ donation following MAiD. Given the ongoing gap between organ demand and supply, the study’s findings support the potential expansion of the donor pool through MAiD pathways, thereby reducing wait times and improving access to life-saving liver transplants.
Impact on Waiting Lists
In Canada, MAiD donation accounted for about a 22% increase in donation after circulatory death activity, translating to roughly eight additional livers per year for transplant over seven years. While not every MAiD candidate is eligible to donate, the data demonstrate a tangible impact on reducing waiting times for patients with end-stage liver disease and related conditions.
Personal and Ethical Considerations
Physicians and patients alike emphasize that MAiD-related organ donation occurs only when the patient independently chooses to donate, independently of their end-of-life decision and with strict safeguards to ensure decisions are voluntary. The study underscores that donation decisions are treated with care and respect, acknowledging the patient’s autonomy and the family’s need for closure.
Professional Perspectives
Co-lead investigator Dr. A. M. James Shapiro notes that these findings are more than numbers; they represent real potential to save lives and reduce suffering for people awaiting liver transplants. Co-lead investigator Dr. Alessandro Parente highlights the broader implications for other organs, with prior research showing positive outcomes for hearts, lungs, and kidneys donated after MAiD. This growing body of evidence supports a broader declaration: MAiD donation can be a compassionate, medically sound option within organ donation programs.
Conclusion: A Step Toward Greater Life-Saving Capacity
The Canadian experience suggests that livers donated after MAiD can perform as well as those from standard donations after circulatory death. As clinicians continue to refine selection criteria and maintain rigorous safeguards, MAiD donation has the potential to meaningfully expand the organ donor pool, shorten waiting times, and offer hope to thousands of patients facing end-stage liver disease or acute liver failure.
Family and Patient Perspectives
For individuals considering MAiD, the opportunity to donate can provide meaningful solace, allowing a final act of generosity that benefits others and offers families a sense of comfort during a difficult time. The study’s authors stress that donation remains a voluntary, carefully regulated choice that respects the patient’s and family’s values and wishes.
