TY - JOUR
T1 - Medical Assistance in Dying (MAiD) as a Source of Liver Grafts
T2 - Honouring the Ultimate Gift
AU - Ray, Samrat
AU - Torres-Hernandez, Alejandro
AU - Bleszynski, Michael Sean
AU - Parmentier, Catherine
AU - McGilvray, Ian
AU - Sayed, Blayne Amir
AU - Shwaartz, Chaya
AU - Cattral, Mark
AU - Ghanekar, Anand
AU - Sapisochin, Gonzalo
AU - Tsien, Cynthia
AU - Selzner, Nazia
AU - Lilly, Leslie
AU - Bhat, Mamatha
AU - Jaeckel, Elmar
AU - Selzner, Markus
AU - Reichman, Trevor W.
N1 - Publisher Copyright:
© Copyright 2022 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Objective: To report the clinical outcomes of liver transplants from donors after medical assistance in dying (MAiD) versus donors after cardiac death (DCD) and deceased brain death (DBD). Summary Background Data: In North America, the number of patients needing liver transplants exceeds the number of available donors. In 2016, MAiD was legalized in Canada. Methods: All patients undergoing deceased donor liver transplantation at Toronto General Hospital between 2016 and 2021 were included in the study. Recipient perioperative and postoperative variables and donor physiological variables were compared among 3 groups. Results: Eight hundred seven patients underwent deceased donor liver transplantation during the study period, including DBD (n=719; 89%), DCD (n=77; 9.5%), and MAiD (n=11; 1.4%). The overall incidence of biliary complications was 6.9% (n=56), the most common being strictures (n=55;6.8%), highest among the MAiD recipients [5.8% (DBD) vs. 14.2% (DCD) vs. 18.2% (MAiD); P=0.008]. There was no significant difference in 1 year (98.4% vs. 96.4% vs. 100%) and 3-year (89.3% vs. 88.7% vs. 100%) (P=0.56) patient survival among the 3 groups. The 1- and 3- year graft survival rates were comparable (96.2% vs. 95.2% vs. 100% and 92.5% vs. 91% vs. 100%; P=0.37). Conclusion: With expected physiological hemodynamic challenges among MAiD and DCD compared with DBD donors, a higher rate of biliary complications was observed in MAiD donors, with no significant difference noted in short-and long-term graft outcomes among the 3 groups. While ethical challenges persist, good initial results suggest that MAiD donors can be safely used in liver transplantation, with results comparable with other established forms of donation.
AB - Objective: To report the clinical outcomes of liver transplants from donors after medical assistance in dying (MAiD) versus donors after cardiac death (DCD) and deceased brain death (DBD). Summary Background Data: In North America, the number of patients needing liver transplants exceeds the number of available donors. In 2016, MAiD was legalized in Canada. Methods: All patients undergoing deceased donor liver transplantation at Toronto General Hospital between 2016 and 2021 were included in the study. Recipient perioperative and postoperative variables and donor physiological variables were compared among 3 groups. Results: Eight hundred seven patients underwent deceased donor liver transplantation during the study period, including DBD (n=719; 89%), DCD (n=77; 9.5%), and MAiD (n=11; 1.4%). The overall incidence of biliary complications was 6.9% (n=56), the most common being strictures (n=55;6.8%), highest among the MAiD recipients [5.8% (DBD) vs. 14.2% (DCD) vs. 18.2% (MAiD); P=0.008]. There was no significant difference in 1 year (98.4% vs. 96.4% vs. 100%) and 3-year (89.3% vs. 88.7% vs. 100%) (P=0.56) patient survival among the 3 groups. The 1- and 3- year graft survival rates were comparable (96.2% vs. 95.2% vs. 100% and 92.5% vs. 91% vs. 100%; P=0.37). Conclusion: With expected physiological hemodynamic challenges among MAiD and DCD compared with DBD donors, a higher rate of biliary complications was observed in MAiD donors, with no significant difference noted in short-and long-term graft outcomes among the 3 groups. While ethical challenges persist, good initial results suggest that MAiD donors can be safely used in liver transplantation, with results comparable with other established forms of donation.
KW - DCD
KW - MAiD
KW - euthanasia
KW - graft survival
KW - liver transplantation
UR - http://www.scopus.com/inward/record.url?scp=85152445812&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000005775
DO - 10.1097/SLA.0000000000005775
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C2 - 36515405
AN - SCOPUS:85152445812
SN - 0003-4932
VL - 277
SP - 713
EP - 718
JO - Annals of Surgery
JF - Annals of Surgery
IS - 5
ER -