Medical Assistance in Dying (MAiD) as a Source of Liver Grafts: Honouring the Ultimate Gift

Samrat Ray, Alejandro Torres-Hernandez, Michael Sean Bleszynski, Catherine Parmentier, Ian McGilvray, Blayne Amir Sayed, Chaya Shwaartz, Mark Cattral, Anand Ghanekar, Gonzalo Sapisochin, Cynthia Tsien, Nazia Selzner, Leslie Lilly, Mamatha Bhat, Elmar Jaeckel, Markus Selzner, Trevor W. Reichman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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.

Original languageEnglish
Pages (from-to)713-718
Number of pages6
JournalAnnals of Surgery
Issue number5
StatePublished - 1 May 2023
Externally publishedYes


  • DCD
  • MAiD
  • euthanasia
  • graft survival
  • liver transplantation


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