maid offers a lifeline to people desperate for organs
as medical assistance in dying continues to be embroiled in controversy, organ donation from maid recipients is on the rise — and canada is leading the way.
5 minute read
yvonne faulkner became the first person in b.c. to be an organ donor after maid.getty
in the late spring of 2017, yvonne faulkner was at work and couldn’t remember how to set up her usual morning conference call. she knew something was wrong and headed to the kelowna general hospital in b.c., where initial testing suggested early onset dementia. an appointment was made for two days later with a neurologist, but in the meantime, the headache she was experiencing got worse and she lost the sight in one of her eyes.
“so there we were with the neurologist and he told us she had glioblastoma,” recalls her husband dan faulkner.
glioblastoma is a deadly form of brain cancer that also killed the tragically hip’s gord downie in 2017.
yvonne was a healthy 57-year-old who played tennis several times a week and loved her garden. she was told she might live a year with a regimen of chemotherapy, radiation and surgery, but that “it was going to be a bad year.” without this course of treatment, her prognosis was short: she would live only six to eight weeks. the grave news prompted yvonne to make two decisions — one was to receive medical assistance in dying (maid), after which she would donate her organs.
“she wanted to somehow turn this into a good thing,” faulkner says.
the first in b.c. to be an organ donor after maid
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the federal government legalized maid in 2016 to allow people who have a serious, incurable illness, disease or disability to apply for and receive maid if they meet eligibility criteria. yvonne faulkner became the first person in b.c. — and the third in canada — to be an organ donor after maid, which the family did with the help of bc transplant. she donated her lungs, liver, kidneys and corneas.
“yvonne saved three lives and improved the lives of others with her corneas,” says faulkner. “it takes a very special person to do this and she was a very special person. because of this, in some ways, i feel she’s still with us.”
in canada, about 65 per cent of patients who request maid have cancer, according to the 2021 report by health canada. and while typically, those with cancer can’t donate because of the risks to organ recipients from invasive cancer cells, yvonne’s cancer was completely encapsulated in her brain, her husband says, allowing her to proceed with organ donation where organs and tissues are tested for safe and effective transplant. it’s an end of life choice that makes a difference, transplant experts say. for example, in 2021, 652 patients were removed from the organ transplant waitlist for a medical or other reason, according to the canadian institute for health information, and 38 per cent of them had died while waiting. the institute also reports a total of 2,782 organ transplants were performed in canada in 2021, with six per cent of those from donors who had received maid.
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canada is performing the most organ transplants from maid
while the organ donation after maid is a practice that is still evolving and controversial — there are ethical and logistical challenges of consent from vulnerable patients — canada is leading the way, performing more organ transplants from maid donors than other countries.
in fact, a recent international review by dutch researchers, published in the american journal of transplantation, found that of the 286 organ donations after euthanasia identified by the paper in canada, belgium, the netherlands and spain combined, nearly half of them — 136 — were canadian. the paper, which looked at the prevalence and success of the practice in the years leading up to and including 2021, also noted that canada is the only country where maid can be approved by a nurse practitioner as well as a physician.
the first transplant surgery after maid done at uhn
dr. marcelo cypel, surgical director of the ajmera transplant centre at the university health network’s toronto general hospital, is at the forefront of advancing organ donation after maid. his team performed the first transplant surgery after maid that was carried out in the home of the patient, a 48-year-old burlington, ont. man with huntington’s disease, to respect his last wishes. he had debilitating pain and a body that was deteriorating from the fatal condition that had killed his dad, but he was able to donate his lungs.
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“many of these patients don’t want to have the maid procedure done at the hospital. they prefer to do at home with the family, so we were able to develop a protocol that allowed the donor to have that procedure done at home, and then transferred to the hospital after the death declaration,” cypel says, explaining that only the lungs are possible for organ donation in this setting because the oxygen still inside the lungs can maintain the organ viability for a couple of hours.
“we have both very strong transplant teams as well as a very well established maid process now,” he says. “about two per cent of all deaths are maid in canada, so a significant number of patients undergo that and some of them can be donors.”
cypel also points out that the vast majority of maid recipients who are organ donors are those with neurodegenerative diseases, such as multiple sclerosis, severe parkinson’s disease or very severe, unsustainable chronic pain.
and although this side of the care process is sad, it’s uplifting to see the good that comes from giving organs to people who would die without them.
“when we do the transplant, some people only have days to live,” he says. “so you can transform that very quickly and that person can breathe normally again. and when i see them months or years later walking the hospital, coming for appointments and they look completely transformed, i think that’s really quite amazing.”
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maid donor organs have better outcomes
cypel has also worked on evaluating the quality of organs from maid donors, reviewing the health of recipients over time. he’s found similar and even better outcomes for these recipients compared to patients who’ve received organ transplants from other donors for both lung and abdominal organs.
“one of the main things with the typical donor for organs is that they’ve usually suffered an event and they are in icu for several days or weeks where they can get infections, the lungs may get injured because they are on ventilators, and there is generally more inflammation in the organs,” he says.
in fact, an earlier study that cypel contributed to, published in the american journal of transplantation last june, showed that maid lung transplant recipient outcomes were excellent, recommending that, “maid should be strongly considered for lung transplantation as a way to respect donor wishes while substantially improving outcomes for recipients with end-stage lung disease.”
for faulkner, who recently had a five-year memorial celebration for his wife at his local tennis club in kelowna, yvonne’s decision for medically-assisted death and then donating organs was not an easy choice. but he has no regrets, only words of support to pass along to others.
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“it’s tough to understand and to go through, but stand by them 100 per cent. it will help them and help the recipients, and, believe me, it’s going to help you.”
karen hawthorne is a toronto-based writer.
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