This article discusses reflections from staff and family (who consented and contributed to this article); and provides an insight into clinical collaboration to assist a person accessing voluntary assisted dying (VAD) to become an organ donor.

The NSW Voluntary Assisted Dying (VAD) Act (2022) allows an eligible adult to access medical help to end their life. The person must fulfil eligibility criteria and be in the late stages of an advanced disease, illness, or medical condition.¹

Depending on the medical diagnosis some people who plan to access VAD may also be eligible to be an organ donor. If the person raises this issue, appropriate health professionals can discuss the options with them.

Six weeks after VAD became available in NSW, our service received a request to simultaneously facilitate VAD and organ donation. Our patient was a 45-year-old man who was deteriorating from a non-metastasised cancer and who had chosen to access VAD. He enquired about donating his organs as he wanted to be able to help others and leave a legacy for life. His wife was very supportive of this wish. The VAD Coordinator liaised with other health professionals to achieve this request.

A description of collaboration and the process can be described in Figure 1.

Figure 1: Description of the process and collaboration

The oncologist requested feasibility testing and once organ donation eligibility was confirmed, the patient chose to have the VAD substance administered two working days later.

All clinical teams involved (eg. VAD, oncology, organ transplant, operating theatres, ward staff, nursing executive as well as NSW Organ and Tissue Donation Service) attended many meetings over the course of the next two days to work together to provide a seamless journey for him and his family. Throughout the process the VAD coordinator monitored his health and updated the family.

On his chosen day, whilst laying in an anaesthetic bay, with his wife in attendance, he said a final goodbye, listening to a favourite song as the VAD substance was administered. In the room next door, a team of theatre staff waited respectfully in silence. Once deceased he was transferred immediately into the operating theatre for only the second organ retrieval in Australia post VAD, successfully donating several organs including the first heart.

Reflections from those involved

This was a new experience for everyone involved and each person had their own personal reflections:

Family member:

“Some people need help at the end, they become exhausted and may need someone to advocate for them, to support their wishes and to make sure their voice is heard. We were fortunate to have the support of the VAD team to achieve my husband’s wishes to donate his organs which was so important to him. By talking to other health professionals, they got the ball rolling and then it just all happened quickly which was what my husband wanted.”

VAD coordinator:

“This was all new to us and we had a short timeframe to arrange things. But everyone stepped up to help us to achieve the best outcome for them. We learnt a lot and developed key contacts for the future. As VAD can be polarising it was wonderful from a personal perspective that everyone really wanted to do their best for this family.”

Nurse Manager Perioperative Services:

“It was a great collaboration of the multidisciplinary team to ensure the patient’s needs and wishes were met. This was a new scenario for theatre staff, so although it was a bit challenging at first, working together we planned care with a common goal to provide the best service we could for this family.”

Donation specialist nurse:

“Usually discussions regarding organ donation are with the family as the person is usually unconscious or intubated in ICU. I found it a little confronting at first talking to the person directly, however it was comforting to me knowing that I was giving him all the information so he knew exactly what would be happening. I was completely blown away by the family and him as they pushed hard to have this case looked in to and their overwhelming desire to help others.”

VAD doctor:

“It went so well for our patient, the whole process was seamless, this is how health should be!”

Next steps to develop clinical practice

Currently there is guidance and policies regarding organ donation on the NSW MoH website and NSW Organ and Donation Service. Updates are being developed in relation to VAD, including first person consent to advise clinicians and families. Locally, we have established professional partnerships and working groups to develop a local policy and guideline for future VAD organ donation which will be distributed across the area health.

Finally, everyone involved will never forget their role in this very special person’s desire to help others.

Acknowledgement: We would like to acknowledge clinical and executive staff of Concord Hospital, Sydney NSW for support and especially Kelly Lewis and Paul Hogan donation specialist nurses for expert knowledge and Janice Chew, Nurse Manager Perioperative Services.

Reference

1 NSW Health Voluntary assisted dying main page – https://www.health.nsw.gov.au/voluntary-assisted-dying/Pages/default.asp

Authors:
Denise Cummins, PhD, MPH, Grad Cert- Palliative Care, Oncology Nursing, Community Nursing, HIV Nursing, RN is Voluntary assisted dying coordinator Concord Hospital Concord NSW and nurse manager, Voluntary Assisted Dying Service, Sydney Local Health District

Kristine Louis, Grad Dip – Health Science (Midwifery), Grad Cert – Stomal Therapy, Grad Dip – Project Management, RN  is Voluntary assisted dying coordinator Concord Hospital Concord NSW and nurse manager, Voluntary Assisted Dying Service, Sydney Local Health District