一名痴呆症患者安乐死后的器官捐赠：一份具有里程碑意义的病例报告。
Organ donation after euthanasia in a patient living with dementia: a landmark case report.
作者信息
van Dijk Nathalie, Vliegen Fabiënne, Ham Angelique, de Jongh Wim, Berkhout Freek Jan, Blankevoort Jeroen, Ten Hoopen Rankie, Bollen Jan, van Mook Walther
机构信息
Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands.
Faculty of Law, Maastricht University, Maastricht, Netherlands.
出版信息
Front Dement. 2023 Dec 5;2:1287236. doi: 10.3389/frdem.2023.1287236. eCollection 2023.
BACKGROUND
Organ donation after euthanasia (ODE) has been performed over 100 times in the Netherlands, primarily involving patients suffering from a neurodegenerative or psychiatric disease. In recent years, the number of euthanasia cases related to dementia has increased in the Netherlands, with some patients living with dementia expressing a wish for organ donation after euthanasia.
METHODS
We describe a unique case of a 67-year-old female diagnosed with primary progressive aphasia as part of frontotemporal dementia who requested and underwent organ donation after euthanasia.
RESULTS
The patient had expressed her explicit wishes for both euthanasia and organ donation, which were discussed with her family physician, the Euthanasia Expertise Center (EE), and an organ donation coordinator. The patient was informed that to proceed with ODE, she should still be capable of voicing a voluntary and well-considered request for organ donation. The legally required euthanasia assessment procedure was carefully completed before ODE. Multiple healthcare professionals assessed the patient's competence, voluntariness, and unbearable suffering. Thereafter the patient's ODE request was granted, and both lungs and kidneys were successfully donated and transplanted. analysis confirmed that all due diligence criteria for euthanasia were met, and the patient's relatives received an anonymous letter of gratitude from one of the organ recipients.
CONCLUSIONS
This unique case demonstrates that ODE is feasible from medical, ethical, and legal perspectives in patients living with dementia. This case highlights several aspects essential to enable an ODE request by a patient living with dementia to be granted, such as the role of the physician performing euthanasia, the relevance of the decision-making capacity of the patient, the presence of an advance directive, and the involvement of and support by relatives and caregivers. However, several unresolved ethical issues surrounding ODE in patients with dementia, especially in patients with advanced stages of dementia, warrant further exploration, including the timing of discussing organ donation after the initial euthanasia request.
背景
在荷兰，安乐死后器官捐赠（ODE）已实施100多次，主要涉及患有神经退行性疾病或精神疾病的患者。近年来，荷兰与痴呆症相关的安乐死病例数量有所增加，一些痴呆症患者表达了安乐死后器官捐赠的愿望。
方法
我们描述了一个独特的案例，一名67岁女性被诊断患有原发性进行性失语症，这是额颞叶痴呆的一部分，她请求并接受了安乐死后器官捐赠。
结果
患者明确表达了对安乐死和器官捐赠的愿望，与她的家庭医生、安乐死专家中心（EE）和一名器官捐赠协调员进行了讨论。患者被告知，要进行ODE，她仍应能够自愿且经过深思熟虑地提出器官捐赠请求。在进行ODE之前，仔细完成了法律要求的安乐死评估程序。多名医疗专业人员评估了患者的行为能力、自愿性和无法忍受的痛苦。此后，患者的ODE请求获得批准，双肺和双肾成功捐赠并移植。分析证实，安乐死的所有尽职调查标准均已满足，患者的亲属收到了一名器官接受者的匿名感谢信。
结论
这一独特案例表明，从医学、伦理和法律角度来看，ODE在痴呆症患者中是可行的。该案例突出了几个对于痴呆症患者的ODE请求获得批准至关重要的方面，例如实施安乐死的医生的角色、患者决策能力的相关性、预先指示的存在以及亲属和护理人员的参与和支持。然而，围绕痴呆症患者ODE的几个未解决的伦理问题，特别是在晚期痴呆症患者中，值得进一步探讨，包括在最初提出安乐死请求后讨论器官捐赠的时机。
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