[Organ donation following physician-hastened death at home]

Patients considering physician-hastened death (PHD) increasingly express a wish to donate organs after death. This fairly unique proposition stems from patients' desire to do something good with (parts of) the same diseased body that has prompted them to request physician-hastened death. In this article we describe a patient with amyotrophic lateral sclerosis (ALS) who expressed this wish. In March 2017 a national guideline on 'Organ donation following physician-hastened death' (ODP) was presented to the Minister of Health, Welfare and Sport of the Netherlands. From the development of this guideline it emerged that, for PHD patients, being forced to experience their final conscious moments in hospital - in order to facilitate organ donation - was a key reason for not choosing ODP. Together with an anaesthesiologist-intensivist, the GP of the ALS patient developed a domestic ODP, thereby overcoming the hurdle of experiencing death in hospital and maintaining the possible option of organ donation. The applied solution is an 'anaesthesia bridge' which separates the experience of farewells, and losing consciousness under pre-medication at home, from biological death and organ donation in hospital.