Organ donation after euthanasia starting at home: a mixed-methods study of preliminary nationwide Dutch experiences

Organ Donation after Euthanasia starting at Home (ODEH) initiates the euthanasia trajectory at home with deep sedation, followed by transfer to the hospital for completion of euthanasia and organ procurement. We evaluated all eight Dutch ODEH procedures up to February 2024 using a mixed-methods design: descriptive analysis of anonymized case data (Dutch Transplant Foundation and hospital records) and semi-structured interviews (November 2023-February 2024) with involved professionals. All procedures were performed in three hospitals. Patients had neurodegenerative disease (n = 6) or psychiatric disorders (n = 2) and were aged from the mid-30s to the early-70s (mean 50.4 years). Professionals highlighted strict separation of euthanasia and donation decisions, time-critical coordination between home and hospital, variation in sedation/anesthesia and transport modality (regular ambulance vs. mobile ICU), regional constraints in staffing and infrastructure, emotional impact on professionals, and registry/coding considerations (including HSMR). ODEH is feasible within the existing Dutch legal framework and is valued for enabling a home farewell without compromising donation. A flexible practice manual defining core safeguards and decision points may support consistent implementation.