108.5: Building a national program for deceased donation after assisted dying in New Zealand from the ground up!
Notice bibliographique
Résumé
Introduction: Following the End-of-Life Choice Act 2019, Assisted Dying became legally available in New Zealand (NZ) in November 2021. Organ Donation New Zealand (ODNZ) received multiple queries from members of the public with terminal illnesses wishing to explore deceased donation, necessitating the development of a national program for Assisted Dying Donation (ADD). Methods: Guided by the principle of giving everyone the opportunity to consider deceased donation, ODNZ collaborated with the Ministry of Health and Health NZ to build an ethical and equitable program for ADD. Building on existing donation after cardiac death (DCD) practice, we identified additional stakeholders including Assisted Dying and Primary Care providers. The national strategy was built on five pillars to uphold existing good practice and preserve public trust. An Ethics Framework was developed iteratively to underpin subsequent clinical practice, creating eight key principles for the program. Stakeholder engagement involved educational webinars and in-person presentation to diverse professional groups with involvement in end-of-life care. International collaboration with donation specialists experienced in ADD in Canada, Belgium, Holland and Australia meant shared learnings facilitated clinical process development for NZ. As NZ has a unique cultural fabric and constitutional obligations to Indigenous rights, processes prioritized cultural safety and equity for Indigenous Māori and other groups. Results: In 2024, NZ became the sixth country worldwide to facilitate a case of ADD. As a result of the groundwork, and the experiences of the donor co-ordination and surgical teams arising from this case, guidelines were developed for an eye tissue donation pathway (for those with non-haematological malignancy) and an organ donation pathway (for non-malignant terminal illness). Educational pamphlets were created to allow those eligible for Assisted Dying to learn more about the ADD process. Lessons from this experience warranting consideration include the impact of the inter-personal relationships over months to years with donors, ramifications of first-person consent, decision making around pre-mortem interventions, the process of hospital admission and identifying optimal location of death. Additionally, interactions between Assisted Dying Providers, donation surgical teams and hospital staff require facilitation. Conclusions: We present our learnings to help other jurisdictions develop similar programs. ODNZ has found the collaborative development process necessary and rewarding, the most inspiring aspect being the privilege of upholding end-of-life wishes of motivated and altruistic individuals. Careful attention to ethical processes and prioritizing quality of end-of-life experience were key.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,021 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,005 | 0,003 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,002 | 0,009 |
| Intégrité de la recherche | 0,003 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,017 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».