Organ Donation After Euthanasia: A Dutch Practical Manual
Bibliographic record
Abstract
To the Editor: The recent publication from the Netherlands regarding the Dutch Practical Manual, detailing guidelines relating to patients’ requests for organ donation after euthanasia, highlights the legal and medical feasibility of such a procedure (1Bollen J de Jongh W Hagenaars J et al.Organ donation after euthanasia: A Dutch practical manual.Am J Transplant. 2016; 16: 1967-1972Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar). However, as of 2016, euthanasia is legal only in the Netherlands, Belgium, Ireland, and Colombia; remains controversial in Canada and the United States; and is the subject of much debate among health care professionals worldwide. Although the primary aim of the paper is to introduce a newly devised patient-centered manual, the authors miss the opportunity to recognize the psychosocial issues that run parallel and that are central to both palliative care and renal disease patients, including ongoing chronic pain, prevailing low mood, reduced quality of life (2Lavoie M Godin G Vézina-Im LA Blondeau D Martineau I Roy L Psychosocial determinants of physicians’ intention to practice euthanasia in palliative care.BMC Med Ethics. 2015; 16: 6Crossref PubMed Scopus (15) Google Scholar, 3Baines LS Little DJ Nee R Jindal RM Non-adherence codes in the new ICD-10: Need for prospective trials.Am J Nephrol. 2015; 42: 148-150Crossref PubMed Scopus (6) Google Scholar, 4Rodriques-Prat A Monteforte-Royo C Porta-Sales J Escribano X Balaguer A Patient perspectives of dignity, autonomy and control at the end of life: Systematic review and meta ethnography.PLoS ONE. 2016; 11: e0151435PubMed Google Scholar). Indeed, pain or anticipated pain, deteriorating quality of life, loss of control over decision making and cognitive impairment have been identified as key drivers in patients requesting euthanasia (5White DB Braddock CH Bereknyei S Curtis JR Toward a shared decision making at end of life in intensive care units: Opportunities for improvement.Arch Intern Med. 2007; 167: 461-467Crossref PubMed Scopus (255) Google Scholar) and primary motivators in living donors’ willingness to donate kidneys (6Jacobs CL Gross CR Messersmith EE et al.Emotional and financial experiences of kidney donors over the past 50 years: The RELIVE Study.Clin J Am Soc Nephrol. 2015; 10: 2221-2231Crossref PubMed Scopus (56) Google Scholar). The common psychosocial drivers of both cohorts of patients are the altruistic desire to alleviate suffering of fellow patients and the desire to introduce some continuance of life after their own death or kidney donation (1Bollen J de Jongh W Hagenaars J et al.Organ donation after euthanasia: A Dutch practical manual.Am J Transplant. 2016; 16: 1967-1972Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar,6Jacobs CL Gross CR Messersmith EE et al.Emotional and financial experiences of kidney donors over the past 50 years: The RELIVE Study.Clin J Am Soc Nephrol. 2015; 10: 2221-2231Crossref PubMed Scopus (56) Google Scholar). This scenario presents physicians with an opportunity to introduce and develop from a psychosocial perspective the potential for organ donation in patients requesting euthanasia during the first phase of the manual, namely, “Patient’s Request for Euthanasia.” We suggest the use of the “Patient-Clinician Communication Framework” (7Epstein RM Street RI Patient-centered communication in cancer care: Promoting healing and reducing suffering. NIH publication no. 07-6225.. US Department of Health & Human Services, National Institutes of Health, Bethesda, MD2007Google Scholar) as a means to facilitate and track psychosocial issues (eg managing uncertainty, responding to emotions) that could run parallel to the Dutch Practical Manual in the lead-up to euthanasia and among patients’ families posteuthanasia. We, however, do not think that our suggestion can be tested in an evidenced-based manner owing to the complex ethical issues surrounding euthanasia. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.102 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.005 |
| Scholarly communication | 0.004 | 0.006 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.011 | 0.013 |
| Insufficient payload (model declined to judge) | 0.008 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".