117.1: Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: 2023 updated guidance for policy
Bibliographic record
Abstract
Canadian Blood Services. Driven by patient requests (like those of Dr. Shelly Sarwal in the film, Her Last Project), Canadian Blood Services assembled a group of experts to examine the 2021, updated Canadian legislation for medical assistance in dying (MAiD) and its impact on organ and tissue donation. The outcome of this work provides an update to the 2019 guidance for policy for clinicians, organ donation organizations, end-of-life care experts, MAiD providers, and policymakers for donation following MAiD in Canada. Methods: CBS assembled a diverse panel of experts from critical care, organ and tissue donation, healthcare administration, MAiD, bioethics, law, and research. Two patients who had been approved for MAiD and two family members of patients who donated organs following MAiD also participated. In a series of three online meetings, participants addressed a variety of donation and MAiD related topics in small and large groups. Recommendations were generated using a modified version of nominal group technique, a structured variation of small-group discussion to reach consensus. Results: Forum participants informed the development of 8 new and 2 updated recommendations for donation following MAiD in Canada. Three themes emerged from the forums as priority considerations in the updated guidelines: 1. Strong support for upholding first person consent for MAiD and organ donation for Track 1 patients who have completed a waiver of final consent. 2. Track 2 patients may be approached for formal consent for organ donation during the mandatory 90-day assessment period if already deemed eligible for MAiD. 3. Organ donation organizations should develop policy regarding directed donation following MAiD. Conclusion: This updated guidance supports the development of policies and practices for donation following MAiD in Canada following the introduction of MAiD legislation in 2016 and an update to legislation in 2021. The recommendations serve as a framework for clinicians to navigate the medical, legal, and ethical challenges that arise when supporting patients requesting donation following MAiD.
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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 | 0.031 | 0.047 |
| Meta-epidemiology (narrow) | 0.002 | 0.003 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.008 | 0.006 |
| Scholarly communication | 0.009 | 0.003 |
| Open science | 0.009 | 0.005 |
| Research integrity | 0.027 | 0.012 |
| Insufficient payload (model declined to judge) | 0.019 | 0.011 |
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".