The first 100 cases of organ donation after euthanasia in the Netherlands: lessons from preliminary experiences

Organ donation after euthanasia (ODE) is an evolving, patient-initiated procedure in the Netherlands. While it gives meaning to donors at the end-of-life, it introduces complex ethical and practical challenges for healthcare professionals. This study aims to describe the clinical characteristics and donation outcomes of the first 100 ODE procedures in the Netherlands, while outlining the practical and ethical dilemmas encountered. A retrospective analysis was performed on prospectively collected data from the first 100 ODE procedures conducted between September 2012 and February 2023. To gain deeper insight into practical experiences and ethical themes, these data were discussed with organ donation coordinators and intensivists involved in the procedures. The analysis focused on clinical characteristics and donation outcomes, as on ethical and practical challenges. Neurodegenerative disorders were the primary underlying cause of suffering (52%), followed by psychiatric conditions (31%). The first 100 procedures resulted in 408 transplanted organs. Most procedures were performed in intensive care units, with general practitioners performing euthanasia. Key ethical and practical challenges included the tension between clinical protocols (e.g., fasting) and patient comfort, the medicalisation of the dying process through invasive monitoring, and the logistical barriers of starting ODE from home (ODEH). Furthermore, ethical concerns persist regarding euthanasia in psychiatric and dementia cases, and the emotional burden on healthcare professionals. Patient-initiated ODE is feasible and allows patients to fulfil altruistic end-of-life wishes, but introduces complex ethical and practical challenges. Balancing organ donation with a dignified, non-medicalised death requires careful planning, especially as ODE expands to psychiatric and early dementia cases. Healthcare professionals face emotional and logistical burdens, yet are motivated by the positive impact on donors and recipients. Insights from these initial cases contributed to the development of the 2024 Dutch guideline, which supports both local and centralised procedures and which removed distinctions between somatic and psychiatric suffering. Further research should explore relatives’ perspectives to understand the broader impact of ODE(H).