Altruism in Extremis: MAID and organ donation with Dr. Bill Wong
News & Updates | April 29, 2022 | Dying With Dignity Canada
April 24 – 30 is Organ and Tissue Donation Awareness Week. In recognition, Dr. Bill Wong has shared his insight and experience with MAID and organ donation with us.
Dr. Bill Wong is an anesthesiologist practicing at Trillium Health Partners in Mississauga/Etobicoke where he is currently the Program Chief and Medical Director of Anesthesiology. He has been involved with medical assistance in dying since legislation was passed in 2016. His medical practice is predominantly hospital based, however he does provide medical assistance in dying to patients in the community. He specializes in cardiac anesthesiology, echocardiography, and critical care. He is also involved in many hospital committees including being the Medical Director for Assistance in Dying and the Chair of the Pharmaceuticals and Therapeutics Committee of the hospital. The current pandemic has also led him to participate and lead in various pandemic activities including airway teams and vaccination clinics. In 2018, Dr. Wong received recognition for his clinical and administrative work from the College of Physicians and Surgeons of Ontario (CPSO) when he received the CPSO Council Award. Recently he was also the recipient of a Trillium Gift of Life Hospital Donation Champion Award for his work engaging stakeholders, hospital partners and community partners in viewing organ and tissue donation after MAID as a standard practice and positive opportunity at the end-of-life.
Tell us when and how you became involved with medical assistance in dying?
My involvement with medical assistance in dying (MAID) evolved from my role as the Program Chief and Medical Director of Anesthesiology at Trillium Health Partners. There was an open call for interested stakeholders in this new hospital program as legislation was being finalized. I have experience with end-of-life care with my work in critical care and I also felt anesthesiologists should be represented in this new committee. As the bioethicist-led team developed policies and studied the legislation, I became aware that compassionate care was core to my beliefs. I also had the support of my youngest son who was studying bioethics in university. I soon became the Medical Director for our Assistance in Dying program and the only provider for the hospital in 2016 until a colleague joined me the next year. I continue helping people requesting MAID in the hospital and the community.
You were the recipient of the Trillium Gift of Life Hospital Donation Champion Award. Tell us about the work you are doing that gave rise to the award.
I have always supported organ and tissue donation and organ transplantation as a physician. At Trillium Health Partners, I participated in the organization of hospital organ donation early on when nontransplant hospitals started to do surgery for organ procurement. I also helped the hospital navigate the start of organ donation after the circulatory determination of death.
In my role as a MAID provider and medical director, and my support for organ donation in the hospital, I helped organize the procedures with our partners, the Trillium Gift of Life Network (TGLN). We enabled people who wish to donate organs or tissue after their death, whether it be from MAID or other modality of death. We organized the people and hospital resources to facilitate the necessary consent/declaration process, screening tests, perioperative services, and patient/family supports. This work has resonated through the hospital and community as many of our professionals and hospital staff have stepped up to the cause and unselfishly participate whenever the situation arises. The goal is to ensure organ and tissue donation after MAID is positively accepted at the end of life to fulfill a person’s altruistic wishes.
Organ donation after a MAID provision is possible in some circumstances. Can you tell us how someone interested could learn about the process and what to consider?
TGLN has resources online and by telephone where people can obtain information about organ and tissue donation after MAID. The discussion around consent for organ donation after MAID is generally done after the person has at least one confirmation of eligibility for MAID as we want to separate these two decisions with consent and eligibility for MAID as the primary goal for the patient.
Organ donation after MAID generally requires provision of MAID in a health care facility where organ procurement can commence quickly. It also involves the coordination of people, resources, and activities which may require careful planning and timing. Of note, organ donation is secondary to the patient’s request for MAID. We would always follow the patient’s request or needs around MAID provision first even if it means organ donation may not be possible. Tissue donation following MAID may occur if the death occurs in or outside the hospital. Organ donation after provision of MAID at home can be done in special circumstances and with specific organs.
The discussion around organ or tissue donation and its consent is best handled by our partners at TGLN. Your MAID provider will provide notification and participate in the facilitation of the activities around MAID but will not participate in the activities around organ donation to keep the roles separate. Other healthcare providers will assist with the process.
How have attitudes about MAID and organ donation changed since MAID legislation passed in 2016? Are there still obstacles to overcome?
I have a sense that MAID has gained in general acceptance over the years. Organ donation in general has also been gaining acceptance but there is still some work to do to have people register as a donor. Now that participation in organ donation after MAID is established, I know there is more awareness amongst healthcare providers and hospitals and the process is well established in some areas. There is still room for improvement as notification to TGLN is increasing and it has yet to be established outside of a hospital. Many people are still not aware that this is possible, as they have not thought that patients who request, are eligible, and proceed with MAID can still have organs or tissue that are eligible for organ/tissue donation and transplantation.
Anything else you would like to share with our readers about MAID and organ donation?
Organ donation after MAID is “Altruism in Extremis.” There is still debate around the ethics around evolving procedures around organ donation. However, our MAID legislation and TGLN has established careful policies around the practice to ensure the autonomy and choices of the person are protected and enabled. These situations are challenging emotionally and morally but we have guidance from TGLN how to proceed ethically and in good conscience.
With MAID we provide, with utmost compassion, a peaceful death for those who are suffering intolerably from a grievous illness. With organ donation, death becomes life. Our patients and their families find solace in knowing that something good can come after the end of a desperate situation. We all hope the recipients of these organ transplants have a renewed and long life. We can make a positive difference in many ways for many people.
What is the best way for Canadians to register for standard organ donation if they want to participate in the program?
The first thing I would generally suggest is for people to let their family and friends know they have an interest in organ or tissue donation after their death. Register as an organ and tissue donor at www.BeDonor.ca or when you renew your driver’s license. You may also visit www.giftoflife.on.ca to learn more about organ and tissue donation in Ontario.