Victoria was the first Australian state to enact a Voluntary Assisted Dying (VAD) law which took effect on June 19, 2019.  Since then, all Australian states (excluding our two territories) have followed suit.

In the three years since enactment, 1035 Victorians have been granted a VAD permit, and 58% of these applicants have died after administration of VAD medications.

In 2018, DonateLife Victoria (DLV) (Victoria’s organ and tissue donation coordination organisation) formed a working group to consider the principles of organ donation after VAD.  While recognising the concepts very much aligned with the core values of our donation service, strict criteria within the law pertaining to how VAD can and cannot be discussed made potential conversations regarding donation after VAD difficult.  There is a reliance on the patient themselves expressing their wish to be a donor, which contrasts DLV’s guiding principle that the potential for donation be part of ALL planned end of life care.  This, coupled with reluctance from health services to engage on the matter meant a suspension of further exploration in this space.

In 2023, two people in regional Victoria contacted DLV via their VAD physician to express their wish to explore donation after being granted VAD permits.  After much consideration, stakeholder involvement and planning, one of these patients went on to become the first person in Australia to donate after VAD, successfully donating their lungs, liver and kidneys for transplantation and other organs and tissues for research.

Based on Victorian experience, of those dying after administration of VAD medications, approximately 100 patients had an underlying cause of death that was not cancer related (with cancer usually being an exclusion for solid organ donation).  This represents a significant potential increase to Victoria organ donor numbers.

In Australia, the number of actual organ donors remains well below those needing a transplant. This is even more pronounced in the COVID-19 era. This begs the question, could awareness of donation potential among VAD patients help bridge the gap between Victoria’s donation and transplantation needs?  Does this also ensure equity for all people at end of life, not just those who die in hospitals on ventilators being offered the opportunity to consider organ and tissue donation as an end-of-life choice?

While further patient facing discussion may require legislative reform, the patient and community benefits appear to make it worthy of consideration.  In the meantime, work needs to continue to ensure that those requesting VAD are sufficiently informed of their potential to donate within the unique legal framework currently in place.