Liver transplantation after medical assistance in dying: Canadian multicenter experience shows favorable outcomes

Parente A, J Hepatol. 2026;84: 329–338
This Canadian multicenter study evaluated liver transplantation following organ donation in the context of medical assistance in dying (MAiD). Among 313 transplantations, 56 livers were transplanted after MAiD, and outcomes were compared with donation-after-circulatory-death grafts. Early graft function as well as short-term patient and graft survival were comparable. These findings highlight the potential of this donation pathway to increase organ availability in countries with MAiD programs.

Background and aims: Given country-specific variance in legislation, limited information is available regarding outcomes of liver transplantation (LT) using medical assistance in dying (MAiD) donation after circulatory death (DCD type-V) grafts. The study compared outcomes following LT using DCD type-V vs. conventional DCD type-III grafts.

Methods: The authors reviewed all LTs using DCD-V and DCD-III donors performed across Canadian provinces between 2016 (MAiD legalization) and 2023. Primary outcomes were patient and graft survival at 1, 3, and 5 years. Secondary outcomes included early allograft dysfunction, length of stay, postoperative complications, and biliary complications.

Results: Among 313 recipients, 56 (17.9%) received DCD-V and 257 (82.1%) DCD-III grafts. DCD-V donors were older (56 vs. 38 years, p < 0.0001) and had similar warm ischemic time (20 vs. 23 min, p = 0.190). Patient survival for DCD-V was 89.3%, 85.7%, and 85.7% at 1, 3, and 5 years, with graft survival of 82.1%, 78.6%, and 78.6%, comparable to DCD-III. DCD-V was not associated with graft loss (odds ratio = 1.64; 95% CI: 0.66–4.08), which was confirmed by multivariable Cox regression analysis (hazard ratio = 1.53; 95% CI: 0.74–3.15). Early allograft dysfunction occurred more frequently with DCD-III (57.5% vs. 42.9%, p = 0.047), whereas length of stay was longer with DCD-V (21.5 vs. 15 days, p = 0.011). Overall complication rates were similar; biliary complications were more common in DCD-V, but this was not statistically significant (32.1% vs. 23.1%, p = 0.153).

Conclusions: Liver grafts from MAiD donors provide outcomes comparable to DCD-III and increased Canadian DCD activity by 21.8%. These findings support MAiD as a valuable additional source of liver grafts, though larger studies are needed to validate long-term safety and efficacy.