General practitioners' perspectives on organ donation after euthanasia: a qualitative exploratory questionnaire study.

Abstract

General practitioners (GPs) play a crucial role in organ donation after euthanasia (ODE). This study explores their knowledge and perspectives regarding medical, ethical, and logistical aspects of ODE to improve patient-centred care and existing guidelines. An exploratory study was conducted among Dutch GPs using an expert-validated online questionnaire covering awareness, experiences, barriers, and ethical considerations. Quantitative data were analysed descriptively; qualitative data underwent thematic analysis, following Standards for Reporting Qualitative Research. Fifty-two GPs participated. Of these, 78% (n = 38) were aware of ODE, 97% (n = 48) had a positive or neutral stance towards ODE, and 31% (n = 15) were familiar with national guidelines. Five themes emerged: (i) patient autonomy and decision-making; (ii) communication and information; (iii) logistical organization; (iv) impact and barriers; and (v) ethical debates. Patient autonomy was reported as central throughout the ODE process, particularly during decision-making and the final phase. Ninety per cent (n = 48) of the GPs preferred assessing whether discussing ODE within that patient's context was appropriate. GPs varied in opinion regarding the preferred timing for discussing ODE: 42% (n = 25) would introduce it during general end-of-life discussions, 27% (n = 16) would wait for the formal euthanasia request, and 17% (n = 10) would choose a patient-tailored moment. GPs expressed concerns regarding extra workload and emotional impact, with 52% (n = 24) hesitant to initiate ODE for these reasons. GPs play a central role in ODE, applying flexible, patient-tailored approaches supporting patient autonomy. Redistribution of tasks by early organ donation coordinator involvement, improved guidelines, and clear patient information could improve ODE care in Dutch general practice.