Organ donation after assisted dying needs safeguards, not roadblocks

Dylan Mordaunt

May 4, 2026

Excessive caution can become its own ethical failure when it comes to organ donation, writes Dylan Mordaunt.

Dylan Mordaunt is a medical doctor and health economist.

OPINION: When a terminally ill New Zealander who has chosen assisted dying asks whether they might also donate organs, the answer should be straightforward.

This is not a hypothetical. In 2024, Organ Donation New Zealand (ODNZ) received about 20 referrals for donation after assisted dying and facilitated the country’s first organ donation after an assisted death. In the same year, 70 deceased donors enabled 213 transplants, while about 400 to 500 New Zealanders were waiting. In a system as small as New Zealand, even a few additional medically suitable donors matter. It matters for patients, families, and the people waiting for transplants today.

If referral happens too late, or if the pathway is so fragmented that nobody takes responsibility, a willing and medically suitable donor may miss the window. That is not moral neutrality. It is a choice in favour of non-donation.

New Zealand does not need to improvise here. It already has the bones of a workable pathway. ODNZ guidance says donation is not raised with the patient until assisted dying is approved. It also says the patient can withdraw from donation at any time without affecting their right to assisted dying. Hospital staff are not compelled to take part, written consent is required, and a pre-donation planning meeting clarifies roles. Those are exactly the sort of protections critics say they want.

Public trust matters too. Minutes from the National Ethics Advisory Committee show these questions are being approached with appropriate seriousness, including tikanga, safeguards against pressure, real chances to change your mind even after hospital admission, and engagement with the disability community. The End of Life Choice Act also protects clinicians who refuse on conscientious grounds. No clinician should be forced into a role they cannot accept. But that is an argument for clear handover, not for blocking a lawful choice.

Nor is this some reckless experiment. Canadian guidance similarly requires the assisted-dying decision to come first, insists on the patient’s own withdrawable consent, and maintains the dead donor rule: organ retrieval must never cause death.

A 2024 Quebec study found that 64 donors after medical assistance in dying provided 182 organs, while a 2024 Dutch nationwide study found comparable kidney transplant outcomes from assisted-dying donors. New Zealand does not need to copy another country wholesale to recognise the broader point: the practice can be ethically governed.

The fairness issue matters too. A lawful option should not depend on geography, institutional comfort, or whether the right clinician happens to know the right number to call. If donation after assisted dying is ethically acceptable under strict safeguards, then it should not be available only to the lucky, the well-connected, or the unusually persistent. Equity matters just as much here as it does anywhere else in healthcare.

New Zealand should not be trying to increase donation after assisted dying by persuasion or drift. But if a person has already chosen assisted dying, organ donation should not be left to luck. Others can benefit from this gift, and the system should respect the wish to offer it.

That means making the option available consistently to all eligible people in the assisted-dying pathway, with clear safeguards and repeated chances to change their mind.

Caution has a job: to screen out pressure, not to stand in the way of generosity.

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More generally, we should never forget that — given the shortage of transplant kidneys — every time a kidney donation is not allowed, someone dies.

Frank