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The combination of legalized assisted suicide and an acute shortage of transplantable organs could bring enormous pressure to bear on the sick and disabled to end their lives, some ethicists warn.
That’s the scenario that’s taking shape in New York, which is set to become the 13th state (along with the District of Columbia) to sanction medically assisted suicide when Gov. Kathy Hochul signs the legislation, as she has promised to do, later this month. The law will take effect six months after it is signed.
Adding to the ethical and moral concerns surrounding the law is the fact that New York has one of the longest waitlists for organ transplants in the U.S. — nearly 8,000 people, or 10% of the national total.
Some ethicists see the linking of organ donation with assisted suicide and euthanasia — which is becoming more common in Canada and some countries in Europe — as a troubling sign of a utilitarian shift in medicine.
“If society promotes the idea that you can regain value by volunteering to die,” Dr. E. Wesley Ely, a former medical director of lung transplantation, told the Register, “we’ll create a suicide pipeline.”
‘Death by Donation’
Euthanasia typically refers to a clinician’s direct injection of lethal drugs, while assisted suicide involves the patient self-administering physician-supplied drugs.
To date, no U.S. states have legalized euthanasia, nor do they have protocols in place for combined assisted suicide and organ donation.
In Canada, both assisted suicide and euthanasia are now legal and fall under the umbrella label of so-called “Medical Assistance in Dying,” or MAID. As assisted suicide has become more widespread — in 2023, it accounted for nearly 5% of all deaths in Canada — there has been a commensurate escalation in MAID-related organ donations. The National Post reported “at least 235 people who have died by MAID have consented to donating their organs” in Canada since 2021, compared to 136 in the five-year period after it was legalized.
Belgium performed the world’s first officially recorded case of organ donation after medically assisted suicide in 2005; the Netherlands followed in 2012, with Canada following in 2016. A 2023 study found that by the end of 2021 some 286 such procedures had furnished organs to 837 recipients, almost half of them in Canada. There, what began as a relatively narrow legalization of MAID in cases of terminal illness has since expanded to include its provision for chronic illness, physical pain and psychological suffering. The Canadian government plans to extend it even further next year to include mental illnesses.
Not everyone believes that legislation like New York’s will inevitably lead to abuses in organ donation, however.
Dr. Arthur Caplan, the founding head of the Division of Medical Ethics at NYU Grossman School of Medicine, is not convinced that assisted suicide and organ donation will converge in the U.S., yet he notes that “slippages” and abuses threaten public trust in the transplant system and acknowledges that reform is needed.
“Public trust still depends on the bright line between ‘you’re dead’ and ‘we’re not going to take any organs before that death is pronounced,’” Caplan said.
Yet new proposals threaten to blur that line.
Scholars have begun proposing in medical journals and advocacy groups the idea of abandoning the century-old “dead-donor rule” so that vital organs can be removed before death is declared, in a practice called imminent-death donation. It eliminates the five-to- 10-minute period of blood and oxygen deprivation — called ischemia — that can damage tissue and render organs unfit for transplantation.
In July 2025, three doctors who work at a medical center that specializes in heart transplants advocated in The New York Times for protocols that would allow for the removal of organs from a living person, causing death.
In a 2019 USA Today column, Ely, a critical care pulmonologist and a professor of medicine at Vanderbilt University Medical Center and president of the Nashville Guild of the Catholic Medical Association, called this proposal “death by donation” and bluntly labeled it “homicide.” NYU Grossman’s Caplan labeled it the “Mayan protocol,” after the Mayans who used to take the hearts out of their live victims. As a doctor, he said, “You can’t go in and take out a vital organ for transplant” from a living patient. “It’s completely unethical.”
Meanwhile, some medical scholars from across the globe are also calling for organ sales to be made legal and to incorporate these sales into a free-market system, as can be seen in the American Journal of Law and Medicine.
The consequences of this thinking are already visible. The World Health Organization estimates that 1 in 10 transplants now occur on the black market — a sobering reminder of what can follow when utilitarian logic takes precedent over human dignity.
In one case illustrating this utilitarian mindset this past year, a Canadian family was forced to flee to the U.S. after doctors in Canada were heard “constantly talking about” harvesting a child’s organs, after a drowning incident left a son with brain damage and an abnormal breathing pattern. Since arriving in New Orleans, the child has seen significant improvement.
Under the U.S. National Organ Transplant Act of 1984, the purchase or sale of a human organ is a Class E felony, though Congress is considering whether to clarify that certain pilot programs do not violate the 1984 act. Comparable prohibitions against the sale of organs exist across the world, with Iran being the lone exception, allowing for the sale of a single kidney from a living donor.
Dysfunctional U.S. System
Medically assisted suicide is gaining a foothold in the U.S. at a time when the current organ-donation system in the United States is on the defensive in the wake of published reports of abuses.
In February 2025, a New York Times investigation revealed widespread breakdowns, with nearly 20% of organs from deceased donors allocated in a manner that bypassed sicker or higher-ranked patients on organ-recipient lists in favor of those more convenient or institutionally beneficial — and sometimes skipping the list entirely, utilizing unethical practices like “open offers” and “hot lists.” This has resulted in the deaths of more than 1,200 patients in the past five years after they were skipped over, according to the Times.
Another June 2025 New York Times story discussed a recently concluded four-year federal investigation by the Health Resources and Services Administration (HRSA). It found that an organ-procurement organization (OPO) now named Network for Hope — the recently merged successor to Kentucky Organ Donor Affiliates (KODA) and Ohio’s LifeCenter — repeatedly pressured families and clinicians to proceed with donation even when patients showed signs of regaining consciousness.
Natasha Miller, a witness to one of these cases, described in an interview with NPR a chaotic scene where, as she was preparing to do her job, an organ donor declared to be dead seemed to be very much alive.
“He was moving around — kind of thrashing. … And then when we went over there, you could see he had tears coming down. He was crying visibly,” Miller, whose job was to preserve donated organs for transplantation, told NPR. “The procuring surgeon, he was like, ‘I’m out of it. I don’t want to have anything to do with it.’”
Miller said she overheard the case coordinator call her supervisor, saying that she needed to “find another doctor to do it” — at which point the supervisor began crying because she was being yelled at and pressured by the case coordinator.
Federal investigators reviewed about 350 halted retrievals and concluded that in 73 cases, the OPO’s staff “should have considered stopping sooner.” They documented practices by the OPO such as taking over cases from doctors, pressuring institutions — including a Catholic one — to authorize organ retrieval, and urging bedside staff to withdraw life support. Sedatives had sometimes masked a patient’s true neurological status, leaving relatives and staff unaware the patient was still functioning and responsive.
“Although the surgeries didn’t happen, the investigation said multiple patients showed signs of pain or distress while being readied for the procedure,” the Times reported. “Most of the patients eventually died, hours or days later. But some recovered enough to leave the hospital.”
Similar alleged abuses were documented elsewhere in another New York Times article published in July 2025. That same day, the Department of Health and Human Services (HHS) released a statement titled “HHS Finds Systemic Disregard for Sanctity of Life in Organ Transplant System.”
“The entire system must be fixed to ensure that every potential donor’s life is treated with the sanctity it deserves,” HHS Secretary Robert F. Kennedy Jr. said in the statement.
John Di Camillo, president of The National Catholic Bioethics Center, a nonprofit organization based in Broomall, Pennsylvania, that provides guidance and resources to uphold the dignity of the human person in health care and biomedical research, told the Register that removing vital organs from a living person is always unethical, “even if the patient requests it.”
“The spread of assisted suicide and recent revelations of abuses in organ procurement, together with growing questions about the adequacy of the criteria used for determining death, demand that we strengthen the dead donor rule — not discard it,” he said in a statement.
Donor Status Revisited
The reported abuses represent only a fraction of the nearly 50,000 organ transplants performed in the U.S. each year, but the negative publicity has created a public-relations crisis for organ-donation organizations.
In just the first few weeks after the Times’ July report, thousands of people removed themselves from donor registries in California, Texas, Colorado, Tennessee and Colorado, Newsweek reported.
“The stories as reported do not reflect the work we do each day to honor donors and save lives, and they omit key details that are essential to understanding how the donation process truly works,” Donate Life California CEO Jim Martin said in a July 25, 2025, statement. The statement did not specify which details were omitted.
In a statement to Newsweek, Martin emphasized that a registered organ donor can help save the lives of up to eight people.
“We also want people to know that registering as a donor does not take away their rights — medical teams work to save lives first, and donation is only considered after all life-saving measures have been exhausted. We welcome questions, invite transparency, and encourage open, informed conversations before making a decision that could impact so many lives.”
Di Camillo of The National Catholic Bioethics Center agrees that transparency and clear, ethical guidelines are critical going forward.
“The calling of health care professionals is to heal, not to sacrifice some for the benefit of others,” he said in a statement. “The donation of tissues and organs can be ethically sound when it constitutes an authentic gift of self, with informed consent and without coercion, and without causing serious injury or death to the donor.”
