Introduction: The implementation of the Voluntary Assisted Dying Act 2017 in Victoria, Australia has introduced new clinical pathways for end-of-life care for certain patients with terminal illnesses. Among these patients, a small number have expressed the wish to donate organs following VAD. The first donation after VAD occurred in Australia in 2023, with the inaugural organ donor being in the state of Victoria. Most cases of donation after VAD involve intravenous administration of VAD substances in controlled settings. However a recent world -first case has demonstrated that organ donation can also occur following oral self-ingestion of VAD substances—under specific clinical conditions, including ICU admission.
This study was conducted at a single centre, University Hospital Geelong, which has played a key role in managing VAD cases in Victoria. Of the six organ donations following VAD state-wide, three have been managed at University Hospital Geelong, underscoring the hospitals significant contribution to this emerging field of care.
Method: A case series review was conducted involving three patients in Victoria who underwent VAD followed by organ donation:
Case 1: A 50-year-old patient with motor neurone disease (MND) who was admitted to ICU specifically for VAD and donation. The patient self-ingested the oral VAD substance in the ICU, and following confirmation of death, proceeded to organ donation. Successful transplantation to three recipients occurred.
Cases 2 & 3: 2 Patients with MND who received intravenous (IV) physician administered VAD substance in ICU, and following confirmation of death, proceeded to organ donation.
Clinical workflows, timing, interdisciplinary collaboration (VAD services, DonateLife Victoria, ICU, and transplant teams), and donor outcomes were evaluated.
Results: All three patients successfully proceeded to organ donation with successful transplantation outcomes. The case of oral ingestion of the VAD substance demonstrates that, with careful planning and ICU admission, self-ingestion of oral VAD substance is compatible with organ donation. ICU admission allowed for close monitoring, minimisation of warm ischaemic time, and adherence to legal and ethical standards. Across all cases, early multidisciplinary coordination was essential. Key challenges included emotional considerations, time sensitivity, and the need for flexible, case-specific planning.
Conclusion: Organ donation following VAD—whether by intravenous or oral substance—is clinically and ethically feasible under Victoria’s legal framework. ICU admission for the purpose of both VAD and donation can support viable pathways, particularly in oral VAD cases. As interest grows, structured guidelines and interdisciplinary education will be essential to support safe, dignified, and patient-centred care.