Introduction: The End of Life Choice Act (2019) provides a new end-of-life option for New Zealanders living with a terminal illness. Assisted dying opens up a space for Māori individuals and their families to consider organ donation. To extend and improve the quality of life for Indigenous New Zealanders organs are urgently needed from Māori donors to match the high demand for kidneys, liver, heart, lung, pancreas, and eye tissue. Our research team undertook a study on Māori family experiences of using assisted dying services. Participants were asked to share their views on organ donation following an assisted death.
Method: The research aim was to explore Māori family experiences of accessing and using assisted dying services including participants’ perspectives of organ donation. Participants were recruited from across New Zealand using Māori networks and hospices. Forty four family interviews were undertaken; people who wished to hasten death using assisted dying services, and bereaved families who supported someone to have an assisted death took part in a face-to-face interview. Twenty support workers (assisted dying clinicians, kai rongoā (natural healers), spiritual leaders, and health professionals) were interviewed for their perspectives. Kaupapa Māori qualitative research methods informed the study. An inductive thematic analysis was used to analyse the data.
Results: A lack of support for organ donation uptake was attributed to Māori participants’ lack of understanding about organ donation and the eligibility criteria as well as a lack of family support to uphold the wishes of registered organ donors following an assisted death. Traditional cultural beliefs functioned as a barrier. The deceased’s body is considered tapu (spiritually restricted); organ removal would disturb the wairua (spirit) in the afterlife. Participants were open to spiritual interventions to “lift tapu” making organ donation culturally safe. Negative historic experiences of early organ donation left families feeling “traumatised” with prolonged grief.
Conclusion: Increased education and resources on organ donation and eligibility criteria are needed to support Indigenous people to consider organ donation in tandem with assisted dying. This would include cultural processes to ensure organ donation is spiritually safe for the deceased and their grieving families. Health professionals and organ donation services could be improved by developing a cultural safety strategy to meet the needs of Indigenous peoples.