World-first organ donation as mum self-administers VAD medication
SOURCE:ABC Australia|BY:Caitlyn Gribbin and Rachel Carbonell
An Australian woman is believed to have become the first person in the world to donate organs after self-administering oral voluntary assisted dying medication.
On the day Karen Duncan died, she arranged to take a limousine to hospital with her two adult daughters, her friends and her poodles to say goodbye.
Ms Duncan, 55, who had an aggressive form of motor neurone disease (MND), was determined to donate her organs after ending her life via voluntary assisted dying (VAD).
Speaking to the ABC before her death, Ms Duncan explained that she wanted to help others if she could.
"If I'm in a position to help people, it's just a given," Ms Duncan said.
"I've always felt very, very strongly about it because if I can't utilise what I've got, I give it away."
Karen Duncan was adamant she wanted to donate her organs. (Supplied: Brodie Cox)
Ms Duncan was very matter-of-fact about her plan but became emotional when she explained why organ donation was important to her.
"It's never really left my mind … I would hope that somebody [in a similar situation] would help my family," she said.
Donating organs after assisted dying is a relatively new practice in Australia and first occurred in 2023.
VAD is now legal everywhere in Australia except the Northern Territory, which announced yesterday it would introduce VAD legalisation by mid-2026.
According to state and territory health department data provided to the ABC, Victoria and Queensland are the only states to report a small number of organ donations after VAD.
Rohit D'Costa, an intensive care doctor and medical director of Donate Life Victoria, said Ms Duncan's "very meaningful" gift was without precedent.
"Karen is, as far as we know, the first person to have donated organs and tissues after self-administration of a VAD substance," Dr D'Costa said.
Rohit D’Costa says the donation is without precedent. (ABC News: Patrick Stone)
"She took the substance herself and died soon afterwards and was able to help others through organ and tissue donation.
"[Karen] showed that is possible … that fills me with the greatest hope in the power of humanity and community."
Ms Duncan was diagnosed with motor neurone disease (MND) in August 2024 and said she "was struggling to walk" within months.
It was a shock for the mother of two, who had always led a "very, very active life".
Soon after her diagnosis, Ms Duncan started having conversations with her family and doctors about VAD.
Karen Duncan's daughters say they are proud of their mother's decision. (ABC News: Rachel Carbonell)
"I would like to take my leave before I get worse than what I am … [this is] not really what I call living," Ms Duncan said.
Ms Duncan's daughter Brieanna Cox said once her mother had decided to access VAD, she became determined to donate her organs too.
"She was really adamant on donating. It was really one of the most important things," Brieanna said.
But combining the two wishes was not straightforward.
Until now, all globally reported instances of organ donation after VAD have happened after the medication was given intravenously by a physician.
Dr D'Costa said those deaths were predictably quick and allowed the best chance of successful organ donation.
"After the circulation stops in the body … the organs don't receive adequate or any blood supply and they start to lose function during that process," Dr D'Costa said.
"We want to make sure that that period is as short as possible."
But in Ms Duncan's home state of Victoria, VAD legislation requires individuals to swallow the life-ending substance themselves, unless they are physically incapable. In that case, intravenous administration occurs.
Ms Duncan said she was initially told that self-administration of the medication would rule organ donation out, but she persevered.
"There was an incident where I was told that I wouldn't be able to donate my organs … and I wasn't happy with that answer.
"So I did some more investigating … and found out that I could."
Karen Duncan (left) had always been active in her life and her diagnosis came as a shock. (Supplied: Brodie Cox)
Dr D'Costa said it was previously thought donation was only possible if the medication had been administered intravenously.
He said with the oral substance, the dying process is slower, and it was thought organ function would deteriorate too much before the transplant could happen.
"Karen challenged that assumption for us and said 'no, well why should that be the case? Can't we at least look into it?'.
"We did and we found that it was possible."
Ms Duncan had to die in a hospital to donate her organs, rather than taking the medication at home, something she said was a small sacrifice to make to help others.
She died 39 minutes after taking the substance, but the lapsed time did not prevent her from donating her lungs, kidneys and heart valve, along with eye tissue for MND research.
Brodie Cox says learning her mother had been a breakthrough case was a proud moment for the family. (ABC News: Patrick Stone)
Ms Duncan's daughter Brodie Cox said her family was surprised to learn her mother had been a breakthrough case.
"We didn't know that this was a world first when we were doing it … it was a super proud moment," Brodie said.
Brieanna said her mother would be "over the moon" to hear she had been able to donate her organs.
"It went exactly how she wanted … she's given other people more time in their life. It's indescribable."
'Ethically complex'
Dominique Martin, a professor in health, ethics and professionalism at Deakin University, said combining VAD and organ donation was an "ethically complex" topic.
"Both VAD and deceased donation are practices that depend a huge amount on public trust in healthcare systems and healthcare professions to ensure that people are not being exploited or coerced during the end-of-life period," Professor Martin said.
She said it was crucial that deciding to undergo VAD was separated from the decision to donate organs.
"When we're talking about an individual who's undergoing assisted dying and is exploring that option for deceased donation, we need to ensure that there is a separation between the people involved on the donation side and on the other side.
"But, at the same time, they need to be able to work together and they need to know how the two practices and the different protocols intersect in order to provide the best quality of care."
Dominique Martin says there are major ethical considerations around combining VAD and organ donations. (Supplied)
Dr D'Costa said guidelines were created in consultation with ethicists to ensure discussions about organ donation occurred only after a person received their VAD permit.
"This was really to separate those two decisions. We didn't want someone to have any sort of conflict internally or perceived conflict about wanting to access donation and therefore proceeding with VAD so that they could donate," Dr D'Costa said.
"That's a protection that's built into our current guidelines."
Brieanna said her mother felt "no pressure at all" during the process.
"To be honest, I found the most pressure from mum because that's what she wanted … but everyone else was really supportive."
Could there be more organ donors?
In 2024, Australia had 527 deceased organ donors, helping 1,328 transplant recipients.
Dr D'Costa said organ donation after VAD had the potential to increase the pool of donors in Australia.
Donating organs after assisted dying is a relatively new practice in Australia. (ABC News: Patrick Stone)
"The number of people accessing VAD has increased over the last few years and even with a small proportion of those dying after VAD being medically eligible for organ donation, we could see 25 or more additional donors per year via this pathway in Victoria," Dr D'Costa said.
International research estimates 10 to 15 per cent of people eligible for VAD are likely to be medically suitable to donate their organs.
"The people that are accessing VAD say it to us in the strongest possible way that, 'we want to be able to donate our organs', and we want to make sure that there's systems in place to do that," Dr D'Costa said.
'Very, very proud'
Before she died, Karen Duncan told the ABC it was her final wish to publicly share her experience.
She was determined to show it was ethically and medically possible to donate organs after self-administering VAD medication.
"I want to make it easier for other people when it comes along," Ms Duncan said.
"I'm hoping to give the maximum amount of organs that I can. That'll be nice."
Karen Duncan said it was her wish to help as many people as possible by donating her organs. (ABC News: Rachel Carbonell)
Ms Duncan's case was presented to the 2025 organ donation congress in Kyoto.
Brodie Cox said she believed her mother would be "very happy" to have been able to donate so many organs.
"She was very selfless. I think she would have been very, very proud."
Brieanna said her mum's determination was "amazing".
"She was my hero, my best friend when she was here and she's an even bigger hero now,"
she said.
"She's in another realm. I'm just so grateful to have a mum like that."