*Purpose: In 2016, Canadian federal legislation was passed creating a regulatory framework for medical assistance in dying (MAiD) for individuals who are suffering from a medically futile condition with foreseeable death. In time, patient initiated requests to become assessed as potential deceased organ donors in advance of dying emerged. In response, our renal program has adopted a policy of accepting MAiD donors when the organs are deemed suitable. As there is a paucity of literature on transplantation from MAiD donors, we report our unique experience and first reported outcomes in North America.

*Methods: We retrospectively analyzed all renal transplant recipients from MAiD donors at London Health Sciences Centre, since we began accepting these offers in 2018. Patients eligible for MAiD underwent circulatory death after administration of life ending therapy and organ procurement was performed as per standard protocol. Ethics approval was obtained to review these outcomes.

*Results: There were a total of 4 patients who became kidney donors and one kidney-pancreas donor. The indication for MAiD in the donors included 3 with debilitating neurological disease, 1 with heart failure and 1 who previously suffered a significant fall resulting in quadriplegia. Mean (SD) donor age was 53 (13) yr, mean (SD) donor BMI was 23.4 (5) kg/m², mean (SD) warm ischemia time (WIT; inclusive of time to asystole, 5 minutes hands-off period, transfer to OR, and time to cannulation) was 20 (5) minutes, and mean cold ischemia time (CIT) was 9 (1.5) hours. One perioperative recipient death occurred due to medical complication unrelated to renal graft function. Other complications were limited to Clavien Grade 1 or 2. No recipients experienced delayed graft function while only two patients experienced slow renal graft function; both were from extended criteria donors. Mean (SD) 30 day creatinine was 100 (42) μmol/L. The transplanted pancreas exhibited immediate graft function and had no pancreatic graft related complications.

*Conclusions: MAiD associated organ donation represents a potential means to increase the donor pool for those awaiting deceased donor organs. The controlled nature of MAiD associated circulatory death has the potential to minimize the deleterious effects of prolonged WIT that may be associated with standard donation after circulatory death. Our institution’s early experience is encouraging, with low WIT, and favorable early graft function results. Ongoing assessment of MAiD outcomes is required to better appreciate the relative quality of these donation opportunities compared to conventional deceased donors.

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