‘How many people will I be able to help?’: When a euthanasia candidate decides to be an organ donor
This is the story of how Anthony Green chose when and how he wanted to die, as one of the 227 people in Spain who have opted to donate their body parts after ending their lives
“How many people will I be able to help after my death? Do you think my kidneys will count?” The questions come from Anthony Green, a 63‑year‑old Briton who has lived in Spain for the past 27 years, almost all of them —except the first two— with multiple sclerosis.
His was a lucid mind in a broken body, and his decision to invoke the country’s Law on the Regulation of Euthanasia (LORE) had recently been approved. Since he had also expressed the wish to donate his organs after death, he was meeting at his home with Javier Fierro, transplant coordinator at the Poniente University Hospital in El Ejido, Alemería. A few months later, Green was to be assisted in dying. His lungs, kidneys and liver would be successfully transplanted into four people: one liver transplant, two kidney transplants, and one double-lung transplant.
“During our coordinator meetings, previous cases of interviews with a living donor had been discussed, but for me, it was the first time,” says Fierro. “The onboarding was very different.” First of all, because it involved leaving his typical environment, the hospital, to go to Green’s home. But above all, because Fierro was speaking face-to-face with a donor, answering their questions and catching a glimpse of their daily life, in addition to their suffering. The two established an uncommon bond. “It was a charming interview,” reflects Fierro. “He was serene, probably because he had thought over his decision for a long time. He seemed to me to be very generous, determined and brave.”
Up until a few years ago, the most common reason for why an organ donor had passed away was brain death. The classic example was via a car accident. But with the improvement of roadways, Spain’s Road Safety Act, and the points-based driver’s license system, there have been fewer such scenarios. Concurrently, the option has been made available to terminally ill patients who wish to donate. In these cases, everything is planned in advance so that the end of life coincides with the retrieval of organs. Those who request euthanasia fall into the category of cardiac death, which has been part of the Spanish regulatory framework since 2012, as explained by Beatriz Domínguez-Gil, director general of Spain’s National Transplant Organization (ONT).
LORE was passed in 2021. Between that year and 2025, 227 people donated their organs through the euthanasia process, according to data from ONT. That number has been growing — there were seven cases in 2021, 42 in 2022, 63 in 2024 and 73 people in 2025 — alongside the number of euthanasia cases. But the proportion of donors has remained stable: of every 100 people who receive help to die with dignity, 14 donate their organs to help others. Behind these numbers lie pain, anguish, and a lot of generosity.
“They are going through a terrible time before they get to the point of expressing their decision to reject treatment and request euthanasia. And amid all that suffering, they decide to donate their organs. That, what they are telling us, is that we live in a chapeau society,” says Domínguez-Gil.
Despite the misinformation that occasionally circulates on social media — especially in the wake of high-profile and traumatic cases, such as the recent euthanasia of 25-year-old paraplegic Noelia Castillo — assisted dying and organ donation are separate processes.
Green decided that he wanted to end things when his quality of life dramatically worsened. Before 2021, he had been open to traveling to Switzerland to carry out the euthanasia process. But with the passage of LORE, he was able to remain in Spain. His family had presented delays for years, trying to put off the final moment, until at the beginning of 2025, Green put it to them plainly: “I don’t sleep or rest, I don’t want to wear a diaper, or spend my days between the bed and the sofa, or feel any more pain. It’s over,” his daughter Samantha remembers him telling her.
They presented the request to his primary care doctor, he was assigned a responsible physician and a care team consisting of a doctor, a nurse and a social worker, and the 10-day review period began. The team visited and spoke with Green to verify he met the requirements, was capable of making the decision, and fully informed, and that his wish to die was not due to a lack of financial resources or access to services like palliative care that could alleviate his symptoms.
“Our problem was not a lack of resources. He wanted to go,” says Samantha, who recognizes that the process was not easy, though she does not wish to go into detail on the matter. She has been sitting in a hospital room and talking about her father’s journey for some time now. At her side, Dr. Fierro stays quiet. He doesn’t have anything to say. At this point in the process, he didn’t know Green’s family. The care team had asked the patient about the possibility of becoming an organ donor, if he had considered the idea, and whether he would like to learn more. Green, surprised because he didn’t think his body parts could be of service to anyone, cried from happiness and said yes. “When they left, my father asked me, ‘Are you sure they want my organs?’” remembers his daughter, who answered jokingly, “Definitely not your muscles, Dad, but why not everything else?”
Donation and euthanasia: Different roads
Green confirmed his wish to die with a second formal request to the new physician. At this point, and not before, the transplant team enters the scene with a first, purely informational visit. Fierro explained to Green that, if he did decide to donate, he would have to undergo some tests to evaluate the health of his organs, and to guarantee that they would work in another person’s body. He also had to die at the hospital, because donation requires that death occur in a medical facility.
Beyond those formal requirements, Fierro notes, “We made it clear to him that he was our priority, and that we would accommodate his wish to donate in whatever way he chose to go.” Then Fierro left, giving Green time to reflect — but not before reminding him that he could change his mind at any time, no explanation necessary.
The roads to euthanasia and to organ donation are independent and have no mutual interaction. The Guarantee and Evaluation Commission, a multi-disciplinary body responsible for making the final decision on assisted death requests, doesn’t know and is not concerned with whether a request is being made by an organ donor. Only when the commission approved Anthony’s request did a second visit with the transplant team take place. During this meeting, the patient tells the team what their plan is.
In Green’s case, he wanted his last conscious memory to take place in his bed, with David Bowie’s music playing and his wife holding his hand. Not his daughter or anyone else, just “the love of his life”, Samantha remembers. Once sedated, an ambulance would take him to Poniente Hospital. Once a concrete, final plan is agreed upon, the consent form for the donation is signed, and a day and time is set for the culmination of the process.
When LORE came into effect during the month of June, the ONT established an internal protocol for euthanasia with organ donation. The first case took place in September. As requests began to trickle in, a nationwide task force was launched to create the current protocol establishing when and how the transplant team steps in. The role of the transplant coordinator is a primary one in this new protocol, which requires they speak face-to-face with the person who has chosen to die. In January 2026, there were 748 coordinators in Spain, 62% of whom were doctors (mostly intensivists) and 38% nurses. “They are trained and prepared to handle situations of grief, so that their intervention does not cause additional pain,” Domínguez-Gil notes with pride.
A few weeks before the date set for the assisted death, Green’s health worsened significantly from a urinary infection. Fierro and the physician responsible for the euthanasia process went to his home. The latter spoke with the patient, while the transplant coordinator stayed in the background. “We could transfer you to the hospital to try to improve your situation. In that case, we can’t guarantee you will be able to return home. Or it all ends here. It’s your decision,” Fierro said. Green asked Samantha, “If they sedate me now, could we go forward with the donation?” His daughter told him they could not. “Well, let’s go to the hospital,” her father concluded.
“Those were very hard days,” remembers an emotional Samantha. Green’s clinical situation improved, but his muscle spasms worsened, causing him intense pain that was tough to manage. He was unable to return home and stick to his original plan. His farewell party was canceled, and a new date was set for his euthanasia. His other daughter, who lives in England, joined the family to spend his final days with him in an ICU room, with a playlist she had prepared. “We tried to make it as close as possible to what he wanted, despite the circumstances,” says Fierro.
On the morning of his final sedation, he inquired about the state of his kidneys. The urinary infection had impacted their functioning, and Green was concerned that they wouldn’t be approved for donation.
He was told that they were perfect and that hospital staff had managed to repair them.
“I’m glad!” Green replied.
A system in need of streaming
When a person wishes to invoke the Organic Law on the Regulation of Euthanasia, they must consult a physician, though not necessarily a primary care physician (it could be a specialist, for example), in order to make the request. If the physician in question has registered as a conscientious objector — they must have done so previously, not on the spot when the case arises — the administration of the health care facility or district must ensure the patient’s rights are upheld. A care team and a responsible physician are assigned, and a 10-day deliberative process begins to assess the euthanasia request. At the end of that period, the request is either accepted or denied. If it is accepted, and the person wishes to proceed, they sign a second request and confirm their decision.
The case file is then forwarded to an external consulting physician specializing in the applicant’s condition, but who has had no prior contact with the patient. This serves as a second opinion, which may or may not confirm the decision of the attending physician. “In Andalusia, a roster of consultants has been established in every health district,” reports Álvaro Tortosa, director of the International University of La Rioja’s expert course in Bioethics for Nursing and a member of the Andalusian Commission for Guarantee and Evaluation. This regional commission is the final step in the procedure. For each case, it appoints a review panel composed of a physician and a lawyer, who issue the final ruling. Tortosa emphasizes that at any time, the individual may file a complaint if they believe a decision was incorrect, as well as postpone or withdraw their request.
If the commission gives the green light, a day and place is set to carry out the assisted death. The deceased is certified as having had a natural death. In theory, the entire process should take some two months. In practice, difficulties and obstacles arise that may lead to it being prolonged. “We are working hard to improve it, but when it comes to advancing rights like this, it takes years for society to accept and normalize it,” Tortosa says. Sometimes, families don’t understand their loved one’s decision and will oppose their choice. On other occasions, it is difficult to find doctors willing to take on a case or serve as consulting physicians. One of the main obstacles, in Tortosa’s opinion, is the lack of training on the subject among health care workers and mid-level staff. “There is still a lot to be done,” says the expert.
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