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The man was in a unique position to decide his own fate, and doctors were fearful that starting the transplant process could put undue pressure on him to choose death, said the University of Montreal doctoral student and consultant to Transplant Quebec.

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Until nine years ago in Canada, the scenario could not even have arisen, as organs were taken only from people declared brain-dead.

“There were so many questions,” Allard said about the discussion triggered by the case.

“There was a big reflection in all the transplant community in Quebec about donations by conscious patients … Not all the surgeons are comfortable with it.”

Transplant Quebec, which oversees the field, eventually polled surgeons about the issue and made up a list of those who would be willing to operate if a similar situation arose, she said.

Though rare, the case could have added relevance as Canada moves toward legalized, physician-aided death, raising the spectre of people consciously offering their organs before dying, said the ethicist.

In the first decades of transplant medicine, organs were taken from patients declared brain-dead, a concept that emerged in the 1970s after the advent of ventilators that could keep hearts and lungs working indefinitely.

But with the continuing shortage of organs — and hundreds of people dying yearly on transplant wait lists — Canadian experts decided in 2006 to adopt what is called donation after cardiac death.