A man lies on a hospital bed, conscious and fully aware of his surroundings. As family members look on, a doctor injects him with two drugs.

The first renders the patient unconscious, putting him in coma, the second, a muscle relaxant, stops his heart.

Time, now, is very much of the essence. A few minutes are allowed for the relatives’ final farewells before he is pronounced dead and a team of surgeons swings into action, removing his liver, kidneys and pancreas.

This year, the euthanasia figure in Holland is expected to pass 6,000, from 3,136 in 2010. Last year eight people donated organs afterwards (stock image of an operation)

As each organ is extracted, it is immediately transferred to separate operating theatres where medics are on hand to transplant it into a patient who lies waiting.

Slick, fast-paced and brutally efficient — while it may sound like some sci-fi scene set in the future, in fact, this chain of events unfolded in a hospital in Holland earlier this year.

What, of course, makes it so extraordinary is that the man, who has not been identified, died at the hands of a doctor.

Having suffered a stroke he had decided that his quality of life was so poor that he wanted to end his life. In the Netherlands, he was able to do this because euthanasia has been legal since 2002.

In that time, the numbers who have died in this way have steadily risen — this year, the figure is expected to pass 6,000, from 3,136 in 2010. Today, of all deaths in the Netherlands, 3.5 per cent are the result of euthanasia.

A similar situation exists in Belgium where doctor-assisted deaths were legalised at much the same time.

Last year, the number of people to die via euthanasia in that country went past 2,000 for the first time, meaning the total has more than doubled in five years.

But largely unnoticed, what has happened in parallel with this spiralling death toll is the growing number of organs then removed for transplant from those who have chosen to die.

The first time someone donated their organs after euthanasia in the Netherlands was in 2012. Last year, eight did so, taking the total number to 15.

It is understood a further 25 such donations have taken place in Belgium.

Last wishes: Arnold Mulder, whose organs were donated after his euthanasia, and his daughter

There, surgeons have praised the quality of lungs coming from these patients, saying they compare favourably to those taken from donors who have died in other ways.

While there is undoubtedly a desperate need for transplant organs, opponents of assisted dying see the development as deeply disturbing.

They think people may feel pressured to end their lives in the belief that others can benefit through their deaths.

And the more ‘normalised’ that euthanasia becomes, they fear, the more the boundaries over organ donation could be pushed.

An academic paper published last week by a Dutch medical researcher explores the possibility that, in future, doctors might be allowed to remove organs from euthanasia patients who are still alive.

What is being suggested is that the patient could be anaesthetised — but not killed — and their organs removed, including the heart and lungs. It would be the removal of the heart that would lead to death.

Medically, this would mean that organs for transplant — hearts and lungs in particular — were more likely to be viable.

The Dutch medical fraternity insists there are as yet no plans to go down this route, but even the discussion of such a possibility has prompted campaigners to warn of the dangers of a slippery slope.

‘The trend is deeply worrying,’ says anti-euthanasia campaigner Lord Carlile of Berriew, who warns that when patients are at their lowest ebb in the immediate aftermath of a serious illness — for example, a stroke — they could be susceptible to persuasion.

‘The pressure to agree to provide a transplantable heart, lung or liver might be huge,’ he says.

‘The evidence of protection of the vulnerable in Belgium and Holland is sketchy at best. The boundaries of euthanasia are pushed yet further back and the potential for doctors to “engineer” these events grows.

‘We have cause to fear such developments and the ethical ambiguity that has been used to justify them.’

The current position in Britain is, of course, very different to that in Holland and Belgium.

Last year, MPs here voted against allowing assisted dying after critics claimed the law would be open to abuse by relatives of vulnerable and elderly people.

And in Holland and Belgium, there are safeguards about precisely who can qualify for euthanasia.

Patients have to put in a request to be euthanised with a doctor, and the doctor, in turn, must find them to be in a medically hopeless condition and to be suffering ‘unbearably’.

A second, and in some cases a third, physician must also be consulted.

But though euthanasia in both countries was introduced to take care of what were described as the ‘hard’ medical cases, in recent years concerns have been raised at the change in medical profile of those undergoing the process.

In Belgium, for example, increasingly they are people with depression or non-terminal conditions.

They include deaf twins Marc and Eddy Verbessem, 45, who were granted their wish to die in December 2012 after they learned they were likely to become blind.

In 2013, Nancy Verhelst, 44, a trans-sexual woman, chose euthanasia after doctors botched her sex-change operation, leaving her with physical deformities she felt made her look like a ‘monster’.

Equally controversial was the euthanasia of a 47-year-old Dutch woman who had tinnitus.

A study by U.S. academics last month found that most of the mental health patients put to death under Dutch euthanasia law were suffering from loneliness.

‘Social isolation,’ they said, was a key motivation behind the euthanasia requests of 37 of 66 cases reviewed.

Against this background, the issue of organ donation clearly raises some deeply worrying issues.

The authorities in Holland and Belgium justify their actions by arguing that patients have the right to self-determination — not just to die in the way they choose, but to donate their organs if they see fit.

With this in mind, guidelines have been established to govern how such donations are conducted.

For a start, whatever the future may hold, the current law states that the patient must be dead.

Also, if the patient is suffering from cancer or some other malignancy, then their organs will almost certainly be deemed unsuitable for donation.

In 2014, this ruled out all but 1,418 of 5,306 euthanasia patients in Holland.

Second, the patient will have to accept dying in hospital rather than at home, which is the choice of the majority of euthanasia patients in the Netherlands.

‘The patient needs to be hospitalised when the physician administers the euthanasia drugs, facilitating optimal organ recovery and optimising transplantation success of these organs,’ explains a paper published earlier this year in the American Journal Of Transplantation by Jan Bollen, of Maastricht University Medical Centre, an authority on the subject.

‘It can be envisaged that it would be more difficult for the patient and his relatives to spend their last hours together in this “cold” environment.

‘More important, after the physician has determined death, the patient has to be transported to the operating room immediately.

‘The patient’s relatives are informed that they should say goodbye to their beloved person before the euthanasia drugs are being administered, since the time between death and organ donation should be minimised.’

In Belgium surgeons have praised the quality of lungs coming from euthanasia patients, saying they compare favourably to those taken from donors who have died in other ways

Once the drugs are administered — the sedative followed by the muscle relaxant — the heart will stop beating and, after a so-called ‘no-touch’ period of five minutes, death will be declared.

The patient is then immediately wheeled into the operating theatre, where organs are removed and transported to the various recipients.

Of course, from the moment of death onwards, the steps taken are similar to those that are followed in other organ transplants.

And because there is a desperate shortage of organs for transplant, some would argue that making use of the organs of suitable euthanasia patients is a sensible way forward.

But there are a number of ethical considerations unique to this way of death. What happens, for example, if a patient tells his doctor he wants to end his life and the doctor then asks him if he has considered donating his organs?

By merely raising this suggestion, might the patient then feel morally obliged to continue despite any subsequent second thoughts?

It is a point explored by Mr Bollen in a second paper published in March, this time in the Journal Of Medical Ethics.

‘Informing a patient about the possibility of organ donation after euthanasia could put a lot of social pressure on the patient, since he could feel pressed to consent,’ he writes. ‘It could potentially even cause a breach of trust with the treating physician, and one might get the impression that the physician is only willing to perform euthanasia because the patient will donate organs.’

Mr Bollen claims that, in practice, such ‘organ-hunting’ would never happen. Before raising the subject, the doctor would check a donor registry list — in Holland, people opt in to be a donor, as in the UK, while in Belgium, everyone is deemed a potential donor unless they opt out. If they are not on the list, it is left to the discretion of the doctor to raise the subject or not, with the proviso that euthanasia and donation are treated as separate, unlinked procedures.

Then there is the fear that pressure could be put on patients by relatives.

In some countries such as the U.S., so-called ‘direct donations’ are allowed — whereby the donor can choose the recipient of their organ. Might a patient be persuaded to end their life specifically to benefit a sick relative?

(Again, in Holland and Belgium this is said not to be an issue because donated organs are distributed by Eurotransplant — a non-profit organisation that facilitates the cross-border exchange of deceased donor organs — which does not allow the donor to choose the recipient). Next is the question of whether the potential donor can undergo any treatment ahead of death to prepare their organs for donation.

In Belgium, after administering the euthanasia drugs, doctors sometimes administer a drug called heparin to prevent clotting within organs that are to be transplanted.

This is not done in Holland because it is seen as unethical to carry out a treatment that does not benefit the patient.

That being the case, many have reacted with alarm at the suggestion that in the future organs might be removed from euthanasia patients while they are still alive.

Some argue that if people want to die and also to donate their organs, why not do so in a way that ensures the organs are in the best possible condition for future transplant?

This issue was raised in Mr Bollen’s most recent paper. ‘The dead donor rule states that donation should not cause or hasten death,’ he wrote. ‘Since a patient undergoing euthanasia has chosen to die, it is worth arguing that the “no-touch” time could be skipped, contributing to the quality of the transplanted organs.

‘It is even possible to extend this argument to a “heart-beating organ donation euthanasia”, where a patient is sedated, after which his organs are removed, causing death. Both options are legally not allowed.’

Unsurprisingly, this suggestion has drawn condemnation from opponents of euthanasia and assisted suicide in Britain.

‘It sounds like the script for a new science fiction horror film,’ said Robert Flello, Labour MP for Stoke-on-Trent South, and co-chairman of the All Party Parliamentary Pro-Life Group.

‘This callous proposal shows just how real the slippery slope would be if we ever introduced the assisted suicide laws in the UK that Dignity in Dying want.’

Mr Bollen was unavailable for comment, so I spoke to his colleague, Professor Ernst Van Heurn, a co-author of his most recent paper, based at the Academic Medical Centre in Amsterdam.

He insisted that their report was simply airing the arguments, rather than supporting the removal of organs before death.

‘We are very much against that,’ he said. ‘ I don’t think this is going to happen — I think it is more than one bridge too far. The current practice will continue.’

Even as matters stand, however, it is clear that support in Holland for euthanasia-derived organs is far from universal.

Doctors taking part in such transplants are told in advance, allowing those with moral objections to stand down.

And then there was the case last year of physiotherapist Arnold Mulder. Having been diagnosed with Parkinson’s disease, the 56-year-old from Nijmegen in the Netherlands decided he wanted to end his life before becoming completely bed-ridden.

The father-of-three was also keen to donate his organs following his death.

‘I do not want to go on with my illness,’ he told a Dutch newspaper. ‘All I want is to donate my organs. Especially my kidneys.

‘Many patients in the Netherlands are waiting anxiously for kidneys, but many donors can’t give them.

‘They must be transplanted within 15 minutes, so, for example, people who die on the roads can’t give their kidneys as there isn’t enough time.’

However, the story hit the headlines after the hospital to which he had been referred for euthanasia and the subsequent transplant refused to carry it out.

Radboud UMC hospital in Nijmegen claimed it had ‘no patient relationship’ with him. But there were media reports that its Roman Catholic status may have played a role in the decision.

After the case was taken up in the Dutch Parliament, another local hospital agreed to carry out Mr Mulder’s last wishes: his kidneys were transplanted into two patients in February last year.

‘Everyone should be able to step into a hospital and say “I want to donate,” ’ said Mr Mulder days before his death. ‘Hospitals should, in turn, receive all types of organ donors with open arms.’