Organ donation after euthanasia is performed in the Netherlands, Belgium, Spain and Canada. In these countries, altruistic patients, who often suffer from a neurodegenerative or psychiatric disease, are able to donate their lungs, liver, kidneys and pancreas. In the Netherlands, they even have the possibility to donate their heart. Research demonstrates that about 10% of all patients who undergo euthanasia might be medically eligible for organ donation. Preliminary short-term outcomes of transplants from these donors demonstrate good results. Intensive care physicians and nurses play an important supportive role in this combined procedure because of their expertise in end-of-life care and organ donation, and because these procedures are often performed in the intensive care unit. This article provides a practical summary of the various steps that need to be fulfilled to facilitate organ donation after a euthanasia procedure. Furthermore, it elaborates on the medical, legal and ethical aspects of organ donation after euthanasia, and identifies the possible advantages and challenges of this meaningful procedure. © 2022, Netherlands Society of Intensive Care. All rights reserved.