The ethical obligation of the dead donor rule

The reasoning of medicine is a practical one and not a moral one. The practical way physicians determine death is based on the permanent cessation of circulation, while the exact moment when irreversibility has been reached is not provable.

Some might wonder whether we are arguing that organ donation should be ethically permitted in all allowing to die cases. One could imagine that a physician, might, for instance, allow a patient to die without that patient’s permission for the express purpose of transplanting organs. We are not, however, arguing that allowing to die is sufficient to make organ transplanting ethically acceptable. As we stated above, allowing to die may [emphasis now added] be morally acceptable—under the proper conditions of consent, disproportionately burdensome treatment, etc. The proper formulation of the distinction between killing and allowing, for those who hold it, is that killing patients is always morally wrong, but that some cases of allowing to die are morally permissible (21). Cases in which patients are allowed to die without consent and with the intention of making them dead solely as a means to make their organs available for transplant are among the morally impermissible cases of allowing to die. One should not allow a patient to die for the sole purpose of making them organ donors any more than one ought to kill them for that purpose. It is fortunate that in most cases of DCDD the allowing to die that precedes it is ethically justifiable.

We posit here, for the sake of engaging this argument, that dead persons can be harmed. We are aware that posthumous harm is a controversial topic, but such debate is out of scope of our article.