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The Moral Insignificance of Death in Organ Donation

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1 Robertson, J.The dead donor rule. Hastings Center Report 1999;29(6):614.

2 E.g., Arnold, R, Youngner, S.The dead donor rule: Should we stretch it, bend it, or abandon it? Kennedy Institute of Ethics Journal 1993;3:263–78; Veatch, R.Abandon the dead donor rule or change the definition of death? Kennedy Institute of Ethics Journal 2004;4:261–76; and Truog, R, Miller, F.The dead donor rule and organ transplantation. New England Journal of Medicine 2008;359:674–5.

3 Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. A definition of irreversible coma. JAMA 1968;205:337–40.

4 See Steinbrook, R.Organ donation after cardiac death. New England Journal of Medicine 2007;357:209–13; and Bernat, J.The boundaries of organ donation after circulatory death. New England Journal of Medicine 2008;359:669–71.

5 Bernat, J, D’Alessandro, A, Port, F, Bleck, T, Heard, S, Medina, J, et al. . Report of a national conference on donation after cardiac death. American Journal of Transplantation 2006;6:281–91.

6 Bernat, J.The debate over death determination in DCD. Hastings Center Report 2010;40(3):3.

7 Bernat, J, Capron, A, Bleck, T, Blosser, S, Bratton, S, Childress, J, et al. . The circulatory-respiratory determination of death in organ donation. Critical Care Medicine 2010;38:963–70, at 967.

8 See, e.g., note 2, Veatch 2004, at n1.

9 Jennett, B.The vegetative state. Journal of Neurology, Neurosurgery and Psychiatry 2002;73:355–6; and Blumenfeld, H.The neurological examination of consciousness. In: Laureys, S, Tononi, G, eds. The Neurology of Consciousness: Cognitive Neuroscience and Neuropathology. Amsterdam: Academic Press; 2009:1530.

10 See Feinberg, J.Harm to Others. New York: Oxford University Press; 1986.

11 Rodriguez-Arias, D, Smith, M, Lazar, N.Donation after circulatory death: Burying the dead donor rule. American Journal of Bioethics 2011;11(8):36–43, at 40.

12 See note 11, Rodriguez-Arias et al. 2011, at 41.

13 See note 11, Rodriguez-Arias et al. 2011, at 41.

14 Luaute, J, Maucort-Boulch, D, Tell, L, Quelard, F, Sarraf, T, Iwaz, J, et al. . Long-term outcomes of chronic minimally conscious and vegetative states. Neurology 2010;75:240–52.

15 Miller, F, Truog, R, Brock, D.The dead donor rule: Can it withstand critical scrutiny? Journal of Medicine and Philosophy 2010;35:299312. See also Miller, F, Truog, R.Rethinking the ethics of vital organ donation. Hastings Center Report 2008;38(6):3846; and Miller, F, Truog, R.Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life. Oxford: Oxford University Press; 2012.

16 Boly, M, Faymonville, M-E, Schnakers, C, Peigneux, P, Lambermont, B, Phillips, C, et al. . Perception of pain in the minimally conscious state with PET activation: An observational study. Lancet Neurology 2008;7:1013–20.

17 Wilkinson, D, Savulescu, J.Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation. Bioethics 2012;26:3248, at 40–41.

18 See note 15, Miller et al. 2010, at 306.

19 See note 2, Veatch 2004. See also Bagheri, A.Individual choice in the definition of death. Journal of Medical Ethics 2007;33:146–9.

20 I thank an anonymous reviewer for helpful comments on an earlier version of this article. The writing of the article was supported by a research fellowship from the Brocher Foundation, Hermance, Switzerland, which is gratefully acknowledged. I thank the other researchers at the Brocher for their constructive comments and questions following a presentation on the issues discussed here.

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
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