Robert D. Truog & Walter M. Robinson, Role of Brain Death and the Dead-Donor Rule in the Ethics of Organ Transplantation.

• Position: Abstracts

31 CRITICAL CARE MED. 2391 (2003).

The "dead-donor rule" requires patients to be declared dead before the removal of life-sustaining organs for transplantation. The concept of brain death was developed, in part, to allow patients with devastating neurologic injury to be declared dead before the occurrence of cardiopulmonary arrest. Brain death is essential to current practices of organ retrieval because it legitimates organ removal from bodies that continue to have circulation and respiration, thereby avoiding ischemic injury to the organs. The concept of brain death has long been recognized, however, to be plagued with serious inconsistencies and contradictions. Indeed, the concept fails to correspond to any coherent biological or philosophical understanding of death.

This article reviews the evidence and arguments that expose these problems and present an alternative ethical framework to guide the procurement of transplantable organs. This...