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The ethical obligation of the dead donor rule

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Abstract

The dead donor rule (DDR) originally stated that organ donors must not be killed by and for organ donation. Scholars later added the requirement that vital organs should not be procured before death. Some now argue that the DDR is breached in donation after circulatory determination of death (DCDD) programs. DCDD programs do not breach the original version of the DDR because vital organs are procured only after circulation has ceased permanently as a consequence of withdrawal of life-sustaining therapy. We hold that the original rendition of the DDR banning killing by and for organ donation is the fundamental norm that should be maintained in transplantation ethics. We propose separating the DDR from two other fundamental normative rules: the duties to prevent harm and to obtain informed consent.

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Notes

  1. 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.

  2. 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.

  3. 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.

Abbreviations

DCDD:

Donation after circulatory determination of death

DDR:

The dead donor rule

W-LST:

Withdrawal of life-sustaining therapy

References

  • Anscombe, G.E.M. 1969. Intention. Ithaca: Cornell University Press.

    Google Scholar 

  • Arnold, R., and S. Youngner. 1993. The dead donor rule: should we stretch it, bend it, or abandon it? Kennedy Institute of Ethics Journal 3 (2): 263–278.

    Article  Google Scholar 

  • Bernat, J.L. 2010. How the distinction between ‘irreversible’ and ‘permanent’ illuminates circulatory-respiratory death determination. Journal of Medicine and Philosophy 35: 242–255.

    Article  Google Scholar 

  • Bernat, J.L. 2013a. Controversies in defining and determining death in critical care. Nature Reviews Neurology. 9: 163–173.

    Article  Google Scholar 

  • Bernat, J.L. 2013b. On noncongruence between the concept and determination of death. Hastings Center Report 43 (6): 25–33.

    Article  Google Scholar 

  • Birch, S.C.M. 2013. The dead donor rule: A defense. Journal of Medicine and Philosophy 38: 426–440.

    Article  Google Scholar 

  • Bratman, M. 1987. Intention, plans, and practical reason. Cambridge: Harvard University Press.

    Google Scholar 

  • Cavanaugh, T.A. 2006. Double effect reasoning, 183–190. New York: Oxford University Press.

    Book  Google Scholar 

  • Collins, M. 2010. Reevaluating the Dead Donor Rule. Journal of Medicine and Philosophy 35: 154–179.

    Article  Google Scholar 

  • Crippen, D. 2008. Donation after cardiac death: Perceptions versus reality. Journal of Intensive Care Medicine. 23 (5): 347–348.

    Article  Google Scholar 

  • Dalle Ave, A.L., and D.M. Shaw. 2016. Donation after circulatory determination of death: What information to whom. Bioethica Forum. 9 (1): 32–38.

    Google Scholar 

  • Dalle Ave, A.L., and D.M. Shaw. 2017. Controlled donation after circulatory determination of death. Journal of Intensive Care Medicine 32 (3): 179–186.

    Article  Google Scholar 

  • Donagan, A. 1999. Choice: The essential element in human action. New York: Routledge and Kegan Paul.

    Google Scholar 

  • Gardiner, D., and R. Sparrow. 2010. Not dead yet: Controlled non-heart-beating organ donation, consent and the dead donor rule. Cambridge Quarterly of Healthcare Ethics 19 (1): 17–26.

    Article  Google Scholar 

  • Jonsen, A.R., M. Siegler, and W.J. Winslade. 2015. Clinical ethics: A practical approach to ethical decisions in clinical medicine, 8th ed, 162. New York: McGraw-Hill.

    Google Scholar 

  • Keown, J. 2002. Euthanasia, ethics, and public policy: An argument against legalization, 18–30. New York: Cambridge University Press.

    Book  Google Scholar 

  • Manara, A.R., P.G. Murphy, and G. O’ Callaghan. 2012. Donation after circulatory death. British. Journal of Anaesthesia 108 (S1): i108–i121.

    Article  Google Scholar 

  • Marquis, D. 2010. Are DCD donors dead? Hastings Center Report 40 (3): 24–31.

    Article  Google Scholar 

  • Menikoff, J. 2002. The importance of being dead: Non-heart-beating organ donation. Issues in Law and Medicine 18 (1): 3–20.

    Google Scholar 

  • Miller, F.G., R.D. Truog, and D.W. Brock. 2010a. The dead donor rule: can it withstand critical scrutiny. Journal of Medicine and Philosophy 35: 299–312.

    Article  Google Scholar 

  • Miller, F.G., R.D. Truog, and D.W. Brock. 2010b. Moral fictions and medical ethics. Bioethics 24 (9): 453–460.

    Article  Google Scholar 

  • Morris v Brandenburg. 2016. Supreme Court of New Mexico No. S-1-SC-35478; 2016-NMSC-027; 356 P.3d 836.

  • Overby, K.J., M.S. Weinstein, and A. Fiester. 2015. Addressing consent issues in donation after circulatory determination of death. American Journal of Bioethics 1 (8): 3–9.

    Article  Google Scholar 

  • Pellegrino, E.D. 1989. Withholding and withdrawing treatments: Ethics at the bedside. Clinical Neurosurgery 35: 164–184.

    Google Scholar 

  • Pellegrino, E.D. 1992. Doctors must not kill. Journal of Clinical Ethics 3 (2): 95–102.

    Google Scholar 

  • President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. 1983. Deciding to forgo life-sustaining treatment: A report on the ethical, medical and legal issues in treatment decisions, 43–89. Washington, DC: US Government Printing Office.

    Google Scholar 

  • Rachels, J. 1975. Active and passive euthanasia. New England Journal of Medicine 292: 78–80.

    Article  Google Scholar 

  • Rady, M.Y., J.L. Verheijde, and J. McGregor. 2008. Organ procurement after cardiocirculatory death: A critical analysis. Journal of Intensive Care Medicine. 23: 303–312.

    Article  Google Scholar 

  • Rady, M.Y., J.L. Verheijde, and J.L. McGregor. 2010. Scientific, legal, and ethical challenges of end-of-life procurement in emergency medicine. Resuscitation 81: 1069–1078.

    Article  Google Scholar 

  • Robertson, J. 1999. The dead donor Rule. Hastings Center Report 29 (6): 6–14.

    Article  Google Scholar 

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

    Article  Google Scholar 

  • Searle, J. 1983. Intentionality: An Essay in the Philosophy of Mind. New York: Cambridge University Press.

    Book  Google Scholar 

  • Shemie, S.D. 2007. Clarifying the paradigm for the ethics of donation and transplantation: was ‘dead’ really so clear before organ donation? Philosophy, Ethics, and Humanities in Medicine. 2: 18.

    Article  Google Scholar 

  • Shewmon, A. 2004. The dead donor rule: Lessons from linguistics. Kennedy Institute of Ethics Journal 14 (3): 277–300.

    Article  Google Scholar 

  • Snyder Sulmasy, L., and P.S. Mueller. 2017. Ethics, Professionalism and Human Rights Committee of the American College of Physicians. Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Annals of Internal Medicine 167: 576–578.

    Article  Google Scholar 

  • Sulmasy, D.P. 1998. Killing and allowing to die: Another look. Journal of Law, Medicine and Ethics 26: 55–64.

    Article  Google Scholar 

  • Sulmasy, D.P., and E.D. Pellegrino. 1999. The rule of double effect: Clearing up the double talk. Archives of Internal Medicine 159 (6): 545–550.

    Article  Google Scholar 

  • Sulmasy, D.P., and L. Snyder. 2010. Substituted interests and best judgments: an integrated model of surrogate decision making. JAMA 304: 1946–1947.

    Article  Google Scholar 

  • Truog, R.D., and F.G. Miller. 2008. The dead donor rule and organ transplantation. New England Journal of Medicine 359 (7): 674–675.

    Article  Google Scholar 

  • Uniform Determination of Death Act, 12 uniform laws annotated 589 (West 1993 and West suppl 1997).

  • Vacco v. Quill. 1997. 117 S.Ct. 2293.

  • Veatch, R.M. 2015. Killing by organ procurement: Brain-based death and legal fictions. Journal of Medicine and Philosophy 40: 289–311.

    Article  Google Scholar 

  • Verheijde, J.L., and M.Y. Rady. 2011. Justifying physician-assisted death in organ donation. The American Journal of Bioethics. 11 (8): 52–54.

    Article  Google Scholar 

  • Washington v. Glucksberg. 1997. 117 S.Ct. 2258.

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Authors and Affiliations

  1. Ethics Unit, University Hospital of Lausanne, Rue Du Bugnon 21, 1011, Lausanne, Switzerland

    Anne L. Dalle Ave

  2. Institute for Biomedical Ethics, University Medical Center 1, Rue Michel-Servet, 1211, Geneva 14, Switzerland

    Anne L. Dalle Ave

  3. Kennedy Institute of Ethics, The Departments of Medicine and Philosophy and the Pellegrino Center for Clinical Bioethics, Georgetown University, 3700 O St, NW, Healy 419, Washington, DC, 20057, USA

    Daniel P. Sulmasy

  4. Neurology Department, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA

    James L. Bernat

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  1. Anne L. Dalle Ave
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  2. Daniel P. Sulmasy
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  3. James L. Bernat
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Correspondence to Anne L. Dalle Ave.

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Dalle Ave, A.L., Sulmasy, D.P. & Bernat, J.L. The ethical obligation of the dead donor rule. Med Health Care and Philos 23, 43–50 (2020). https://doi.org/10.1007/s11019-019-09904-8

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