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How (not) to think of the ‘dead-donor’ rule

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Abstract

Although much has been written on the dead-donor rule (DDR) in the last twenty-five years, scant attention has been paid to how it should be formulated, what its rationale is, and why it was accepted. The DDR can be formulated in terms of either a Don’t Kill rule or a Death Requirement, the former being historically rooted in absolutist ethics and the latter in a prudential policy aimed at securing trust in the transplant enterprise. I contend that the moral core of the rule is the Don’t Kill rule, not the Death Requirement. This, I show, is how the DDR was understood by the transplanters of the 1960s, who sought to conform their practices to their ethics—unlike today’s critics of the DDR, who rethink their ethics in a question-begging fashion to accommodate their practices. A better discussion of the ethics of killing is needed to move the debate forward.

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Notes

  1. Lest there be any confusion, the kind of absolutism I have in mind is the kind G.E.M. Anscombe described when she spoke of there being “certain things forbidden whatever consequences threaten” and “simply in virtue of their description as such-and-such identifiable kinds of action…” [1, p. 10] (emphasis original).

  2. Robert Sade, e-mail message to author, October 26, 2015.

  3. Or, as an anonymous reviewer suggests, they might even consider the particular organs harvested in this specialized context as technically non-vital.

  4. One should not interpret the DDR so narrowly as to think that it only forbids killing by removing organs, but not killing for obtaining organs (pace Christian Coons and Noah Levin [6]). The fact that one could consent to be killed by the surgical removal of organs but not for the sake of their removal is simply irrelevant in the context of organ donation, the context to which the DDR applies (such a person is not a donor at all). In that context, no donor is indifferent to the good of having one’s organs harvested for the sake of helping others, and no transplant team is indifferent to the good of harvesting healthy organs for transplant.

  5. This would also rule out procurement procedures that would leave individuals in a diminished state, even if they were not killed.

  6. Levin is one of the few writers on this topic who notes the difference between the Death Requirement and the Don’t Kill rule, but he thinks that the Death Requirement is the “historically accurate” formulation despite conceding that “the origins of the DDR are unclear” [13, p. 2–3]. Both of these claims I contest below.

  7. Some contend that the Don’t Kill rule is violated because withdrawing life support is what “causes death” not the underlying pathology [15, p. 2]. While this requires fuller treatment, my quick reply is that framing human action in terms of its causal activity or inactivity is a poor way to understand human action. Does a boy scout cause the death of his breathless and unconscious scout master (imagine some accident out on the trail) when he ceases to perform mouth-to-mouth resuscitation after an hour? The fact that the scout master could have lived longer had the scout not given up does not offer a sufficient understanding of what the scout does—certainly he does not kill him. It seems that there is at least a morally relevant distinction between being a cause of death (which may affect the timing of it) and being the cause of death (which is the source of the fatal sequence) [16]. This is not to say that someone’s death cannot be intended by withdrawing life support, but doing so does not require such an intention. For further treatment on this topic see Jensen [17].

  8. This is also the source of the controversy over so-called donation-after-circulatory-death protocols.

  9. According to critics of Paul Morrisey’s proposal: “Midline laparotomy and bilateral nephrectomy [the procedures that remove both kidneys] after the original brain injury is an additional iatrogenic (penetrating and blunt) trauma resulting in extracranial tissue injuries and potentially hastening or causing death. Surgery can induce post-operative cardiovascular instability secondary to blood loss, intraoperative fluid shifts, and intravascular hypovolemia. In the absence of optimal perioperative resuscitation, the final common pathway is an early onset of hypotension and cardiovascular collapse. The latter becomes the lethal pathophysiology and proximate cause of death upon WLS [withdrawing life support]” [18, p. 18].

  10. This sort of thinking is captured well in DeVita and Snyder’s description of four cases in which donation-after-circulatory-death protocols were used [19]. They report that, in the effort to standardize these protocols, some transplant teams and procurement officials were concerned “that an overly liberal policy might result in a public outcry that would jeopardize the future of organ donation” [19, p. 136]. I take what they mean by an “overly liberal policy” to include removing vital organs from donors who have satisfied neither neurological nor circulatory criteria.

  11. There is a question about the non-innocent—people on death row—which I leave aside, since such a practice depends on the validity of the death penalty, an issue that needs to be resolved before any “death-by-transplant-surgery” proposal can be evaluated.

  12. Albert Jonsen is worth quoting: “To be more precise…, the ‘rule utilitarianism’ that combines respect for rule and principle with the goals of human and social thriving is the dominant ethos of bioethics at the level of public policy” [108, p. 44].

  13. I take her language about “utilitarian” and “deontological” values to be indicative of a conflict between the standard bioethical principles of beneficence and respect for persons, not utilitarian or deontological ethics in a theoretical sense.

  14. Paul Ramsey’s survey of how this updating process went about presents the best summary of the relevant issues and events under consideration at the time [30].

  15. In fact, Daube, who fled Germany in 1933, did not spend time in a camp, though his father did [37]. Woodruff and de Wardener spent time in the notorious Changi camp in Singapore.

  16. Guy Alexandre’s neurological criteria for death, which he used in nine separate occasions, included “(1) complete bilateral mydriasis; (2) complete absence of reflexes, both nature and in response to profound pain; (3) complete absence of spontaneous respiration, five minutes after mechanical respiration has been stopped; (4) falling blood pressure necessitating increasing amounts of vasopressive drugs…; (5) a flat EEG” (quoted in [40, p. 69]).

  17. It seems that Schreiner was committed to the odd view that life is essentially bound up with the presence of a beating heart rather than the presence of adequate circulation.

  18. Miller and Truog, who ardently believe physicians cause the death of their patients when they remove life support from them [15], are, in a sense, modern-day witnesses for the defense in the trial of Potter’s assailant.

  19. Potter’s case was not unique. In May of 1968, Denton Cooley, a pioneering heart transplant surgeon from Texas, came under scrutiny after procuring a heart from a thirty-six-year-old welder named Clarence Nicks, who also suffered severe brain trauma from a brawl. The Harris County medical examiner worried that his autopsy investigation would be compromised if he were tasked with determining the cause of death in someone who no longer had a heart. While he eventually ruled that the cause of Nicks’ death was the massive brain injury, the legal definition of death was thought to be in conflict with the changing medical definition, providing the legal space for the defense to assert that it was Cooley, and not the brawlers, who were responsible for Nicks’ death [49, 50]. The conflict between medical examiners and transplanters came to a fever pitch when Stanford University’s Norman Shumway, another pioneering transplant surgeon, retrieved a heart from the body of a homicide victim without the examiner’s authorization. In this case, the defense attorneys succeeded in arguing that it was Shumway who killed the victim, rather than the victim’s assailant [51]. Similarly, in 1987, the assailant who shot Pamela James in the head had his murder charges dropped, since his defense attorney discovered in the coroner’s report that the time of James’ death coincided with the time that the transplant team removed her heart. To bolster his case, the defense attorney enlisted the aid of a neuropathologist, who determined James’ brain injury was of a “lower-grade” and did not preclude a chance at recovery. Since James was denied the chance of recovering, his client was not responsible for her death [52, 53]. In none of these cases was it ever suggested that homicide law should be changed to accommodate lethal surgery, since homicide law was relatively clear, while the definition of death was not. For better or for worse, two concepts of death were emerging, which had far-reaching implications for medical liability and organ transplantation: medical death, based on neurological or circulatory criteria, and legal death, based only on circulatory criteria. Doctors and lawyers struggled to articulate a unified definition of death that would adequately represent the physical facts, while serving the purposes of medicine and law (the best example comes from [54]).

  20. To be sure, when pressed about whether one could consent by an advanced directive to donate one’s organs only if one was in a state of irreversible unconsciousness, Giertz replied, “I think it would be better if we were able to take organs from living persons while they are unconscious, but with their previous permission” (quoted in [40, p. 155]). Later, however, he qualified his claim, saying that he was thinking of the kidneys only, not organs like the heart. These remarks were in reference to a Stockholm case where a brain-damaged patient had a single kidney removed and then was taken off a respirator twenty-four hours later. As stated, his remarks are ambiguous, since they occur in the context of questions about the validity of Alexandre’s tests for brain death and whether brain-death is equivalent or not to death. There is no evidence to suggest that Geirtz had “higher-brain death” in mind, as though irreparable damage to one’s cerebrum were sufficient for death. In fact, Geirtz is aware of such an idea and deems it to be an unacceptable gerrymandering of death; he says such a view would leave the “biological and medical frame of reference” [60, p. 148]. Thus, it appears that he endorsed something like Morrisey’s previously mentioned protocol over Alexandre’s brain-death-based protocol because he did not agree with Alexandre that the brain-damaged patient was nothing more than “heart–lung preparations”—a description that originates from the dissection laboratory rather than the hospital bedside [61, p. 149].

  21. Evidence for the view that the law against homicide is an artifact of the belief that life is sacred is found in the legal history outlined in the U.S. Supreme Court case Washington v. Glucksberg (1997), which ruled against the constitutionality of physician-assisted suicide.

  22. See also [23, 24, 74]

  23. Robert Veatch likewise rejects the soundness of this argument, though he accepts premise (2), and rejects premise (1), because in his view we can be considered dead if we irreversibly lose our “higher” brain capacities for conscious experience [83, 84]. Even the famed euthanasia advocate Rachels agrees, since in his view it is appropriate to fix “the time of death at the point at which consciousness is no longer possible” [73, p. 43]. Still others defend the idea that brain death is equivalent to death and that we should comply with the DDR [71, 85].

  24. The idea that there might be a deeper concern about what those symbols signify and whether to have an interest in transplantation is to have an interest in a lethal enterprise is not seriously considered.

  25. Other critics deny premise (1): Tom Tomlinson [95] and John Robertson [8] think the concept of irreversibility can be satisfied if the donor’s do-not-resuscitate order within its scope, which would make any attempt to revive the donor after asystole impermissible. In this view, the modality of impermissibility is thought to be strong enough to satisfy the irreversibility condition even if there is a patient in the next room who is in the same physical condition as the donor but wants to be and is able to be revived. Still, others appeal to higher-brain criteria that render premise (1) false [90].

  26. It should be noted that I think neither the case for equating withdrawing life support with killing nor the case against declaring death on the basis of total brain failure succeeds at all (see [17, 102,103,104] for some recent scholarship on these issues). I am currently agnostic about our DCD protocols, however. Another paper for another time.

  27. To be sure, how death is defined is crucial in that there is some support for donating organs when one criterion for “higher-brain” death is satisfied. Be that as it may, James DuBois and Emily Anderson report, “69% agreed that they would only allow donation after the patient was taken off the ventilator and his or her heart stopped beating, which would require use of a DCD protocol and reduce the number of procurable organs” [105, p. 69].

  28. An admirably forthright discussion of the wrongness of killing can be found in the article by Walter Sinnott-Armstrong and Miller [106]; for a response to their ideas, see Adam Omelianchuk [107].

References

  1. Anscombe, G.E.M. 1958. Modern moral philosophy. Philosophy 33: 1–19.

    Article  Google Scholar 

  2. Chaten, Frank. 2014. The dead donor rule: Effect on the virtuous practice of medicine. Journal of Medical Ethics 40: 496–500.

    Article  Google Scholar 

  3. Miller, Franklin G., and Robert D. Truog. 2008. Rethinking the ethics of vital organ donations. Hastings Center Report 38: 38–46.

    Article  Google Scholar 

  4. Fost, Norman. 2004. Reconsidering the dead donor rule: Is it important that organ donors be dead? Kennedy Institute of Ethics Journal 14: 249–260.

    Article  Google Scholar 

  5. Bernat, James L. 2008. The boundaries of organ donation after circulatory death. New England Journal of Medicine 359: 669–671.

    Article  Google Scholar 

  6. Coons, Christian, and Noah Levin. 2011. The dead donor rule, voluntary active euthanasia, and capital punishment. Bioethics 25: 236–243.

    Article  Google Scholar 

  7. Koppelman, Elysa R. 2003. The dead donor rule and the concept of death: Severing the ties that bind them. American Journal of Bioethics 3: 1–9.

    Article  Google Scholar 

  8. Robertson, John A. 1999. Delimiting the donor: The dead donor rule. Hastings Center Report 6: 6–14.

  9. Rodríguez-Arias, David, Maxwell J. Smith, and Neil M. Lazar. 2011. Donation after circulatory death: Burying the dead donor rule. American Journal of Bioethics 11: 36–43.

    Article  Google Scholar 

  10. Bernat, James L. 2013. Life or death for the dead-donor rule? New England Journal of Medicine 369: 1289–1291.

    Article  Google Scholar 

  11. Fost, Norman. 1999. The unimportance of death. In The definition of death: Contemporary controversies, ed. Stuart J. Youngner, Robert M. Arnold, and Renie Schapiro, 161–178. Baltimore: John Hopkins University Press.

    Google Scholar 

  12. Khushf, George. 2010. A matter of respect: A defense of the dead donor rule and of a “whole-brain” criterion for determination of death. Journal of Medicine and Philosophy 35: 330–364.

    Article  Google Scholar 

  13. Levin, Noah Michael. 2013. The role of death in the moral permissibility of solid organ procurement after cardiac death and its implications. Dissertation, Bowling Green State University. https://etd.ohiolink.edu.

  14. Morrissey, Paul E. 2012. The case for kidney donation before end-of-life care. American Journal of Bioethics 12: 1–8.

    Google Scholar 

  15. Miller, Franklin G., and Robert D. Truog. 2012. Death, dying, and organ transplantation: Reconstructing medical ethics at the end of life. New York: Oxford University Press.

    Google Scholar 

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

    Article  Google Scholar 

  17. Jensen, Steven J. 2011. Killing and letting die. In The ethics of organ transplantation, ed. Steven J. Jensen, 170–194. Washington, DC: Catholic University of America Press.

    Google Scholar 

  18. Wertin, Thomas M., Mohamed Y. Rady, and Joseph L. Verheijde. 2012. Antemortem donor bilateral nephrectomy: A violation of the patient’s best interests standard. American Journal of Bioethics 12: 17–20.

    Article  Google Scholar 

  19. DeVita, Michael A., and James V. Snyder. 1993. Development of the University of Pittsburgh Medical Center policy for the care of terminally ill patients who may become organ donors after death following the removal of life support. Kennedy Institute of Ethics Journal 3: 131–143.

    Article  Google Scholar 

  20. Beauchamp, Tom L., and James F. Childress. 2013. Principles of biomedical ethics, 7th ed. New York: Oxford University Press.

    Google Scholar 

  21. Cochrane, Thomas I. 2011. Allow the dying to donate: Replace the dead donor rule. In The ethics of organ transplantation, ed. Steven J. Jensen, 135–154. Washington, DC: Catholic University of America Press.

    Google Scholar 

  22. Chen, Yen-Yuan, and Wen-Je Ko. 2011. Further deliberating burying the dead donor rule in donation after circulatory death. American Journal of Bioethics 11: 58–59.

    Article  Google Scholar 

  23. Collins, Mike. 2010. Reevaluating the dead donor rule. Journal of Medicine and Philosophy 35: 1–26.

    Article  Google Scholar 

  24. Miller, Franklin G., Robert D. Truog, and Dan W. Brock. 2010. The dead donor rule: Can it withstand critical scrutiny? Journal of Medicine and Philosophy 35: 299–312.

    Article  Google Scholar 

  25. Sade, Robert M. 2011. Brain death, cardiac death, and the dead donor rule. Journal of the South Carolina Medical Association 107: 146–149.

    Google Scholar 

  26. Shafer-Landau, Russ. 2015. The fundamentals of ethics, 3rd ed. New York: Oxford University Press.

    Google Scholar 

  27. Choper, Jesse H. 1982. Defining “religion” in the first amendment. University of Illinois Law Review 1982: 579–613.

  28. Nussbaum, Martha C. 2012. The new religious intolerance: Overcoming the politics of fear in an anxious age. Cambridge: Harvard University Press.

    Book  Google Scholar 

  29. Pellegrino, Edmund D. 2002. Professionalism, profession and the virtues of the good physician. Mount Sinai Journal of Medicine 69: 378–384.

    Google Scholar 

  30. Ramsey, Paul. 1970. The patient as person: Explorations in medical ethics. New Haven: Yale University Press.

    Google Scholar 

  31. Fletcher, Joseph F. 1954. Morals and medicine: The moral problems of the patient’s right to know the truth, contraception, artificial insemination, sterilization, euthanasia. Princeton: Princeton University Press.

    Google Scholar 

  32. Williams, Glanville L. 1957. The sanctity of life and the criminal law. New York: Alfred A. Knopf.

  33. Scribner, Belding H. 1964. Ethical problems of using artificial organs to sustain human life. Transactions of American Society for Artificial Internal Organs 10: 209–212.

    Google Scholar 

  34. Murray, J.E., J.H. Harrison, and J.P. Merrill. 1956. Renal homotransplantation in identical twins. Surgical Forum 6: 432–436.

    Google Scholar 

  35. Barry, John M., and Joseph E. Murray. 2006. The first human renal transplants. Journal of Urology 176: 888–890.

    Article  Google Scholar 

  36. Starzl, Thomas E. 1992. The puzzle people: Memoirs of a transplant surgeon. Pittsburgh: University of Pittsburgh Press.

    Book  Google Scholar 

  37. Daube, David. 2008. The jottings of David Daube: Reflections from the 20th century by one of its foremost legal minds, ed. Calum Carmichael. New York: YBK Publishers.

    Google Scholar 

  38. Murray, Joseph E., John P. Merrill, Gustave J. Dammin, J. Hartwell Harrison, Edward B. Hager, and Richard E. Wilson. 1964. Current evaluation of human kidney transplantation. Annals of the New York Academy of Sciences 120: 545–557.

    Article  Google Scholar 

  39. Starzl, Thomas E. 1967. Ethical problems in organ transplantation: A clinician’s point of view. Annals of Internal Medicine 67: 32–36.

    Article  Google Scholar 

  40. Wolstenholme, G.E.W., and Maeve O’Connor (eds.). 1966. Ethics in medical progress: With special reference to transplantation. London: Churchill.

    Google Scholar 

  41. Woodruff, M.F.A. 1966. Transplantation: The clinical problem. In Ethics in medical progress: With special reference to transplantation, ed. G.E.W. Wolstenholme, and Maeve O’Connor, 6–23. Boston: Little, Brown.

    Google Scholar 

  42. Schreiner, G.E. 1966. Dialysis and transplantation: Ethical problems. In Ethics in medical progress: With special reference to transplantation, ed. G.E.W. Wolstenholme, and Maeve O’Connor, 126–133. Boston: Little, Brown.

    Google Scholar 

  43. Hamburger, J. 1966. Some general considerations. In Ethics in medical progress: With special reference to transplantation, ed. G.E.W. Wolstenholme, and Maeve O’Connor, 134–138. Boston: Little, Brown.

    Google Scholar 

  44. Cortesini, R. 1966. Outlines of a legislation on transplantation. In Ethics in medical progress: With special reference to transplantation, ed. G.E.W. Wolstenholme, and Maeve O’Connor, 171–181. Boston: Little, Brown.

    Google Scholar 

  45. Daube, David. 1966. Transplantation: Acceptability of procedures and the required legal sanctions. In Ethics in medical progress: With special reference to transplantation, ed. G.E.W. Wolstenholme, and Maeve O’Connor, 188–201. Boston: Little, Brown.

    Google Scholar 

  46. Ethical guidelines for organ transplantation. 1968. JAMA 205: 341–342.

  47. Halley, M. Martin, and William F. Harvey. 1968. Medical vs. legal definitions of death. JAMA 204: 423–425.

    Article  Google Scholar 

  48. Elliot, D.W. 1964. Editorial: When is the moment of death? Medicine, Science and the Law 4: 77–80.

    Article  Google Scholar 

  49. Baker, Jeffrey C. 1968. Liability and the heart transplant. Houston Law Review 6: 85–112.

    Google Scholar 

  50. Redefinding death. 1968. Newsweek, May 20.

  51. Jentzen, Jeffrey M. 2009. Death investigation in America: Coroners, medical examiners, and the pursuit of medical certainty. Cambridge: Harvard University Press.

    Book  Google Scholar 

  52. Marrison, Benjamin. 1988. Did doctors act to soon in harvest of organs in Pamela James case? The Blade, March 6.

  53. Munson, Ronald. 2002. Raising the dead: Organ transplants, ethics, and society. New York: Oxford University Press.

    Google Scholar 

  54. Capron, Alexander Morgan, and Leon R. Kass. 1972. Statutory definition of the standards for determining human death: An appraisal and a proposal. University of Pennsylvania Law Review 121: 87–118.

    Article  Google Scholar 

  55. Berman, Emile. 1968. The legal problems of organ transplantation. Villanova Law Review 13: 751–758.

    Google Scholar 

  56. Kutner, Luis. 1969. Due process of human transplants: A proposal. University of Miami Law Review 24: 782–807.

    Google Scholar 

  57. Woodside, Frank C. 1970. Organ transplantation: The doctor’s dilemma and the lawyer’s responsibility. Ohio State Law Journal 31: 66–109.

    Google Scholar 

  58. Murray, Joseph E. 2001. Surgery of the soul: Reflections on a curious career. Canton, MA: Science History Publications.

    Google Scholar 

  59. Fost, Norman. 1983. The new body snatchers: On Scott’s the body as property. Law and Social Inquiry 8: 718–732.

    Google Scholar 

  60. Giertz, G.B. 1966. Ethical problems in medical procedures in Sweden. In Ethics in medical progress: With special reference to transplantation, ed. G.E.W. Wolstenholme, and Maeve O’Connor, 139–148. Boston: Little, Brown.

    Google Scholar 

  61. Bishop, Jeffrey Paul. 2011. The anticipatory corpse: Medicine, power, and the care of the dying. South Bend: University of Notre Dame Press.

  62. Hamilton, David. 2012. A history of organ transplantation: Ancient legends to modern practice. Pittsburgh: University of Pittsburgh Press.

    Book  Google Scholar 

  63. Murray, Joseph E. 1964. Moral and ethical reflection on human organ transplantation. Linacre Quarterly 31: 54–56.

    Google Scholar 

  64. Beecher, Henry K., R.D. Adams, and A. Clifford Barger. 1968. A definition of irreversible coma: Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death. JAMA 205: 337–340.

    Article  Google Scholar 

  65. Singer, Peter. 1994. Rethinking life and death: The collapse of our traditional ethics, 2nd ed. New York: St. Martin’s Press.

    Google Scholar 

  66. Giacomini, Mita. 1997. A change of heart and a change of mind? Technology and the redefinition of death in 1968. Social Science and Medicine 44: 1465–1482.

    Article  Google Scholar 

  67. Oderberg, David S. 2000. Applied ethics: A non-consequentialist approach. Oxford: Blackwell.

    Google Scholar 

  68. Koch, Tom. 2012. Thieves of virtue: When bioethics stole medicine. Cambridge: MIT Press.

    Google Scholar 

  69. Belkin, Gary. 2014. Death before dying: History, medicine, and brain death. Oxford: Oxford University Press.

    Google Scholar 

  70. Siminoff, Laura A., Christopher Burant, and Stuart J. Youngner. 2004. Death and organ procurement: Public beliefs and attitudes. Social Science and Medicine 59: 2325–2334.

    Article  Google Scholar 

  71. President’s Council on Bioethics. 2008. Controversies in the determination of death: A white paper of the President’s Council on Bioethics. Washington, DC: President’s Council on Bioethics. http://hdl.handle.net/10822/559343.

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

    Article  Google Scholar 

  73. Rachels, James. 1986. The end of life: Euthanasia and morality. Oxford: Oxford University Press.

  74. Brock, Dan W. 1992. Voluntary active euthanasia. Hastings Center Report 22: 10–22.

    Article  Google Scholar 

  75. Smith, Wesley J. 2001. Culture of death: The assault on medical ethics in America. San Francisco: Encounter Books.

    Google Scholar 

  76. Truog, Robert D. 1997. Is it time to abandon brain death? Hastings Center Report 27: 29–37.

    Article  Google Scholar 

  77. Riley, Lauren J. 2011. A call to reject the neurological standard in the determination of death and abandon the dead donor rule. Notre Dame Law Review 87: 1749–1795.

    Google Scholar 

  78. Sade, Robert M., and Andrea Boan. 2014. The paradox of the dead donor rule: Increasing death on the waiting list. American Journal of Bioethics 14: 21–23.

    Article  Google Scholar 

  79. Shewmon, D. Alan. 1997. Recovery from “brain death”: A neurologist’s apologia. The Linacre Quarterly 64: 30–96.

    Article  Google Scholar 

  80. Shewmon, D. Alan. 1998. “Brainstem death,” “brain death” and death: A critical re-evaluation of the purported equivalence. Issues in Law and Medicine 14: 125–145.

    Google Scholar 

  81. Shewmon, D. Alan. 2001. The brain and somatic integration: Insights into the standard biological rationale for equating “brain death” with death. Journal of Medicine and Philosophy 26: 457–478.

  82. Shewmon, D. Alan. 2004. The dead donor rule: Lessons from linguistics. Kennedy Institute of Ethics Journal 14: 277–300.

    Article  Google Scholar 

  83. Veatch, Robert M. 1975. The whole-brain-oriented concept of death: An outmoded philosophical formulation. Journal of Thanatology 3: 13–30.

    Google Scholar 

  84. Veatch, Robert M. 1993. The impending collapse of the whole-brain definition of death. Hastings Center Report 23: 18–24.

    Article  Google Scholar 

  85. Bernat, James L. 1998. A defense of the whole-brain concept of death. Hastings Center Report 28: 14–23.

    Article  Google Scholar 

  86. Jox, Ralf J. 2014. Sketching the alternative to brain death: Dying through organ donation. American Journal of Bioethics 14: 37–39.

    Article  Google Scholar 

  87. Nair-Collins, Michael, and Franklin G. Miller. 2016. Is heart transplantation after circulatory death compatible with the dead donor rule? Journal of Medical Ethics 42: 319–320.

    Article  Google Scholar 

  88. Arnold, Robert M., and Stuart J. Youngner. 1993. The dead donor rule: Should we stretch it, bend it, or abandon it? Kennedy Institute of Ethics Journal 3: 263–278.

    Article  Google Scholar 

  89. Veatch, Robert M. 2008. Donating hearts after cardiac death–Reversing the irreversible. New England Journal Of Medicine 359: 672–673.

    Article  Google Scholar 

  90. Veatch, Robert M. 2010. Transplanting hearts after death measured by cardiac criteria: The challenge to the dead donor rule. Journal of Medicine and Philosophy 35: 313–329.

    Article  Google Scholar 

  91. Marquis, Don. 2010. Are DCD donors dead? Hastings Center Report 40: 24–31.

    Article  Google Scholar 

  92. Marquis, Don. 2014. Death as a legal fiction. American Journal of Bioethics 14: 28–29.

    Article  Google Scholar 

  93. Joffe, Ari R., Joe Carcillo, Natalie Anton, Allan deCaen, Yong Y. Han, Michael J. Bell, Frank A. Maffei, John Sullivan, James Thomas, and Gonzalo Garcia-Guerra. 2011. Donation after cardiocirculatory death: A call for a moratorium pending full public disclosure and fully informed consent. Philosophy, Ethics, and Humanities in Medicine 6: 1–20.

    Article  Google Scholar 

  94. Shewmon, D. Alan. 2010. Constructing the death elephant: A synthetic paradigm shift for the definition, criteria, and tests for death. Journal of Medicine and Philosophy 35: 256–298.

    Article  Google Scholar 

  95. Tomlinson, Tom. 1993. The irreversibility of death: Reply to Cole. Kennedy Institute of Ethics Journal 3: 157–165.

    Article  Google Scholar 

  96. Wilkinson, Dominic, and Julian Savulescu. 2012. Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation. Bioethics 26: 32–48.

    Article  Google Scholar 

  97. Miller, Franklin G., and Robert D. Truog. 2012. Going all the way: Ethical clarity and ethical progress. American Journal of Bioethics 12: 10–11.

    Article  Google Scholar 

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

    Article  Google Scholar 

  99. Tollefsen, Christopher. 2008. Ten errors regarding end of life issues, and especially artificial nutrition and hydration. In Artificial nutrition and hydration, ed. Christopher Tollefsen, 213–226. Philosophy and Medicine 93. Dordrecht: Springer.

  100. Fox, Renée C. 1993. “An ignoble form of cannibalism”: Reflections on the Pittsburgh Protocol for procuring organs from non-heart-beating cadavers. Kennedy Institute of Ethics Journal 3: 231–239.

  101. Fox, Renée C., and Judith P. Swazey. 2013. Spare parts: Organ replacement in American society, 2nd ed. New Brunswick: Transaction Publishers.

    Google Scholar 

  102. Lee, Patrick. 2016. Total brain death and the integration of the body required of a human being. Journal of Medicine and Philosophy 41: 300–314.

    Article  Google Scholar 

  103. Condic, Maureen L. 2016. Determination of death: A scientific perspective on biological integration. Journal of Medicine and Philosophy 41: 257–278.

    Article  Google Scholar 

  104. Moschella, Melissa. 2016. Integrated but not whole? Applying an ontological account of human organismal unity to the brain death debate. Bioethics 30: 550–556.

    Article  Google Scholar 

  105. DuBois, James, and Emily Anderson. 2006. Attitudes toward death criteria and organ donation among healthcare personnel and the general public. Progress in Transplantation 16: 65–73.

    Article  Google Scholar 

  106. Sinnott-Armstrong, Walter, and Franklin G. Miller. 2013. What makes killing wrong? Journal of Medical Ethics 39: 3–7.

    Article  Google Scholar 

  107. Omelianchuk, Adam. 2015. ‘Total disability’ and the wrongness of killing. Journal of Medical Ethics 41: 661–662.

    Article  Google Scholar 

  108. Jonsen, Albert R. 2001. Beating up bioethics. Hastings Center Report 31: 40–45.

    Article  Google Scholar 

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  1. The University of South Carolina, Columbia, SC, USA

    Adam Omelianchuk

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Omelianchuk, A. How (not) to think of the ‘dead-donor’ rule. Theor Med Bioeth 39, 1–25 (2018). https://doi.org/10.1007/s11017-018-9432-5

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  • DOI: https://doi.org/10.1007/s11017-018-9432-5

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