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3 Am. J. Bioethics 1 (2003)

handle is hein.journals/ajbio3 and id is 1 raw text is: 





The Dead Donor Rule and the


Concept of Death: Severing the


Ties That Bind Them

Elysa R. Koppelman, Oakland University



One goal of the transplant community is to seek ways to increase the number of people who are
willing and able to donate organs. People in states between life and death are often medically excel-
lent candidates for donating organs. Yet public policy surrounding organ procurement is a delicate
matter. While there is the utilitarian goal of increasing organ supply, there is also the deontologic
concern about respect for persons. Public policy must properly mediate between these two con-
cerns. Currently the dead donor (dd) rule is appealed to as an attempt at such mediation. I argue
that given the lack of consensus on a definition of death, the dd rule is no longer successful at medi-
ating utilitarian and deontologic concerns. I suggest instead that focusing on a particular person's
history can be successful.


Advances in medical technology have enabled us to
isolate and separate the three main components
thought to be central to death-components that
previously seemed to happen almost simulta-
neously. While one's brain, heart, and breathing
used to stop functioning within moments of each
other, advances in technology have enabled us to
maintain the functions of some even though others
have been lost. These suspended states have called
into question our previous ideas about life and
death. While people in PVS (permanent vegetative
state) or who satisfy the criteria for brain death do
not appear to fit our previous conceptions of death,
neither do they fit our previous conceptions of liv-
ing. Through technological advances we have cre-
ated slippery areas between life and death. Or, per-
haps more accurately, we have extended these
states, enabling their discovery and forcing us to
deal with them. Should we mourn for the patient
in PVS? Should her marriage be dissolved? Can we
take organs from her?
   There is currently an organ shortage. While the
number of patients awaiting transplants continues
to increase, the number of organ donors remains
virtually unchanged. The transplant community
continually seeks ways to increase the number of
people who are willing and able to donate organs.
People in states between life and death are often
medically excellent candidates for donating organs.
Basic body functions can be maintained, keeping
organs fresh. And taking organs from these pa-


tients will increase the organ supply. Yet public
policy surrounding organ procurement is a delicate
matter. While there is the utilitarian goal of in-
creasing the organ supply, there is also the deonto-
logic concern about respect for persons. The end of
increasing the organ supply is a good one. But the
goodness of the end does not justify using any
means to achieve that end. Potential donors should
not be treated as mere means to the end of organ
procurement. We should not harm potential do-
nors in the name of utilitarian goals, but we would
harm potential donors by failing to treat them
with respect.
   We can thus characterize the concerns of the or-
gan transplant community as the attempt to recon-
cile or mediate the utilitarian goal with deonto-
logical considerations about respect for persons.
The question that needs to be answered is this:
how can we successfully temper efforts to foster the
utilitarian goal without at the same time sig-
nificantly undermining that goal? Currently, deci-
sions about harvesting organs are made according
to a principle called the dead donor rule (dd rule),
which tempers the utilitarian goal of increasing
the organ supply on the basis of a distinction be-
tween life and death. According to the dd rule it is
immoral to kill patients by taking their organs.
This means that living persons cannot donate vital
organs and cannot donate nonvital organs if doing
so would lead to death. Advocates of the dd rule
seem to suggest that life gives people a particular


Keywords

dead donor rule
organ donation
organ procurement
definition of death
persistent vegetative state
(PVS)
public policy

Open Peer
Commentary

Robert M. Veatch, p. 10
Noam J. Zohar, p. 12
James Lindemann Nelson,
p. 13
James J. McCartney, p. 15
David Steinberg, p. 17
Bethany Spielman, p. 18
Wayne Shelton, p. 20
Jerry Menikoff. p. 21
Denise M. Dudzinski, p. 23
D. Micah Hester, p. 24
Barbara A. Koenig, p. 26
Timothy Lillie, p. 28
Sheldon Zink, p. 29
Laura A. Siminoff. p. 30
Howard Trachtman, p. 31


ajob 1


Winter 2003, Volume 3, Number 1
@ 2003 by The MIT Press


I TargetArticle

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