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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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