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The price of our illusions and myths about the dead donor rule
  1. Robert Truog
  1. Correspondence to Dr Robert Truog, Center for Bioethics, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA; robert_truog{at}

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The recent consensus statement from the American Thoracic Society perfectly captured the central ethical dilemma in organ procurement: ‘the tension between the need for both “live organs” and a “dead donor” has required the development of very explicit criteria for declaring the “moment” of death, despite the absence of a biological basis for this degree of precision’.1

As such, what is most notable about the paper by Dalle Ave et al2 is their description of how the transplantation community has twisted themselves into pretzels creating ethical justifications for increasingly contrived ways to extract functioning organs from people deemed to be dead. In so doing, they are sustaining ethical myths and illusions that have ceased to have any face validity in terms of common sense clinical practice. Let me explain.

The driving force behind these contortionist efforts is the so-called dead donor rule (DDR), which seeks to establish a bright line, or ethical firewall, between the dying process and organ procurement.3 But this bright line has always been an illusion. In donation following the diagnosis of brain death, for example, the living body of a person with a devastating brain injury is fully supported until after the organs can be removed. In donation after …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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