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An unquestioned assumption in the debate on the dead donor rule
  1. Michael Nair-Collins
  1. Correspondence to Dr Michael Nair-Collins, Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL 32304, USA; michael.nair-collins{at}

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Frank Miller and I recently argued that the common assertion that ‘brain dead’ patients merely appear to be alive, though in reality are dead, is false.1 This assertion relies on an inaccurate and overly simplistic understanding of the role of medical technology in the physiology of a ‘brain dead’ patient. In response, Symons and Chua endorsed our conclusions regarding the vital status of the ventilated ‘brain dead’ patient, and then pursued the question: what does this imply if we are to preserve the dead donor rule?2

To their credit, Symons and Chua unflinchingly acknowledge that if we seek to maintain the dead donor rule then we must restrict not expand the donor pool because ‘brain dead’ individuals are still living. This would mean fewer organs, and hence more deaths of those on the waiting list. This is the price of holding to the conviction that doctors must never kill patients in order to procure organs for transplantation. Of course, that has always been the price: the dead donor rule is principally a deontic prohibition, not a consequentialist rule designed to maximise good outcomes.

Symons’s and Chua’s view is a valid position in the debate on death and the ethics of vital organ procurement, and …

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  • i The estimate of $6.1 billion was derived by summing the total calendar-year Medicare costs of each class of organ recipient for 2014, from Tables 5, 10, 15, 20, 25 and 30 in Schnitzler et al 2018 (reference 8). This should not be construed as an estimate of the cost of new transplants in 2014 alone; instead, this cross-sectional single year estimate includes initial transplantation costs for those individuals who received a transplant in 2014 as well as follow-up costs for individuals who received a transplant prior to 2014 (and for whom Medicare was the payer). My thanks to Erica Heasley for locating and compiling this information.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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