By Wesley J. Smith
Sunday, December 28, 2025
The “dead donor rule” (DDR) is a legal and ethical
mandate that requires vital organ donors to be truly dead before their body
parts are procured. A corollary to the rule holds that people cannot be killed
for their organs. The DDR promotes trust in the system and protects the
vulnerable — but is flexible enough to permit living donations of one kidney
and parts of a liver from altruistic donors.
Utilitarian bioethicists have long argued against the DDR and its corollary based on the
notion that killing those who are dying or want to donate will relieve the
suffering of people who want to live and need an organ. And here we go again.
The Journal of Medical Ethics — out of Oxford — has published a long and
complicated piece by Ohio bioethicist Lawrence J. Masek arguing that patients
who want to donate should be able to be killed during — or as a direct result
of — the organ-procurement process.
First, the author pulls a typical switcheroo often seen
in bioethical discourse. Here’s a relevant example: We were assured over many
years that brain dead is “dead.” Now, that this is accepted widely, many
bioethicists are claiming that actually, it isn’t. If they are right, the DDR
would preclude organ procurement from such patients. But these bioethicists
claim instead that procuring organs from those diagnosed as brain dead also
means that we can harvest comatose patients whose brains are clearly
functioning.
See how that works? Rather than stick to the rule, expand
it and pretend it is not being stretched.
This is Masek’s tactic too. He claims that since taking
one kidney in an altruistic living donation harms the patient through reduced
kidney function without violating the DDR, it is also okay to take the liver of
a patient that will lead to death a few hours later.
Similarly, he suggests surgery to save a fetus harms the
mother through incisions and the like, which she accepts as of less importance
than the life of her baby. He also says an emergency C-section that will likely
lead to the death of the mother to save the baby is an example of harm caused
that should also permit doctors to procure vital organs while the donor is
still alive. From the article (citations omitted):
Performing the
c-section would cause blood loss, which would be the cause of the woman’s
death, so the do-not-kill principle prohibits the c-section in this case, even
though the only alternative is allowing both the woman and her child to die. I
see the fact that a principle requires allowing two patients to die instead of
saving one patient as a problem for the [DDR do not kill] principle.
He also claims palliation at the end of life as another
example:
Another objection
to the do-not-kill principle is that it prohibits lethal palliation[misnomer
alert!], such as the use of an analgesic that relieves pain but also has the
side-effects of slowing respiration and causing death. Lethal palliation is
widely accepted even among proponents of the DDR
And, he even claims that volunteering to have one’s
organs taken to save others is akin to other “heroic” life sacrifices:
If people may jump
on a grenade to save other soldiers or jump in front of a speeding motorcycle
to save a child, then they may sacrifice their lives by donating a heart or
other vital organ. I agree that sacrificing one’s life to save another by
jumping on a grenade or in front of a motorcycle is analogous to sacrificing
one’s life to save another by donating a vital organ.
But these examples are utterly sophistic. The (stacked
deck) medical hypotheticals Masek offers either do not kill the patient,
or if death comes in the C-section hypothetical and end-of-life palliation
[which is not known as “lethal palliation”] examples, they would be
cases of death as undesired and unintended side effects (which can
happen in any medical procedure). (This is the principle of double effect,
which Masek misapplies in his piece.)
Moreover, in the C-section and palliation examples–as
well as refusing life support–the patient might not die as a result of the
care. You never know.
Jumping on a grenade to save other soldiers is not the
same as the soldiers throwing that person on the grenade, which would be
more akin to a surgeon killing for organs. Because whether death happens
immediately, say by taking a heart, or takes hours after taking a liver,
harvesting vital organs from a living person is intended to kill that
patient to save the life of another. Besides, such extraordinary exigencies
as the grenade example cannot be the basis of reasoned public policy.
Transforming doctors into killers would open the door to
all sorts of gruesome policies, such as euthanasia by organ harvesting. Yes,
Masek goes there:
Another reason to
accept the DDR is the belief that anyone who denies the DDR must defend
euthanasia. Permitting lethal organ procurement would enable patients to commit
suicide by donating their vital organs, but the same is true of permitting
lethal palliation and the refusal of life support. That a person could do X
(eg, donate vital organs, take a lethal painkiller or refuse life-support) as a
means of killing oneself does not mean that anyone who does X intends to kill.
(I do not defend organ donation euthanasia, which is donating a vital organ in
order to end one’s life in order to end suffering, which would be an example of
intending death as a means of relieving suffering, because I have argued that
lethal organ procurement is not necessarily an example of intending death.)
Please. Take a liver and there can be only one outcome.
The patient would know it. The doctors would know it.
Besides, euthanasia conjoined with organ harvesting is already allowed in
Belgium, New Zealand, Australia, Netherlands, and Canada–and in some cases that
has been an inducement for choosing to be killed or affected the timing of when
the death facilitation would take place–to widespread media applause.
Why do I bother to discuss this and other such articles
here? Isn’t professional discourse akin to arguing about how many angels can
dance on the head of a pin?
No! Public policy is often formulated through this very
kind of back and forth in professional journals. This kind of top-down policy
making is why feeding tubes can be legally withdrawn from unconscious patients
and gender-confused children can be administered puberty blockers in many jurisdictions.
Which is why I try to bring these ivory-tower discussions
into the public square. People need know what is being planned for them.
Because as I always say, if you want to see what is going to go very wrong
in society next, read bioethics, medical, and science journals. Some of the
articles published there will curl your toes.
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