What is Death and Why Do We Insist on the Dead Donor Rule? A Response to Our Critics

Abstract

What is death: a process or a specific declaration? Is it a biological continuum of events or a decision based on medical, ethical, and legal criteria? In our view, it is both, and there are philosophical and theological, but also very pragmatic reasons why the problem of death puts our ethical concerns to the test. The procedures of organ donation, either following brain death or after circulatory arrest, reveal a critical need to discuss, to define and sometimes even to jeopardize our judgments and sensibilities on the issue.

In most cases, we contend, the question whether a patient is dead or not seems medically and even philosophically clear. Still, the many intriguing and sharp responses to our article on cDCD and the dead donor rule, for which we are most grateful, indicate that clinical praxis sometimes verges on the borders of our established rules and procedures. That points to our main reason for reconsidering the dead donor rule (DDR): As soon as we raise the question of death, we are also delving into the question of human life and its value. In the following, we will do our best to answer some key issues raised in the responding articles, but we can by no means do justice to all. And to those commentators who were concerned that we undermine ethical principles, we will once more confirm that we need the DDR in order to protect life and human dignity in the procedures of transplantation medicine. However, we will here pick up on three points that may serve the purpose of further clarifying our argument: (i) When are cDCD donors dead? (ii) How can we discuss the DDR constructively in order to rediscover its purpose? (iii) What do we mean by causation and ‘vital organs’ when it comes to definitions of death?