File this in the “As If We Don't Already Have Enough to Worry About” file:

Leading members of the organ transplantation community—backed by some bioethicists—have been waging a quiet campaign for more than ten years to do away with the “dead donor rule,” a crucial ethical protection that requires donors of non paired vital organs to have died before their body parts can be procured.

This isn't a fringe movement.

Indeed, an article urging the extinction of the dead donor rule just appeared in the New England Journal of Medicin , probably the most prestigious medical journal in the world. ("The Dead Donor Rule and Organ Transplantation" NEJM (359:7, August 14, 2008).

The authors, Robert D. Troug, MD, a physician at Harvard Medical School, and Franklin D. Miller, a bioethicist at the NIH, claim that patients brain dead may not really be dead, since, as one example, some patients declared dead by neurological criteria secrete certain hormones.

Nor, they argue, should patients whose organs are procured under protocols that permit harvesting two-to- five minutes after full cardiac arrest be considered deceased because some of these patients might be resuscitated with vigorous CPR.

But if they are right—and be clear, I don't accept their premise—then surely the ethical answer isn't to broaden the categories of living patients who are harvested!

Rather it is just the opposite; to tighten the rules to ensure that organs are taken from only truly dead patients. Otherwise, medical ethics will be mutated into mere medical expediency.

Troug and Miller disagree. Rather than death being the primary ethical consideration, they argue, the real issue should be that old catchall that justifies multitudinous wrongs; "choice.” They write:

Whether death occurs as the result of ventilator withdrawal or organ procurement, the ethically relevant precondition is valid consent by the patient or surrogate. With such consent, there is no harm or wrong done in retrieving vital organs before death, provided that anesthesia is administered. With proper safeguards, no patient will die from vital organ donation who would not otherwise die as a result of the withdrawal of life support.

No. No. No.

First, not all patients whose life support is removed necessarily die. More to the point, why should we trust bioethicists and organ transplant professionals to enforce "proper safeguards" when this article claims that the current safeguards aren't adequate despite our having been assured for years that they are?

And if the only thing that matters is consent, why not let any seriously ill patient be killed for their organs? Indeed, why not suicidal people who aren't otherwise sick?

Efforts to undermine the dead donor rule are not only wrong morally, they are profoundly unwise.

If members of the transplant community keep pushing to permit killing for organs, that sound you hear will the mass tearing up of organ donor cards by masses of people who want to be really and truly dead before their livers, hearts, and kidneys are made available for the use of other people.

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