dead donor rule

Wesley J. Smith appeared on the Vicki Mckenna Show on August 28, 2026, to discuss the debates occurring in bioethics and medical journals to make previously unthinkable things acceptable and regularly practiced. For instance, they discuss how treating gender dysphoria in young children with puberty blockers was once unthinkable, but after being debated in the professional journals, it has been widely accepted. Now, bioethicists are proposing that the “dead donor rule” should be done away with in order to harvest organs. Read “‘Death by Organ Donation’ Pushed in Prestigious Medical Journals”

The late Fr. Richard John Neuhaus famously wrote that bioethicists “professionally guide the unthinkable on its passage through the debatable on its way to becoming the justifiable until it is finally established as the unexceptional.”

He was right. Radical bioethical policies don’t just appear like magic out of the ether. Controversial—even pernicious—ideas are often debated in bioethics and medical journals where few among the public ever see them. Then, if a general consensus is reached within the field, policies once considered “unthinkable” are “suddenly” elevated into the justifiable and become unexceptional public policy.

Here are just two examples. Legalizing assisted suicide was once way beyond the pale. Then, bioethicists began arguing in favor of such laws, after which hastened death became debatable, then justifiable, and now, in many jurisdictions, so unremarkable that many thousands of people have died by that method.

The legalization of assisted suicide/euthanasia corrupts medical ethics and not just because killing patients or assisting their suicides is a direct violation of the Hippocratic oath. No: Transforming sick and disabled people into a killable caste also objectifies them as potential natural resources to be mined or harvested.

Hastened death and organ-harvesting have already been conjoined in Canada, Australia, New Zealand, Spain, the Netherlands, and Belgium. (In the latter two countries, some cases have involved mentally ill patients.) The practice has been supported in prominent medical journals. It is not alarmism to note that the idea is gaining ever wider acceptance among the medical and bioethics intelligentsia.

But killing and then harvesting doesn’t go far enough for some mainstream bioethicists. Where euthanasia is legal, they don’t see why organ procurement can’t also be the means of death for patients who want to donate. In other words, don’t just kill and then harvest; harvest to kill.

Euthanasia conjoined with organ harvesting just took a particularly disturbing turn in Spain, where a woman was euthanized and then had part of her face transplanted. From the Catalan News story: Vall d’Hebron University Hospital in Barcelona has performed the world’s first face transplant with a donor who passed away from euthanasia. Around 100 medical professionals took part in the partial face transplant, a highly complex operation using neurovascular microsurgery techniques that lasted about 24 hours. In presenting the milestone procedure, the healthcare director, Maria José Abadías, highlighted the “extraordinary generosity of the donor,” the “collective effort” behind the operation and the “pride” of all workers who took part in it. Don’t get me wrong. There is no inherent moral Read More ›

I welcome Lawrence Masek’s response to my criticism of his journal article. I am sorry he didn’t appreciate my perspective, but I take nothing back.

Let’s start with a matter of little importance. Masek claimed I said his article would curl your toes. No, I wrote that I cover articles published in the professional journals because “some” of them would. Whether your digits react to his effort thusly is a matter for you to decide.

As to the substance of his rebuttal, Masek claims at great length that the dead donor rule, which forbids killing for organs, would also prohibit many common interventions in clinical medicine as “suicide.” He writes:

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.

This is verifiably untrue. Dying from a side effect of an ethical medical treatment like palliation is not suicide any more than a patient dying during heart surgery is euthanasia.

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 Read More ›

The “dead donor rule” is the cement that binds the public’s trust in organ transplant medicine. Under the DDR (other than in living donations, such as of one kidney) organs cannot be procured unless donors, in the words of the Munchkins, are not merely dead but really most sincerely dead.

There are two means of declaring death. Let’s call the first “heart death,” that is an irreversible cessation of all cardio/pulmonary function. The other is popularly known as “brain death,” (death declared by neurological criteria) in which function in the whole brain and each of its constituent parts have irreversibly ceased. The key word in both means of declaring death is “irreversible.”

But something appears to have gone badly off the rails in the field of procuring organs after heart death. A long New York Times expose found cases of patients who were clearly alive when organ procurement began. At the same time, a very disturbing report by the Department of Health and Human Services contained similar findings.

First, the NYT. From “A Push for More Organ Transplants Is Putting Donors at Risk”:

Last spring at a small Alabama hospital, a team of transplant surgeons prepared to cut into Misty Hawkins.…Days earlier, she had been a vibrant 42-year-old with a playful sense of humor and a love for the Thunder Beach Motorcycle Rally. But after Ms. Hawkins choked while eating and fell into a coma, her mother decided to take her off life support and donate her organs. She was removed from a ventilator and, after 103 minutes, declared dead.

A surgeon made an incision in her chest and sawed through her breastbone. That’s when the doctors discovered her heart was beating. She appeared to be breathing. They were slicing into Ms. Hawkins while she was alive.

The horror! Why are such awful things happening?