DEATH AND THE

DEAD DONOR RULE

Prepared by: Hazel Imee M. Castor, RN

WHAT IS DEATH?

Definition
Medical Definiton
Death is the permanent cessation of all bodily function.
Legal Definiton
-Cessation of life as indicated by the absence of blood
circulation, respiration, pulse, and other vital functions.

Definition
Legal and Medical Purposes Definiton
Death is the irreversible cessation of all of the following:
EEG assessed flat-lined total cerebral function;
Spontaneous function of the respiratory system;
Spontaneous function of the Circulatory System

Definition
In 1980, According to UDDA (Uniform
Determination of Death Act), it is an
irreversible cessation of circulatory
and respiratory functions and
irreversible of all functions of the brain.
(Mappes and De Grazia, 2001)

Background
1954 - The era of clinical organ transplantation began
Joseph Murray transplanted a kidney from one identical twin
into another.
Liver and heart transplantation, both of which require organs
that could be obtained only from people who are already
dead, became realities, respectively, in 1963 (Thomas Starzl)
and 1967 (Christiaan Barnard). Survival rates after both liver
and heart transplantation remained low until the introduction
of cyclosporine in 1980.

Background
Demand for increasing numbers of organs, especially from
dead individuals, producing a paradox: the need for both a
living body and a dead donor.

 There is only one kind of death when one is dead, one is

dead but death can be determined in the two different
ways described in the law. A brain dead individual who is
warm and pink with heart beating and lungs ventilating is just
as dead, legally, as an individual whose body has turned cold
after the heart has permanently stopped beating

DEAD DONOR RULE

 The DDR is neither a law nor a regulation it is a

description of an ethical norm: an organ donor must be dead
before vital organs are removed.

Dead Donor Rule

The donor must first be dead for
managing potential organ
donors.

Dead Donor Rule

A persons life and care must never be
compromised in favour of the potential
organ recipients
(Mappes and De Grazia, 2001)

HOW DEAD YOU HAVE TO BE?

Brain Dead
All of the functions of the human
brain have come to a permanent
stop.

Issues Concerning the Dead

Donor Rule

BRAIN DEAD DONORS ARE NOT

REALLY DEAD
Many patients who meet all
the criteria for brain death
do not in fact have
irreversible cessation of all
functions of the entire brain.

WITHDRAWING LIFE SUPPORT CAUSES DEATH

It is not a legally or morally culpable act.
The claim that if withdrawing life support causes death, it is
unethical is a non sequitur because the central issue here is
not causation, but is the overriding principle of respect for the
patient's autonomy.

WITHDRAWING LIFE SUPPORT CAUSES

DEATH
The right of self-determination can be exercised by a
competent person directly or through an advance directive,
or by a proxy appointed by the patient or a legally authorized
surrogate agent.

MAINTAINING MECHANICAL VENTILATION

FOR BRAIN DEAD PATIENTS
When the potential donor is declared dead, the dead patient
continues to remain in a mechanical ventilator as if still living
until the organs are harvested.
This picture leaves healthcare professionals and families
with feeling of ambiguity. Nurses experience moral suffering.

RECOVERING VITAL ORGANS FROM THE

NEARLY DEAD IS ETHICALLY
ACCEPTABLE
Given valid consent for withdrawing life support and for
organ donation, if it is acceptable to cause a brain dead
patient's death by withdrawing life support, then it logically
must be acceptable to cause the patient's death by recovery
of vital organs before withdrawal of life support.

A HIGHER BRAIN STANDARD OF DEATH

Many bioethicists are discussing the pros
and cons of altering or overturning the dead
donor rule so that organs can be retrieved
from patients who have no higher brain
function but do have lower brain function
such as those in persistent vegetative state
and babies born with anencephaly.
(e.g., Koppelman 2003, Veatach, 2003)

A Severe Shortage of Organs for

babies
A severe shortage of
organs exists for babies.
One of the main reasons
that anencephalic babies
are not considered more
often for organ donation is
that by the time they meet
brain death criteria, their
organs are usually too
damaged to be of use.

IS ABANDONEMENT OF DDR IS
FEASIBLE?
The DDR is needed as a safeguard against removal of
organs prematurely under the pressure of increasing the
number of organs available for transplantation.

 In answer to this, it is not the DDR that prevents such

abuses, rather, the real safeguards are three requirements
that are currently in effect:
a valid decision
valid consent
no conflicts of interest in the consent process

 The rationale for abandoning the DDR has radical theoretical

implications: the physician who withdraws life support causes
the patient's death (not the underlying disease), brain death
does not constitute death of a person, and surgeons recover
organs from donors who are dying, not actually dead.

Conclusion
The Dead Donor Rule should continue to be observed in
transplant practice. But the definition of death can advance
over the centuries, as science develops more precise tests of
brain function.

 Giving organs to people

who can make good use of
them will allow other people
to have many more years of
meaningful life.

References
Barbor, LL.B., Bioethics: A Philosophical Journey and A critical Analysis into the
Life Sciences: A Guide to Healthcare Providers Second Edition, 2010, pp 73-79
Butts J, Rich K. Nursing Ethics Across the Curriculum and into Practice, 2006
Encyclopedia of Death and Dying. http://www.deathreference.com/DaEm/index.html retrieved April 21, 2016
Greenberg G. The New Yorker. 2001. Aug 13, As good as dead; p. 36.
Gupta and Gupta. Illustrated pocket Nurses Dictionary, 2008

References
Miller FG, Truog RD. Rethinking the Ethics of Vital Organ Donations.
Hastings Center Report. 2008;
Miller FG, Truog RD, Brock DW. Moral Fictions and Medical Ethics.
Bioethics. 2010
Siminoff LA, Burant C, Youngner SJ. Death and organ procurement:
public beliefs and attitudes. Kennedy Inst Ethics J. 2004
Truog RD, Robinson WM. Role of Brain Death and the Dead Donor
Rule in the Ethics of Organ Donation. Critical Care Med. 2003

Thats all! Thank YOU!