Should Doctors Relax the 'Dead-Donor Rule' to Increase Organ Transplants?


When I was a student, a trauma surgeon described how, in the early days of transplants, he had to physically restrain the transplant surgeons from “harvesting” the kidneys of potential donors. So enthusiastic were surgeons about this exhilarating technology that they were willing to sacrifice one life for another, for they tended to count a life saved by transplant as being of more than ordinary value, perhaps double; and, no doubt irrationally, I have remained mildly suspicious of them, the transplant surgeons, ever since.

There were two opposing articles in a recent edition of the New England Journal of Medicine about the ethics of transplantation. For a number of years the supply of organs for transplant has not equalled the demand, and one way of meeting it would be to relax slightly the rules governing the removal of transplantable organs from donors. At the moment the dead-donor rule (known as the DDR -- an acronym that for me still brings first to mind the German Democratic Republic) prevails, according to which the donation of an organ must not kill the donor.

One of the authors suggests that the DDR is routinely violated in any case and that, in so far as it is obeyed, it limits the number of organs available for transplant and thereby allows people to die who could have been saved. But, says the author, “it is not obvious why certain living patients, such as those who are near death but on life support, should not be allowed to donate their organs, if doing so would benefit others and be consistent with their own interests. ... Allegiance to the DDR ... limits the procurement of transplantable organs by denying some patients the option to donate in situations in which death is imminent and donation is desired.”