National Review
Bioethicist: Let Surgeons Kill Patients During Organ Harvesting
By Wesley J. Smith
December 28, 2025 11:18 AM
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 — out of Oxford — has published a long and complicated piece by Ohio bioethicist Lawrence J. Masek arguing that patients who want to donate should be able to be killed during — or as a direct result of — the organ-procurement process.
First, the author pulls a typical switcheroo often seen in bioethical discourse. Here’s a relevant example: We were assured over many years that brain dead is “dead.” Now, that this is accepted widely, many bioethicists are claiming that actually, it isn’t. If they are right, the DDR would preclude organ procurement from such patients. But these bioethicists claim instead that procuring organs from those diagnosed as brain dead also means that we can harvest comatose patients whose brains are clearly functioning.
See how that works? Rather than stick to the rule, expand it and pretend it is not being stretched.
This is Masek’s tactic too. He claims that since taking one kidney in an altruistic living donation harms the patient through reduced kidney function without violating the DDR, it is also okay to take the liver of a patient that will lead to death a few hours later.
Similarly, he suggests surgery to save a fetus harms the mother through incisions and the like, which she accepts as of less importance than the life of her baby. He also says an emergency C-section that will likely lead to the death of the mother to save the baby is an example of harm caused that should also permit doctors to procure vital organs while the donor is still alive. From the article (citations omitted):
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Performing the c-section would cause blood loss, which would be the cause of the woman’s death, so the do-not-kill principle prohibits the c-section in this case, even though the only alternative is allowing both the woman and her child to die. I see the fact that a principle requires allowing two patients to die instead of saving one patient as a problem for the [DDR do not kill] principle.
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He also claims palliation at the end of life as another example:
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Another objection to the do-not-kill principle is that it prohibits lethal palliation[misnomer alert!], such as the use of an analgesic that relieves pain but also has the side-effects of slowing respiration and causing death. Lethal palliation is widely accepted even among proponents of the DDR
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And, he even claims that volunteering to have one’s organs taken to save others is akin to other “heroic” life sacrifices:
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If people may jump on a grenade to save other soldiers or jump in front of a speeding motorcycle to save a child, then they may sacrifice their lives by donating a heart or other vital organ. I agree that sacrificing one’s life to save another by jumping on a grenade or in front of a motorcycle is analogous to sacrificing one’s life to save another by donating a vital organ.
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But these examples are utterly sophistic. The (stacked deck) medical hypotheticals Masek offers either do not kill the patient, or if death comes in the C-section hypothetical and end-of-life palliation [which is not known as “lethal palliation”] examples, they would be cases of death as undesired and unintended side effects (which can happen in any medical procedure). (This is the principle of double effect, which Masek misapplies in his piece.)
Moreover, in the C-section and palliation examples–as well as refusing life support–the patient might not die as a result of the care. You never know.
Jumping on a grenade to save other soldiers is not the same as the soldiers throwing that person on the grenade, which would be more akin to a surgeon killing for organs. Because whether death happens immediately, say by taking a heart, or takes hours after taking a liver, harvesting vital organs from a living person is intended to kill that patient to save the life of another. Besides, such extraordinary exigencies as the grenade example cannot be the basis of reasoned public policy.
Transforming doctors into killers would open the door to all sorts of gruesome policies, such as euthanasia by organ harvesting. Yes, Masek goes there:
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Another reason to accept the DDR is the belief that anyone who denies the DDR must defend euthanasia. 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. That a person could do X (eg, donate vital organs, take a lethal painkiller or refuse life-support) as a means of killing oneself does not mean that anyone who does X intends to kill. (I do not defend organ donation euthanasia, which is donating a vital organ in order to end one’s life in order to end suffering, which would be an example of intending death as a means of relieving suffering, because I have argued that lethal organ procurement is not necessarily an example of intending death.)
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Please. Take a liver and there can be only one outcome. The patient would know it. The doctors would know it.
Besides, euthanasia conjoined with organ harvesting is already allowed in Belgium, New Zealand, Australia, Netherlands, and Canada–and in some cases that has been an inducement for choosing to be killed or affected the timing of when the death facilitation would take place–to widespread media applause.
Why do I bother to discuss this and other such articles here? Isn’t professional discourse akin to arguing about how many angels can dance on the head of a pin?
No! Public policy is often formulated through this very kind of back and forth in professional journals. This kind of top-down policy making is why feeding tubes can be legally withdrawn from unconscious patients and gender-confused children can be administered puberty blockers in many jurisdictions.
Which is why I try to bring these ivory-tower discussions into the public square. People need know what is being planned for them. Because as I always say, if you want to see what is going to go very wrong in society next, read bioethics, medical, and science journals. Some of the articles published there will curl your toes.
