Jim Thomas

Many believe that the ethical problems of donation after cardiocirculatory death (DCD) have been "worked out" and that it is unclear why DCD should be resisted. In this paper we will argue that DCD donors may not yet be dead, and therefore that organ donation during DCD may violate the dead donor rule. We first present a description of the process of DCD and the standard ethical rationale for the practice. We then present our concerns with DCD, including the following: irreversibility of absent circulation has not occurred and the many attempts to claim it has have all failed; conflicts of interest at all steps in the DCD process, including the decision to withdraw life support before DCD, are simply unavoidable; potentially harmful premortem interventions to preserve organ utility are not justifiable, even with the help of the principle of double effect; claims that DCD conforms with the intent of the law and current accepted medical standards are misleading and inaccurate; and consensus statements by respected medical groups do not change these arguments due to their low quality including being plagued by conflict of interest. Moreover, some arguments in favor of DCD, while likely true, are "straw-man arguments," such as the great benefit of organ donation. The truth is that honesty and trustworthiness require that we face these problems instead of avoiding them. We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death. These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent. These are tall orders, and require open public debate. Until this debate occurs, we call for a moratorium on the practice of DCD

It's a bold but frankly risky opening shot for Kaebnick, Gusmano, and Murray to commence their report by claiming that a “majority opinion” or a “near‐con­sensus” has now been reached on the matter of synthetic biology. Risky because “majority opinions,” even in well‐established controversies, are highly unstable (events will have many surprises in store) but also risky because... well... the majority of whom, exactly? North American bioethicists? Invitees to Washington roundtable discus­sions? Or some sort of broader meaningful public major­ity? According to the authors, the particular unspecified majority they have in mind agrees that a social contract of sorts has already been hammered out in which “society should allow the technology to proceed and even provide it some financial support.”Has the burgeoning debate over synthetic biology re­ally already come to a gentleman's agreement brokered roughly along terms described by the U.S. President's Commission for the Study of Bioethical Issues in its re­port of 2011? I don't think so.