Proposal to Allow “Death by Organ Donation” for Euthanasia Patients

A paper in the *New England Journal of Medicine* outlines a controversial model called “Death by Organ Donation.” Under this framework, patients who have chosen physician-assisted euthanasia would be anesthetized and have their hearts, lungs, livers and kidneys removed while the organs are still functioning, rather than after a lethal drug has been administered. Proponents argue that this would preserve organ viability and honor the donor’s altruistic intent.

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U.S. law currently prohibits removing organs from living patients, adhering to the Dead Donor Rule, which requires death before procurement. While several states have legalized assisted-suicide, the practice of surgically extracting organs from a patient who is still alive remains illegal nationwide. Countries such as Canada, the Netherlands and Spain permit physician-assisted death, but they still require organ removal only after death.

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• “It would be an ethical thing to do because this is something the patients have chosen for themselves.” — Dr. Robert Truog, physician and bioethicist, Harvard Medical School

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• “If we're committed to respecting the autonomy of individuals at the end of their life… that's the ethical justification for death by donation.” — Ruth Faden, bioethicist, Johns Hopkins University

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• “This is asking surgeons to take a living person into the operating room and to come out with a dead person, which I think is murder.” — Lainie Friedman Ross, bioethicist, University of Rochester

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• “You could be doing real damage to both the physician-assisted suicide system and the organ donation system.” — Lori Andrews, bioethicist and professor emerita, Chicago-Kent College of Law

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• “If there are people who want to donate organs, this would be the way to maximize their wishes and their altruistic goal to help others.” — Dr. Carter Winberg, critical-care physician, Harvard

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Opponents warn that the model could erode public trust in both organ donation and end-of-life care, likening the procedure to “murder” and suggesting it may create a perception of physicians as “vultures.” Concerns also focus on the possibility of expanding the practice beyond euthanasia patients to those in hospice or assisted-suicide contexts, potentially opening avenues for abuse.

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The authors of the proposal call for a new ethical conversation about linking euthanasia with organ donation, emphasizing the need for stringent safeguards and informed-consent protocols before any legislative or clinical changes are considered.

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