Non-heart-beating donation: ethical aspects

Non-heart-beating donation (NHBD) is under considerable ethical debate including concerns that the donor is not really dead when organs are procured and that withdrawing therapy may be expedited to harvest needed organs. We suggest a two-step process to NHBD based largely on the ethical principle of beneficence. First, once a decision has been made that there is no reasonable hope of survival for the patient and that active treatment is of no further benefit and should be withdrawn, NHBD can be suggested. Second, once the decision for NHBD has been made, there is no reason for further delay and withdrawal of treatment should be implemented as rapidly as possible to ensure that the quality of the donated organs remains optimal for the maximal benefit of the organ recipient.