Recently, several articles in the scholarly literature on medical ethics proclaim the need for "responsible scholarship" in the debate over the proper criteria for death, in which "responsible scholarship" is defined in terms of support for current neurological criteria for death. In a recent article, James M. DuBois is concerned that academic critiques of current death criteria create unnecessary doubt about the moral acceptability of organ donation, which may affect the public's willingness to donate. Thus he calls for a closing of the debate on current death criteria and for journal editors to publish only critiques that "substantially engage and advance the debate." We argue that such positions as DuBois' are a threat to responsible scholarship in medical ethics, especially scholarship that opposes popular stances, because it erodes academic freedom and the necessity of debate on an issue that is literally a matter of life and death, no matter what side a person defends.

It is worrying to see that, while acknowledging that “deciding when human beings are dead” is one of the “ethical issues involved in the area of organ transplantation,”1 the American Academy of Pediatrics set it …

The donation of organs after cardiac death in infants is not morally justified and should not be continued.

Ben Saunders claims that actual consent is not necessary for organ donation due to 'normative consent', a concept he borrows from David Estlund. Combining normative consent with Peter Singer's 'greater moral evil principle', Saunders argues that it is immoral for an individual to refuse consent to donate his or her organs. If a presumed consent policy were thus adopted, it would be morally legitimate to remove organs from individuals whose wishes concerning donation are not known. This paper disputes Saunders' arguments. First, if death caused by the absence of organ transplant is the operational premise, then, there is nothing of comparable moral precedence under which a person is not obligated to donate. Saunders' use of Singer's principle produces a duty to donate in almost all circumstances. However, this premise is based on a flawed interpretation of cause and effect between organ availability and death. Second, given growing moral and scientific agreement that the organ donors in heart-beating and non-heart-beating procurement protocols are not dead when their organs are surgically removed, it is not at all clear that people have a duty to consent to their lives being taken for their organs. Third, Saunders' claim that there can be good reasons for refusing consent clashes with his claim that there is a moral obligation for everyone to donate their organs. Saunders' argument is more consistent with a conclusion of 'mandatory consent'. Finally, it is argued that Saunders' policy, if put into place, would be totalitarian in scope and would therefore be inconsistent with the freedom required for a democratic society.

Your Editorial's call for serious discussion of laws governing the diagnosis of death (Nature 461, 570; 2009) is most welcome, if long overdue. It is imperative that those involved in the practice of transplantation know the status of organ donors.

In this paper, we argue that living kidney donation involves a violation of the principle of non-maleficence, to "do no harm." It is, therefore, morally wrong for physicians, surgeons, and other medical professionals to be involved in such a practice. Using kidney donation as an example, we discuss recent literature on both short-term and long-term risks to the kidney donor and argue that such risks make the practice of living donor nephrectomy unethical. By extension, the even more risky donation of other solid organs during life is also unethical.