Miller Franklin G, Truog Robert D, Brock Dan W
National Institutes of Health, Bethesda, MD 20892-1156, USA.
J Med Philos. 2010 Jun;35(3):299-312. doi: 10.1093/jmp/jhq019. Epub 2010 May 3.
Transplantation of vital organs has been premised ethically and legally on "the dead donor rule" (DDR)-the requirement that donors are determined to be dead before these organs are procured. Nevertheless, scholars have argued cogently that donors of vital organs, including those diagnosed as "brain dead" and those declared dead according to cardiopulmonary criteria, are not in fact dead at the time that vital organs are being procured. In this article, we challenge the normative rationale for the DDR by rejecting the underlying premise that it is necessarily wrong for physicians to cause the death of patients and the claim that abandoning this rule would exploit vulnerable patients. We contend that it is ethical to procure vital organs from living patients sustained on life support prior to treatment withdrawal, provided that there is valid consent for both withdrawing treatment and organ donation. However, the conservatism of medical ethics and practical concerns make it doubtful that the DDR will be abandoned in the near future. This leaves the current practice of organ transplantation based on the "moral fiction" that donors are dead when vital organs are procured.
重要器官移植在伦理和法律上一直以“死亡供体规则”（DDR）为前提——即要求在获取这些器官之前确定供体已经死亡。然而，学者们有力地论证了，重要器官的供体，包括那些被诊断为“脑死亡”的供体以及根据心肺标准被宣布死亡的供体，在获取重要器官时实际上并未死亡。在本文中，我们通过拒绝其潜在前提（即医生导致患者死亡必然是错误的）以及放弃该规则会剥削弱势患者的说法，来挑战DDR的规范依据。我们认为，在撤掉维持生命支持治疗之前，从依赖生命支持维持生命的活体患者身上获取重要器官是符合伦理的，前提是撤掉治疗和器官捐献都有有效的同意。然而，医学伦理的保守性和实际问题使得DDR在近期被放弃的可能性存疑。这使得当前基于“道德虚构”（即在获取重要器官时供体已死亡）的器官移植做法得以延续。
