Ethical issues in brain death and multiorgan transplantation.

There is a consensus in Western society that "brain death" is the medical and legal standard for human death. Patients in persistent vegetative states may have lost their "personhood," but they are not dead. It may be desirable to maintain the physiologic processes of a brain-dead pregnant woman to permit the birth of her child. The determination of brain death and plans for multiorgan transplantation should be conducted independently. It is axiomatic that the multiorgan transplantation donor must be dead. Therefore, living anencephalic infants and patients in persistent vegetative states cannot be organ donors. It is permissable to temporarily maintain the physiologic processes of brain-dead patients in order procure their organs for transplantation. Society will have to decide if money spent on multiorgan procurement and transplantation is better spent in other areas of health care.