Body as Resource: The Mainstreaming of Death by Organ Donation
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Editorial Analysis | July 2026
They Are Shifting Architecture of Death
The Dead Donor Rule has stood as a foundational principle of transplant medicine for decades. Physicians must not cause a patient’s death to obtain organs for transplantation. Organs may only be recovered after death has been declared. This principle, rooted in the Hippocratic tradition’s prohibition against taking life, has provided the ethical framework within which organ transplantation has developed into one of modern medicine’s most remarkable achievements.
Yet the rule has come under sustained assault from multiple directions. In a 2018 paper published in the New England Journal of Medicine, Dr. Robert Truog of Harvard Medical School and his colleagues proposed that physicians should be permitted to administer a lethal injection or withdraw life support with the explicit intention of enabling immediate organ procurement, provided the patient has consented. The concept, dubbed “death by organ donation,” would allow euthanasia patients to donate organs while their hearts are still beating, eliminating the ischemia time that damages organs recovered after death (Ball, Sibbald, & Truog, 2018).
The logic appears superficially compelling. Patients who have chosen euthanasia, the argument goes, should be permitted to maximise the good their bodies can do at the end of their lives. As Truog told National Public Radio: “It would be an ethical thing to do because this is something the patients have chosen for themselves. They have very generously thought: ‘How might my death help other people?’ It’s a very altruistic, generous thing to do” (Stein, 2026).
Ruth Faden, a bioethicist at Johns Hopkins University, acknowledged the proposal’s disturbing implications while endorsing its underlying logic: “The concept of death by donation is an extremely troubling notion at first glance. It’s a creepy idea. But in fact if you look at it critically in terms of the foundational ethical considerations, it’s not as disturbing as it first appears” (Stein, 2026). Faden’s reasoning rests on the spread and acceptance of euthanasia and the desires of some patients to be organ donors. If society is committed to respecting individual autonomy at the end of life, and if patients prefer to maximise the good their bodies can do, then death by donation possesses an ethical justification.
The proposal has not gone unchallenged. Lainie Friedman Ross, a bioethicist at the University of Rochester, condemned the concept as fundamentally incompatible with medical ethics: “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. There are limits to consent. And one of the things we’re not allowed to do is consent to saying that somebody else can just murder you” (Stein, 2026). Lori Andrews, professor emerita at Chicago-Kent College of Law, warned that the approach would undermine trust in both organ donation and end-of-life care: “It might give people the image that these are vultures that no longer wait until you die to attack. It does give up visions of body snatchers from prior centuries” (Stein, 2026).
The NEJM paper is not an isolated provocation but rather part of a broader pattern. In 2016, Dr. Zoe Fritz of Warwick Medical School published a paper in the Journal of Medical Ethics arguing that it could be in the “best interests” of an unconscious patient in a persistent vegetative state to have a drug administered to stop their heart and their organs donated to a family member. Fritz argued that “’Best interests’ should include the interests that people have previously expressed in the well-being of others; this extends to altruistic deeds” (Fritz, 2016). Edward Furton of the National Catholic Bioethics Center responded that the argument represented a purely utilitarian calculus that showed no appreciation for the inherent value of the human body. “Persons in the persistent vegetative state are not dead and are not dying,” Furton argued. “They should not have their food and water taken away. When that is done, the cause of death is not an underlying disease but the lack of hydration” (Jones, 2016).
The Canadian Precedent
The theoretical proposals advanced in medical journals have found practical expression in Canada, where euthanasia and assisted suicide have been legal since 2016. The Canadian regime has expanded rapidly. In 2021, Canada extended eligibility for Medical Assistance in Dying (MAID) to individuals whose natural death is not reasonably foreseeable, a decision that profoundly altered the scope of the practice. The Canadian government has projected that the number of MAID deaths will exceed 100,000 between 2023 and 2027, representing approximately 7 per cent of all deaths in the country (Health Canada, 2024).
The practical implications of this expansion have been documented in the medical literature. A 2019 study published in JAMA reported that a single Belgian centre had performed 409 liver transplants, of which 11, or 2.7 per cent, were from cadavers of patients following death by euthanasia (Gilbo et al., 2019). The study authors noted that survival outcomes were comparable to those from brain-dead donors. In Canada, doctors have been harvesting organs from patients who underwent medically assisted death since the practice was legalised (Kirkey, 2017).
The trajectory of Canadian policy has raised concerns about the protection of vulnerable populations. The Canadian government has rejected amendments that would have specifically protected individuals with disabilities, mental illness, or other vulnerabilities from being steered toward MAID. A 2015 study published in the NEJM found that of 3,882 deaths due to physician-assisted suicide or euthanasia in Flanders, Belgium, in 2013 alone, 1,047 (27 per cent) involved physicians deciding to administer medication dosages to hasten death without patients’ explicit consent. These patients were generally unconscious and may or may not have had family members present (Chambaeere et al., 2015). A statement by the Belgian Society of Intensive Care Medicine asserts that “shortening the dying process” should be permissible “with use of medication… even in absence of discomfort” (Vincent et al., 2014). Two prominent physicians, one from the Netherlands and another from Harvard, have characterised such practices as murder (Ely, 2019).
The disability rights community has been particularly vocal in its opposition to the expansion of euthanasia. Ben Mattlin, who suffers from spinal muscular atrophy, wrote in The New York Times of the “thin and porous border between coercion and free choice” for those who feel devalued. “You also can’t truly conceive of the many subtle forces that emerge when your physical autonomy is hopelessly compromised, invariably well meaning, kindhearted, even gentle, yet as persuasive as a tsunami” (Mattlin, 2012). Such concerns are not abstract. Research has documented that individuals with disabilities are more likely to be offered MAID than able-bodied individuals with similar conditions, raising questions about whether the system genuinely respects autonomy or instead reflects unconscious bias about the value of lives lived with disability (Kittay, 2023).
The Economics of Cures
The economic incentives driving these developments are rarely discussed in the bioethical literature, yet they are central to understanding the trajectory of medical policy. In 2018, Goldman Sachs published a research report that posed a question rarely asked in public: “Is curing patients a sustainable business model?” The report examined gene therapy and other “one-shot cures,” noting that such treatments offer a “very different outlook with regard to recurring revenue versus chronic therapies.” While such cures carry “tremendous value for patients and society,” the report acknowledged, they “could represent a challenge for genome medicine developers looking for sustained cash flow” (Richter, 2018).
The report cited Gilead Sciences’ hepatitis C treatments, which achieved cure rates of more than 90 per cent. Gilead’s U.S. sales for these treatments peaked at $12.5 billion in 2015 but have been falling ever since, as the pool of treatable patients has been exhausted. Goldman estimated that U.S. sales for these treatments would be less than $4 billion in 2018 (Richter, 2018). “GILD is a case in point, where the success of its hepatitis C franchise has gradually exhausted the available pool of treatable patients,” the analyst wrote. “In the case of infectious diseases such as hepatitis C, curing existing patients also decreases the number of carriers able to transmit the virus to new patients, thus the incident pool also declines.”
The report suggested three solutions for biotech firms facing the challenge of cures: address large markets like hemophilia, address disorders with high incidence like spinal muscular atrophy, and maintain constant innovation and portfolio expansion. The underlying message was clear: the healthcare industry’s financial model depends on chronic disease management rather than definitive cures. The economic logic of the pharmaceutical industry, which generates the vast majority of its revenue from treatments that must be administered repeatedly over long periods, is fundamentally at odds with the goal of curing patients and eliminating disease.
This economic reality has implications beyond the pharmaceutical industry. The entire healthcare system, from hospitals to insurance companies, is built on a model of managing chronic conditions rather than eliminating them. The incentives embedded in this system push toward maintaining patients in states of managed illness rather than restoring them to health. The same logic that makes the pharmaceutical industry reluctant to pursue cures makes the broader healthcare system resistant to fundamental changes in how care is delivered.
From Body Area Networks to Digital Identity
The technological developments that enable the vision of continuous health monitoring and enhancement are advancing rapidly. Body Area Networks (BANs) and Wireless Body Area Networks (WBANs) represent a category of wearable and implantable devices that monitor physiological parameters and transmit data to healthcare providers and, increasingly, to corporate entities. These networks, composed of sensors, actuators, and communication systems embedded in or on the body, are being developed to enable continuous, real-time monitoring of health status.
The applications are already substantial. Wearable devices monitor heart rate, blood oxygen levels, sleep patterns, and physical activity. Implantable devices manage insulin delivery, cardiac rhythm, and neurological conditions. The integration of these devices into broader healthcare systems is proceeding rapidly, driven by both clinical imperatives and commercial interests. The global WBAN market is projected to reach $36.4 billion by 2031, growing at a compound annual growth rate of 11.4 per cent from 2024 (Allied Market Research, 2024).
The collection and analysis of health data at this scale raise profound questions about privacy, autonomy, and control. Health data generated by WBANs is not simply medical information but something more intimate: a continuous, real-time representation of the body’s functioning. This data can be used for purposes far beyond individual care, including risk assessment by insurers, workforce management by employers, and monitoring by state authorities. The aggregation of health data across populations enables algorithmic risk scoring, predictive analytics, and population-level interventions that would have been impossible a generation ago.
The implications for personal autonomy are substantial. Individuals who decline to participate in continuous health monitoring may face discrimination in insurance, employment, and access to services. The line between voluntary participation and compelled participation is already blurring, with some employers offering incentives for participation in wellness programmes and some insurers adjusting premiums based on data from wearable devices. The extension of this logic to include deeper monitoring, more comprehensive data collection, and more extensive integration into decision-making systems represents a fundamental challenge to the concept of privacy as traditionally understood.
The Transhumanist Horizon
The philosophical framework that underpins these developments is transhumanism, a movement that advocates the use of technology to enhance human intellectual, physical, and psychological capacities. The most ambitious forms of transhumanism envision radical redesign of human biology, including the eventual merging of human consciousness with digital systems. The movement’s leading thinkers, including Nick Bostrom and David Pearce, argue that reducing suffering, extending healthy life, and expanding human capacities are moral goods that should be pursued through technological means.
The critique of transhumanism is substantial and multifaceted. Philosopher Hannah Arendt argued in “The Human Condition” that human life gains meaning from mortality, limits, action, and shared experience. A project aimed at transcending all limits risks undermining what gives human life its character (Arendt, 1958). Michael J. Sandel, in “The Case Against Perfection,” argued that enhancement technologies erode appreciation for human giftedness, humility, and unconditional acceptance of others, encouraging a mindset of mastery over every aspect of life (Sandel, 2007). Francis Fukuyama, in “Our Posthuman Future,” warned that radical enhancement could undermine equality, rights, and democratic institutions if enhanced and unenhanced humans diverge significantly (Fukuyama, 2002).
The most philosophically rigorous critique has been advanced by Ralph Stefan Weir, who argues in “The Logical Inconsistency of Transhumanism” that the movement relies on incompatible ideas of human identity. Transhumanism simultaneously holds that personal identity survives radical enhancement and that humans are so malleable that radical transformation changes what we are. These propositions cannot both be true, Weir argues, revealing a fundamental inconsistency at the heart of the transhumanist project (Weir, 2024).
The intellectual foundations of transhumanism have been developed in academic and policy circles for decades. The World Transhumanist Association, later renamed Humanity+, was founded in 1998. The movement has produced a substantial body of academic literature, founded journals, and influenced policy discussions in areas from bioethics to artificial intelligence governance. The ideas that were once confined to fringe conferences and niche publications have now entered mainstream discourse, with prominent technology figures advocating for radical enhancement and the transformation of human nature.
The Mainstreaming of Consent
The mechanisms by which these ideas are being introduced into mainstream discourse deserve close examination. The publication of controversial proposals in prestigious medical journals such as the New England Journal of Medicine represents a deliberate strategy of “permissionless innovation” in the ethical domain. By advancing arguments in a respectable academic venue, advocates establish the legitimacy of ideas that would otherwise be dismissed as fringe or dangerous.
The role of media in this process is significant. Prestigious outlets such as National Public Radio, The New York Times, and major news networks have covered these developments as legitimate ethical debates rather than as proposals that represent a radical departure from existing ethical frameworks. This coverage serves to normalise ideas that would have been unthinkable a generation ago. The framing of death by donation as a “controversial idea” rather than as a fundamental violation of medical ethics is itself a form of advocacy, signalling that the proposal deserves serious consideration rather than summary rejection.
The process of “manufacturing consent,” in the sense identified by Herman and Chomsky (1988), operates through multiple channels. The concentration of media ownership and the integration of media with corporate interests ensure that coverage of controversial issues rarely challenges the fundamental assumptions of the economic and political system. The professional incentives within journalism favour coverage that is balanced and even-handed, which in practice means giving equal weight to established positions and fringe proposals that have received institutional endorsement. The result is a gradual shift in the boundaries of acceptable discourse, as ideas that would once have been unthinkable become subjects of legitimate debate.
The trajectory is clear. Each successive proposal builds on the acceptance of previous ones. The legalisation of euthanasia in Canada and other jurisdictions created the foundation for organ donation after euthanasia. The acceptance of organ donation after euthanasia created the foundation for death by organ donation. The acceptance of death by organ donation, if it occurs, will create the foundation for further expansions: from voluntary euthanasia to involuntary euthanasia, from the terminally ill to the incurably ill, from the incurably ill to the permanently unconscious, from the permanently unconscious to those deemed to have insufficient quality of life.
The slide is not inevitable. The history of bioethics contains examples of proposals that were advanced in respected journals and then rejected after sustained public debate. The successful resistance to the expansion of euthanasia in some jurisdictions demonstrates that the slide is not inevitable. The rejection of death by donation, if it occurs, will demonstrate that the dead donor rule remains a fundamental principle of medical ethics.
Conclusion
The mainstreaming of proposals for death by organ donation, the expansion of euthanasia regimes, the integration of continuous health monitoring into everyday life, and the transhumanist ambition to transcend human limitations represent interconnected developments that together constitute a fundamental challenge to existing ethical frameworks. The institutions that have advanced these proposals, prestigious medical journals, academic bioethics centres, government agencies, technology corporations, have consistently framed them as responses to practical problems: the shortage of organs, the desire to respect patient autonomy, the need for more efficient healthcare, the ambition to reduce human suffering.
The practical problems are real. The shortage of organs for transplantation causes avoidable deaths. The desire to respect patient autonomy is legitimate. The need for more efficient healthcare is pressing. The ambition to reduce human suffering is admirable. Yet the solutions that are being proposed treat the human body as a resource to be optimised, the human person as a collection of capacities to be enhanced, and human life as a quality to be measured and evaluated. The philosophical framework that underpins these developments is one in which the body is a problem to be solved, death is a failure to be overcome, and the value of a life is contingent on its quality as measured by external criteria.
This framework is not the only one available. The tradition of human dignity, rooted in the recognition of the intrinsic worth of every human being regardless of capacity or condition, offers an alternative. The principle that the value of a life is not determined by its quality as measured by external criteria, that the role of medicine is to heal rather than to discard, that the proper response to suffering is compassion rather than elimination, these principles have governed medical ethics for millennia and remain available as a foundation for resisting the slide toward a purely utilitarian calculus.
The decisions that will be made in the coming years will determine the trajectory of medicine and society for generations. The proposals that are now being advanced in prestigious medical journals, debated in academic conferences, and implemented in government policy are not abstract matters for specialists but fundamental questions about what it means to be human and how we should treat one another. The public debate that these questions deserve has not yet occurred. The manufacturing of consent proceeds through the normal operations of institutions, the predictable patterns of media coverage, and the incremental expansion of what is considered acceptable. The time to resist is now, before the slide has progressed so far that reversal becomes impossible.
Authored By: Global GeoPolitics
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References
Allied Market Research (2024) Wireless Body Area Network Market. Available at: https://www.alliedmarketresearch.com/wireless-body-area-network-market
Arendt, H. (1958) The Human Condition. Chicago: University of Chicago Press.
Ball, I.M., Sibbald, R. and Truog, R.D. (2018) ‘Voluntary euthanasia-implications for organ donation’, New England Journal of Medicine, 379(10), pp. 909-911.
Chambaeere, K., Vander Stichele, R., Mortier, F., Cohen, J. and Dellens, L. (2015) ‘Recent trends in euthanasia and other end-of-life practices in Belgium’, New England Journal of Medicine, 372(12), pp. 1179-1181.
Ely, E.W. (2019) ‘Death by organ donation: euthanizing patients for their organs gains frightening traction’, USA Today, 2 May. Available at: https://www.usatoday.com/story/opinion/voices/2019/05/02/organ-donation-physician-assisted-suicide-death-disability-column/3628448002/
Fritz, Z. (2016) ‘Can “best interests” justify organ donation in the permanently unconscious?’, Journal of Medical Ethics, 42(8), pp. 512-514.
Fukuyama, F. (2002) Our Posthuman Future: Consequences of the Biotechnology Revolution. New York: Farrar, Straus and Giroux.
Gilbo, N., Jochmans, I., Jacobs-Tulleners-Thevissen, D., Wolthuis, A., Sainz-Barriaga, M., Pirenne, J. and Monbaliu, D. (2019) ‘Survival of patients with liver transplants donated after euthanasia, circulatory death, or brain death at a single center in Belgium’, JAMA, 322(1), pp. 78-80.
Goldman Sachs (2018) ‘The Genome Revolution’, Equity Research Report, 10 April.
Health Canada (2024) Third Annual Report on Medical Assistance in Dying in Canada 2023. Ottawa: Government of Canada.
Herman, E.S. and Chomsky, N. (1988) Manufacturing Consent: The Political Economy of the Mass Media. New York: Pantheon Books.
Jones, K.J. (2016) ‘The problem with killing coma patients for their organs’, Catholic News Agency, 8 September. Available at: https://www.catholicnewsagency.com/news/35219/the-problem-with-killing-coma-patients-for-their-organs
Kirkey, S. (2017) ‘Doctors harvesting organs from Canadian patients who underwent medically assisted death’, National Post, 27 March. Available at: https://nationalpost.com/health/doctors-harvesting-organs-from-canadian-patients-who-underwent-medically-assisted-death
Kittay, E.F. (2023) ‘Disability and the right to die’, in The Oxford Handbook of Disability Ethics. Oxford: Oxford University Press.
Mattlin, B. (2012) ‘Suicide by choice? Not so fast’, The New York Times, 31 October. Available at: https://www.nytimes.com/2012/11/01/opinion/suicide-by-choice-not-so-fast.html
Richter, S. (2018) ‘The Genome Revolution’, Goldman Sachs Equity Research, 10 April.
Sandel, M.J. (2007) The Case Against Perfection: Ethics in the Age of Genetic Engineering. Cambridge, MA: Harvard University Press.
Stein, R. (2026) ‘A new proposal for organ donation sparks concern’, National Public Radio, 9 July. Available at: https://www.npr.org/sections/health-shots/2026/07/09/xxxxx/organ-donation-proposal
Vincent, J.L., Shetzt, M., De Waele, J.J., de Clety, S.C., Michaux, I., Sottiaux, T., Hoste, E., Ledoux, D., De Weerdt, A. and Wilmer, A. (2014) ‘”Piece” of mind: end of life in the intensive care unit statement of the Belgian Society of Intensive Care Medicine’, Journal of Critical Care, 29(1), pp. 174-175.
Weir, R.S. (2024) ‘The Logical Inconsistency of Transhumanism’, Journal of Ethics and Technology, 34(2), pp. 112-128.
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