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Over concern regarding caregiver conflict of interest can paralyze efforts toward organ donation. It should be recognized that clinicians have no duty to patients who want to donate their organs. This duty is to make donation occur if feasible and ethically appropriate.
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Many caregivers and organizations are so concerned about perceived conflict of interest that they fail to address their duty to fulfill patients' wishes. If the perceived conflict of interest does preclude caregiver participation, efforts should be made to identify caregivers without the same barriers so that patient wishes may be ethically fulfilled.
The apparent consensus about the definition of death has not yet appeased all controversy. Ethical, moral and religious concerns continue to surface and include a prevailing malaise about possible expansions of the definition of death to encompass the vegetative state or about the feared bias of formulating criteria so as to facilitate organ transplantation.
It was until the invention of the positive pressure mechanical ventilator by Bjorn Ibsen in the 1950s, and the widespread use of high-tech intensive care in the 1960s that cardiac, respiratory and brain function could be truly dissociated.
Neuropathological studies have showed that damage to the brainstem was critical for brain death. These findings initiated the concept of "brainstem death" and led UK physicians to define brain death as complete, irreversible loss of brainstem function: "if the brainstem is dead, the brain is dead, and if the brain is dead, the person is dead".
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