Table 5.

Potential ways forward that accept both the intractable metaphysical and epistemic problems with brain death

Potential solution	Pro	Con	Conclusion
Accept higher BD: death of the person	-Likely correct: compatible with the transplant intuition, the remnant person problem, and considerations of conjoined twinning	-Unacceptable implications for some: religions [is the human person separable from the human organism], and society [irreversible PVS, early fetus, and possibly neonates are not alive, and thus have no rights]	Likely not acceptable
Accept BD as a legal fiction	-Treat the BD as analogous to the dead in law, as they lack an interest in continued existence	-Legal fictions are known to be fictions: would need to acknowledge that BD is not really death -The reason for the analogy would also apply to higher BD, raising the problems above	Likely not acceptable
Abandon the dead donor rule	-Acknowledges the metaphysical and epistemic problems -Respects non-maleficence (duty to do no harm) and autonomy (duty to obtain informed consent) -Maintains trust in medicine by being trustworthy	-Need to acknowledge the analogy to withdrawal of life-support as a form of justified killing, and thus not murder -Possible adverse effect on organ donation rates and trust in organ donation (and medicine)	Likely acceptable

BD brain death, PVS permanent vegetative state