Definition of Death and the Dead Donor Rule. Some Critical Reflections

This article examines the evolution of the concept of death beginning with the Harvard Medical School report of 1968, a document that introduced the neurological criterion of “brain death” in order to address the challenges posed by intensive care medicine and organ transplantation. The author offers a critical appraisal of the principal objections to this paradigm, which are organized into two broad domains: on the one hand, cortical death theories that equate the end of the person with the irreversible loss of consciousness; on the other hand, holistic critiques advanced by thinkers such as Hans Jonas and Alan Shewmon, who dispute the brain’s role as the sole integrative centre of the organism and adduce clinical evidence of the persistence of complex biological functions in patients declared brain-dead. Through an analysis of well-known clinical cases—such as those of Marion Ploch, Trisha Marshall, and Jahi McMath—the paper highlights the deep fracture between clinical epistemology and the sensory perception of “visible death,” demonstrating how the abstract character of brain death gives rise to ethical and so-cial tensions. Finally, the article addresses the crisis of the Dead Donor Rule (DDR) and the recent semantic shift from the concept of “irreversibility” to that of “permanence”, as introduced in the 2023 guidelines. In conclusion, the author proposes transcending the ontological aporias by adopting a model grounded in rigorous informed consent, restricted to “narrow clinical conditions”, with the aim of safeguarding donor dignity and maintaining public trust in the transplant system.