The dead donor rule justifies current practice in organ procurement for transplantation, and states that organ donors must be dead prior to donation. The majority of organ donors are diagnosed as having suffered brain death, and hence are declared dead by neurological criteria. However, a significant amount of unrest in both the philosophical and medical literature has surfaced since this practice began forty years ago. I argue that, first, declaring death by neurological criteria is both unreliable and unjustified, but further, (...) the ethical principles which themselves justify the dead donor rule are better served by abandoning that rule and instead allowing individuals who have suffered severe and irreversible brain damage to become organ donors, even though they are not yet dead and even though the removal of their organs would be the proximal cause of death. (shrink)