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English's arguments in favour of presumed consent for organ donation ignore serious problems with the current system of organ transplantation.1 People who sign organ donation cards claiming that they will be donating organs “after my death” may not realise that organ donors declared dead by brain based criteria are not dead in the usual sense. Their hearts are beating, their bodies are warm, and they do not seem to be dead. Family members may be understandably reluctant to sign a form authorising what they believe to be the killing of their loved one by removal of vital organs.
In addition, there has been widespread questioning of both the philosophical and scientific viability of brain death criteria.2 3 Such questioning of brain death criteria by reputable physicians and philosophers should not be taken lightly and shows that presumed consent for a practice that may involve doctors killing patients is premature.
Finally, before any notion of presumed consent can be considered, the issue of adequate informed consent to organ donation must be addressed. Without adequate informed consent, the current system of voluntary consent for organ donation is problematic. Any system of presumed consent is also problematic.
Competing interests: None declared.