To the Editor: In the recent article by Richards and Rogers, the ethical and legal arguments made to justify antemortem interventions for organ donation after cardiac death (DCD) raise some questions.1

First, do antemortem interventions harm the patient? Anticoagulants (eg, heparin) expand intracranial haemorrhage and hasten the death of potential donors with acute ischaemic or haemorrhagic strokes. Large volumes of crystalloid fluids are infused to maintain organ perfusion, while exacerbating cerebral oedema and accelerating the onset of brain stem herniation and infarction in potential donors. Vasodilators are infused for organ preservation, causing hypotension and early onset of cardiorespiratory arrest after discontinuation of mechanical ventilation. While it may be debatable whether these interventions can cause harm to a person destined to die, they certainly shorten the dying process and hasten death.2