Table 1 Clarification of the arguments surrounding the interpretation of the 'irreversibility' of death.

Permanent is a reasonable 'construal' of irreversible.

The ordinary meaning of irreversible is 'not capable of being reversed.' Permanent is not a 'construal' of irreversible at all.

There is a moral/legal obligation not to resuscitate.

Irreversible is not a moral/legal concept. The obligation to or not to resuscitate is due to the patient being alive. Death is a state of a body, and those in exact states cannot be both dead and alive.

There is no difference in outcome by waiting for irreversibility.

This admits that permanence is a prognosis of death, not a diagnosis of death. The DCD donor is living (even if he/she may be dying).

Autoresuscitation does not occur after 65 seconds of absent circulation.

This is based on inadequate data (n = 5), and tries to explain away the Lazarus phenomenon.

Permanence accords with accepted medical standards and the intent of the law.

This is misleading and inaccurate. This ignores ontologic and moral issues. This mischaracterizes accepted medical standards. The intent of the law was not 'permanence'.

Brain death is not required to diagnose death.

The intent of the law is that there is only one death per person. DCD donors are not brain dead.