Lisa Day appears to argue in favor of hastening the death of potential organ donors in order to optimize the viability of recovered organs.1 Specifically, she seems to support taking organs from donors in the same terms as withdrawing life support. Like treatment withdrawal, in her scenario “taking the organs hastens or causes the donor’s death,”1 but to do so would increase the supply of viable organs for donation. I have a strong commitment to transplantation, with statements in favor of ethical organ donation in my advance directive and with my driver’s license.In light of my beliefs, the arguments presented in this column were of great concern. Start with a question: Assuming consent, should absolutely everything possible be done to save innocent life threatened by disease or trauma? One assumes the answer would be yes, and we could perhaps then say that certainly organs can be removed from a donor before his or her death to increase both the probability of saving life and the number of lives saved.In truth, though, we stop far short of doing everything to save life. As one author puts it, “If I am sick unto death, and the only thing that will save my life is the touch of Henry Fonda’s cool hand on my fevered brow, then all the same, I have no right to be given the touch of Henry Fonda’s hand on my fevered brow.”2 Note that, in this example, Fonda is not required to take any extraordinary risk to his own life outside the risk of travel. Nonetheless, societal ethics would not require even this minor inconvenience for the honorable goal of saving a life.The argument is that a still-living donor should go well beyond inconvenience and sacrifice his or her life. Can we justify accepting this evil effect—the death of the donor—for the sake of the good effect of saving the recipient’s life? Day mentions the principle of double effect,1 but that classic doctrine does not hold here. Before resorting to it, all of 4 criteria must be met, one of which is “that the good effect is not produced by means of the evil effect.”3 Dr Day would apparently agree that removing a vital organ for transplant kills the donor and is the means of saving the recipient.Although Dr Day likens removal of organs to withdrawal of life support, there is an important difference. All medical forms of life support are artificial, put there by health care professionals. This applies to ventilators, balloon pumps, vasopressors, even intravenous accesses. Organs that have a potential to be transplanted were put there by the force that created the donor, whether one views that force as divine or natural. It is an invasive procedure to remove any of them. This alone indicates a significant difference between withdrawal of artificial technological devices and removal of native organs.A last concern that should prevent us from taking vital organs from the living is commodification of a person, the conversion of that donor from a being with intrinsic moral worth to a mere raw material that can be bought and sold. It is not mere “moral self-indulgen[ce],” much less “selfishness”1 for professionals to keep the clear distinction between people who can be donors (brain- or cardiac-dead patients whose proxies believe they would consent) and those who cannot (the living). Society itself depends on the ethics of those professionals.