Robert Truog, a physician and bioethicist at Harvard Medical School, co-authored a paper in the New England Journal of Medicine proposing that patients undergoing euthanasia be allowed to donate organs while still alive. The proposal, termed Death by Organ Donation, suggests that patients would be anesthetized and have their organs removed while still functioning.

"What if they chose to be organ donors? The problem is that under current standards doctors must not cause death in the process of procuring organs for transplant," Truog said. He proposed linking the procedures: "I would say a more appropriate framework is that for patients who are choosing to die from euthanasia they could also choose to have euthanasia linked with organ donation." Truog argued this approach respects patient autonomy: "It would be an ethical thing to do because this is something the patients have chosen for themselves." He noted that under the current system, organs often deteriorate after death, but with this method, "So the organs would still be in ideal condition."

Truog described the motivation of potential donors: "They have very generously thought: 'How might my death help other people? It's a very altruistic, generous thing to do.'" He questioned the logic of the current restrictions: "Why would it not be OK for patients to say, 'I've chosen to die by a lethal injection. Isn't there some way I can help others?' They should be able to donate organs as a lasting gift to others. And denying them that option doesn't seem to make any sense."

Euthanasia involves doctors administering lethal drugs to cause the death of a patient and is illegal in the U.S. However, it is legal in Canada, the Netherlands, and Spain. In the U.S., multiple states have legalized assisted-suicide, in which doctors give patients lethal drugs to take at home.

The proposal challenges the Dead Donor Rule, which requires that patients must be dead before any organs are removed and states that doctors cannot kill patients in the process of removing organs. The suggested change aims to address the desire of some patients to donate organs in a way that maximizes their functionality.