A report from Denver, Colorado (Mark M Boucek and colleagues. New England Journal of Medicine 2008;359:709–14; see also editorial, ibid: 749–50, and Perspective articles, ibid: 669–71, 672–3 and 674–5) of three infants who had heart transplants from donors pronounced dead after cessation of cardiac activity has reignited controversy about donor death and transplantation.

Two of the three recipients had complex congenital heart disease and the third had severe dilated cardiomyopathy. Their mean age was 2.2 months and all were at high risk of death. The mean age of the donors was 3.7 days and they all had severe neurological injury from birth asphyxia. After the withdrawal of life support the mean time to asystole was 18 min. The duration of asystole before the declaration …