Unlike some critics of the dead donor rule, I do not defend consequentialism or deny the personhood of any potential organ donor. Instead, I argue that the principles of ethics and action theory that support the dead donor rule also prohibit widely accepted procedures, including kidney and partial liver transplants from living donors, fetal surgeries that permanently damage the uterus, sequential or domino liver transplants and lethal palliation. If physicians sometimes may cause death as a result of relieving a patient’s pain, then they sometimes may cause death as a result of fulfilling the patient’s desire to donate a vital organ.