Lawrence Masek argues that the dead donor rule (DDR) is rationally unjustifed because it relies on mistaken assumptions about harm, killing and intention in medical ethics. I believe his case does not succeed, because his analysis relies on ambiguous terms such as ‘harm’ and ‘death’ and his action theory does not inspire trust, something that is integral to public policy. So long as upholding public confidence in transplantation practices depends on respecting the donor’s life and minimising conflict of interests, the DDR will remain in place as the defining norm of deceased organ donation.