Elective ventilation describes the procedure of transferring selected
patients dying from rapidly progressive intracranial haemorrhage from
general medical wards to intensive care units for a brief period of ve
ntilation before confirmation of brain stem death and harvesting of or
gans. This approach in Exeter has led to a rate of kidney retrieval an
d transplant higher than has been achieved elsewhere in the United Kin
gdom, with a stabilisation of numbers on patients on dialysis. Recentl
y doubt has been cast on the legality of our practice of elective vent
ilation on the grounds that relatives are not permitted to consent to
treatment of an incompetent person when that treatment is not in the p
atient's best interests. We are thus faced with the dilemma of a proto
col that is ethical, practical, and operates for the greater good but
which may be illegal. This article explores various objections to the
protocol and calls for public, medical, and legal debate on the issues
.