The “dead-donor rule” requires patients to be declared dead before the removal of life-sustaining organs for transplantation. The concept of brain death was developed, in part, to allow patients with devastating neurologic injury to be declared dead before the occurrence of cardiopulmonary arrest. The term “decoupling” generally refers to the tim- ing of the request for organ donation. A request for donation is said to be “decoupled” if it occurs after, rather than before or concurrent with, the pronounce- ment of death.