In Napoleon’s empire, physicians were prohibited from declaring death until they had performed a “death watch” for 24 h.7 In today’s hospitals, we commonly declare death at the moment of asystole, confident that nothing consequential will happen to the patient over the next several minutes and that the routine flow of hospital activity will provide an adequate death watch to ensure that the criteria for irreversibility are satisfied. But when the few minutes following the onset of asystole may involve lethal actions such as surgical incision and the removal of vital organs, the methods of assessment must be correspondingly more precise. In particular, if one holds that the DDR is an inviolate principle of organ donation, then the difference between “dying” and “dead” becomes crucial. Even a very slim chance of a false positive makes a difference. If the patient is, in fact, not dead or not known to be dead at the time of the declaration of death, then the DDR has been violated.