Interest

You may argue since those patients are inevitably dying, it doesn't matter to have some extra treatment to maintain their organ perfusion.

No, you're wrong there. There is more than a fine line of difference between end-of-life palliative care and all those intravenous fluid and inotropes to sustain the blood pressure. (It may be fun to see your pulse go mad with dopamine or noradrenaline infusion - at least fun for your rivals.)

True, very often we do advise our patients and relatives to surrender and forget about further treatment - but that's for the benefit of the patient (for example, to avoid unnecessary suffering as a result of aggressive surgery). Palliative or symptomatic care is never the item to be withheld for any living Homo sapiens.

To go one step further, it is therefore not appropriate to start those "organ maintenance" procedures in someone with irreversible brain damage and the GCS falls to 5 - even if the family volunteered to have organ donation (which did happen more than once). Our primary objective is to act according to the interest of that patient - who is still alive - and not the family. You won't stick a needle into your patient's leg in order to please the family, will you ?

PS. Our supreme objective may be to act for our own benefit and prevent our names from appearing in the court or, even worse, the media. Well, in that case one should explain and explore in full detail - to all parties concerned - about the potential risk of every remotely possible and impossible complications, as well as the complications of those complications, with an inevitable though not totally unwelcome nor undesirable conclusion that we should do nothing.