A recent position statement from academics in Malta, which has the stated support of the Vatican, has opened the door to using DCD (donation after circulatory death) without brain death testing prior to organ harvesting. In DCD, a patient who is in the intensive care unit with severe brain injury and unable to breathe on their own may be declared to be irreversibly comatose. In conjunction with the family, a decision is made to remove them from the mechanical ventilator that was necessary to ensure breathing continues. If, when removed from the ventilator, a patient does not breathe on their own, oxygen in the blood rapidly falls and leads to cessation of the heart and death. In DCD, usually five minutes have to elapse, during which the patient is repeatedly tested for any responses that might show they are still alive. After five minutes, circulatory death is declared and organ harvesting is permitted. These criteria for DCD stress that the donation must be voluntary, that the donor must be dead and that there is a clear separation between the treating team and the transplant team.