France, Spain and US are three leader countries in activity of organ procurement and transplantation. Donation after cardiac death is one of the strategies they have been implemented in order to face organ shortage. Donation after cardiac death is internationally considered to be an encouraging source of organs for transplantation both because of its capacity to significantly increase the donor pool and because of the quality of the organs obtained from non-heart-beating organ donors. These protocols give rise to important ethical issues that have been widely discussed in the international literature. The aim of this paper is to identify and discuss the ethical issues that these protocols raise in these three countries.