Donation after cardiac death (CDC) is an important issue in the spiritual care and hospital chaplaincy ministry to patients, staff, and families in the Pittsburgh Mercy Health System. Key members of the interdisciplinary care teams must be well informed about the facts of this controversial issue. Ethical decisions made in particular cases contribute to the development of hospital policies and the establishment of “best practices” in large Catholic health care systems throughout the United States, and must be made with the utmost care. This article provides a brief history and overview of donation after cardiac death and discusses the major ethical issues that were addressed during CDC policy development for the Pittsburgh Mercy Health System. The issues center on questions of whether donors are really dead. Specific issues include death criteria, including the time of pronouncement of death; conflicts of interest; treatment of patients and their loved ones; and organ preservation techniques. National Catholic Bioethics Quarterly 7.3 (Autumn 2007): 527–543.