Twice Dead; the reinvention of death

Margaret Lock, 2002, Twice Dead: Organ Transplants and the Reinvention of Death, Berkeley and Los Angeles: University of California Press

One of the key debates in organ transplantation is the definition of death. The mostly held definition is the Harvard definition which is brain dead- no EEG, no brain stem activity. There is a need for organs for transplantation and the medical profession is tinkering with the definition of death so as to get more viable organs for transplantation.

The definition of death has been modified to either brain dead or cardiac death. Cardiac death occurs if there is proof that when a heart stops, it is irreversible and unlike to resume beating again. The National Institute of Medicine suggests 5 minutes but hospitals have been reducing the time to 2 minutes and even 90 seconds. This means that a potential organ donor is pronounced dead when he or her heart stops for 90 seconds and is prepared for organ harvesting. In 90 seconds, the brain will still be alive. In some hospitals, such patients are given large dose of morphine in case the potential donor feels 'pain'. This is a funny argument because if someone feels pain, that person must still be alive. I suspect the reason is that if allowing the heart to stop doesn't cause brain death, the morphine will, thus sparing the doctors, hospital, and ethics committees the embarrassment of being sued because the heart restarts during organ harvesting.

Margaret Lock did a good job of documenting the shifting definition of death. The interesting title is because an organ donor may die twice. His or her heart stops (cardiac death), then the body is hocked to a machine and the heart restarted and then allowed to stop when the organ harvesting has been done. This is a very thought provoking and frightening book about organs transplantation.

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