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As a result of the practice of organ transplantation, do we ultimately require a re-thinking of the meaning of death?

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  1. Introduction.
  2. Defining and redefining death.
    1. Current definitions.
    2. Critique of the current formulation of brain death.
  3. Is it time to abandon brain death?
    1. Alternative approaches to the formulation.
    2. Should organs from patients in pvs be used?
  4. Conclusion.
  5. Bibliography.

Ever since its inception in the 1950s, organ transplantation has been accompanied by questions about the ethics of taking organs from the dead and living and giving them to others. Discussions abound among physicians, ethicists, policy makers, and the public. At first living and willing relatives were used as organ sources for transplantation, due to antigenic incompatibility between unrelated persons. But with the development of powerful immunosuppressive drugs came an increase in cadaveric grafts. The supply shortage of transplantable organs stimulated society to search for new ways of procuring them. At the end of the 1960s, when surgeons first contemplated the systematic use of irreversibly unconscious patients as a source of human organs, a new legal definition of death was urgently needed to protect physicians from being charged with murder. It was essential that the new death be a diagnosable event and that it be timed to allow the removal of organs before onset of ischaemia.

[...] The Virtues in Medical Practice. New York, NY: Oxford University Press; 1993:124. Jonsen AR. What does life support support? In: Winsdale ed. Personal Choices and Public Commitments: Perspectives on the Humanities. Galveston, Tex: Institute for the Medical Humanities; 1988:66-67. Youngner SJ, Landefeld Coulton CJ, Juknialis BW, Leary M. "Brain death and organ retrieval: a cross-sectional survey of knowledge and concepts among health professionals". JAMA. 1989; 261:2205-2210. Halevy Brody B. Brain death: reconciling definitions, criteria, and tests. Ann Intern Med. 1993; 119:519-525. [...]

[...] Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ 1996; 313: 13-16.- The House of Lords in Airedale NHS Trust v. Bland [1993] 1 All ER 821, [1993] 2 WLR 316 ultimately had to decide whether that young man should live or die. Anthony Bland had been in a PVS for four years when his family and doctors applied to the Court for a declaration that to withdraw nutrition and hydration would be lawful. Their lordships were in complete agreement that a doctor is under no duty to provide or continue treatment which is not in the patient's best interests and that Tony Bland's condition was irreversible, rendering the continuation of treatment ?futile?. [...]

[...] "ABCs of brain stem death: prognostic significance of a dead brain stem". BMJ. 1983; 286:123-124. Veatch RM. "The whole-brain-oriented concept of death: an outmoded philosophical formulation". J Thanatol. 1975; 3(1):13-30. Veatch RM. "Brain death and slippery slopes". J Clin Ethics. 1992; 3:181-187. Veatch RM. "The impending collapse of the whole-brain definition of death". Hastings Cent Rep. 1993; 23(4):18-24. Beecher HK. The new definition of death: some opposing views. Presented at the meeting of the American Association for the Advancement of Science. [...]

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