NCPA - National Center for Policy Analysis


October 9, 2008

Almost all rich countries have adopted a definition of death based on the extinction of activity in the brain, rather than in the heart or any other organ.  But as demand for organs increase, doctors are under pressure to shift the line that divides life from death, so that they can get organs for transplant at a time when they are more likely to be in a healthy condition, says the Economist.

The debates stems from the Catholic Church -- which is under pressure to return to the alleged unambiguity of permanent cardiac arrest.  However, some doctors say that the church is jumping the gun; they should first address the more difficult question of when a person can be declared dead, says the Economist:

  • In America, this means monitoring the brain's electrical chatter to make sure the whole organ is dead. In Britain, the brain's stem is regarded as the crucial part.
  • Either criterion, however, seems more reasonable than just registering a pulse, since it is the brain, not the heart, which makes the individual.
  • In August 2008, a paper in the New England Journal of Medicine described a recent trend to revert to using cardiac death as the critical marker -- though it takes a few minutes for the brain to die, when a person's heart stops beating, they are dead.
  • Death in such cases is therefore based on a decision to not resuscitate, not the impossibility of resuscitation, and these cases are increasing in America from zero (1996) to 7 percent (2006).

Doctors say this gerrymandering of the division between life and death will continue as long as doctors have to abide by the dead-donor rule -- vital organs can only be removed from dead bodies.  Instead, they propose that someone whose brain is devastatingly and irreversibly damaged, and who has previously given his informed consent, should be able to donate vital organs while still alive.

Source: Editorial, "O death, when is thy sting?" The Economist, October 4, 2008.

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