Twice Dead: Organ Transplants and the Reinvention of Death

Twice Dead: Organ Transplants and the Reinvention of Death by Margaret Lock. University of California Press, $24.95/£17.95, pp 429. ISBN 0 529 22814 6. Rating: ★★★★

Perhaps most British doctors feel that the subject of brain death is complete. Surely Christopher Pallis and his colleagues did a good job 15 years ago in defining the clinical criteria for diagnosing brain stem death . These have proved well defined and robust in practice. British procedures for obtaining organs and tissues from donors are careful and dignified. Transplantation is necessarily a good thing. We sympathise with relatives of the tragically dead and their predicament in contemplating organ harvesting from the loved one. Organ removal has disturbing moments but the practice of transplantation is life affirming and marvellous. So that is all right then?

Remember the notorious BBC Panorama programme in the 1980s: “Are transplant donors really dead?” Although this was a farrago of inaccuracy, organ donation was reduced for a decade owing to change in public sentiment. Latterly, opinion in the United Kingdom has changed even more in relation to the bodies of the dead and the controversial retention of body parts and tissues for medical uses.

The definition and diagnosis of death remains problematic around the world. The recent death of the surgeon Christiaan Barnard prompted much obituary coverage, substantially adverse, of his life and work. His personality and notoriety contributed to continuing unease in the subject. In an article about Barnard, Raymond Hoffenberg reported qualms over his own diagnosis of the death of a heart donor in 1967 .

Now Margaret Lock produces a superbly scholarly study from her point of view as an academic comparative anthropologist or ethnographer. An anthropologist is not an experienced physician. Journalistic and almost tabloid sensationalising and juxtaposition of available evidence—including her own impressions, individual narratives, and the published record of heroic and sometimes shady goings on in the field—seem at first outrageous to the medical or scientific mind. How can these sources be equivalent?

However, Lock is interviewing the people really involved: relatives and recipients, transplanters and harvesters. Her approach is informative at many levels precisely because she is exploring the cultural perceptions that are the source of public opinion. Cultural strain remains greatest in Japan, where concepts of brain death remain unacceptable to many people and traditional attitudes to death reverence the body and its transformation into a new ancestor.

Lock misses out the dreaded Panorama episode and the recent UK organ retention scandals but her study is otherwise wide ranging, cosmopolitan, and comprehensive, over the entire topic of death and dying and the ethical, philosophical, and cultural bases of transplant practice.

Although the author carries a donor consent card, she has qualms: the need for organ donors has in effect caused the redefinition of death and thus has somehow dehumanised the donors. Debate on these issues deserves continued medical attention. Questions of life and death are here to stay; but perhaps transplantation is even more important than that.