Twice Dead: Organ Transplants and the Reinvention of Death (California Series in Public Anthropology, Vol. 1) (Volume 1)

Tales about organ transplants appear in mythology and folk stories, and surface in documents from medieval times, but only during the past twenty years has medical knowledge and technology been sufficiently advanced for surgeons to perform thousands of transplants each year. In the majority of cases individuals diagnosed as "brain dead" are the source of the organs without which transplants could not take place. In this compelling and provocative examination, Margaret Lock traces the discourse over the past thirty years that contributed to the locating of a new criterion of death in the brain, and its routinization in clinical practice in North America. She compares this situation with that in Japan where, despite the availability of the necessary technology and expertise, brain death was legally recognized only in 1997, and then under limited and contested circumstances. Twice Dead explores the cultural, historical, political, and clinical reasons for the ready acceptance of the new criterion of death in North America and its rejection, until recently, in Japan, with the result that organ transplantation has been severely restricted in that country. This incisive and timely discussion demonstrates that death is not self-evident, that the space between life and death is historically and culturally constructed, fluid, multiple, and open to dispute. In addition to an analysis of that professional literature on and popular representations of the subject, Lock draws on extensive interviews conducted over ten years with physicians working in intensive care units, transplant surgeons, organ recipients, donor families, members of the general public in both Japan and North America, and political activists in Japan opposed to the recognition of brain death. By showing that death can never be understood merely as a biological event, and that cultural, medical, legal, and political dimensions are inevitably implicated in the invention of brain death, Twice Dead confronts one of the most troubling questions of our era. Medical Knowledge And Technology Have Been Sufficiently Advanced For Surgeons To Perform Thousands Of Transplants Each Year. This Text Traces The Discourse Since 1970 That Contributed To The Locating Of A New Criterion Of Death In The Brain. Preamble: Accidental Death 1 -- Trauma 14 -- The Procurement 17 -- The Gift 23 -- Death's Shadow 27 -- 1. Boundary Transgressions And Moral Uncertainty 32 -- Reanimation 54 -- 2. Technology In Extremis 57 -- Narrow Escapes 76 -- 3. Locating The Moment Of Death 78 -- Jumping The Gun 101 -- 4. Making The New Death Uniform 103 -- Tragedy 127 -- 5. Japan And The Brain-death Problem 130 -- Aggressive Harvesting 147 -- 6. Technology As Other: Japanese Modernity And Technology 149 -- Born Of A Brain-dead Mother 165 -- 7. Prevailing Against Inertia: An Interim Resolution To The Brain-death Debate 167 -- Becoming A Good Angel 190 -- 8. Social Death And Situated Departures 191 -- Disconcerting Movements 208 -- 9. Imagined Continuities: On Becoming An Ancestor 209 -- Memory Work 232 -- 10. When Bodies Outlive Persons 235 -- Procurement Anxiety 259 -- 11. When Persons Linger In Bodies 263 -- Transcendence Through Music 288 -- 12. The Body Transcendent 291 -- A Court Order 310 -- 13. The Social Life Of Human Organs 315 -- A Reliable Man 341 -- An Unsatisfactory Intelligence 345 -- 14. Revisiting Vivisection In A World Short Of Organs 347 -- A Dubious Definition Of Death 363 -- Reflections 365. Margaret Lock. Includes Bibliographical References (p. 379-415) And Index. In this book I show how brain death is associated with different sets of assumptions about what constitutes the end of human life in Japan and North America.