Twice Dead: Organ Transplants and the Reinvention of Death

Twice Dead: Organ Transplants and the Reinvention of Death. Margaret Lock. Berkeley: University of California Press, 2002. xii + 429 pp.

Margaret Lock explores the different responses to a newly defined medical death"brain death"-in Japan and in North America. She documents the tortured history of public scandals and endless media debates that characterized the Japanese situation and contrasts this to what she argues was an easy acceptance of the idea on the part of Canadians and Americans. The core of her argument is that a long European history of treating cadavers as objects with exchange value-- commodities-and a greater trust of medical professionals in the United States and Canada explain the willing acceptance of death defined by neurological criteria in North America. By contrast, the Japanese treat death as a "familial and social occasion" (p. 8), consider the dead revered ancestors that demand respect, believe that physicians are untrustworthy, and worry about the loss of cultural identity with the adoption of Western science and technology. These factors, Lock writes, account for a long delayed and still hesitant acceptance of brain death in Japan.

Background on organ transplantation and on the development of the brain-death criteria provides the context for the comparison between Japan and North America. Moving vignettes are interspersed with chapters that tack back and forth between Japan and North America. In addition to secondary sources, public opinion polls, and published ethical arguments, Lock draws on her own interviews and observational data. Unfortunately, there is no discrete "methods" section, which means that readers who wish to assess the basis of Lock's cross-cultural analysis must keep a running tally as data sets are mentioned. My count indicates that between 1996 and 1999 Lock interviewed in Japan 27 adults in Tokyo (a nonrandom sample), 19 emergency physicians, 23 physicians in other specialties, eight nurses, and one social worker. In Canada and the United States, she interviewed 40 intensivists, 32 physicians in other specialties, and eight nurses. She also interviewed 30 organ recipients in Montreal and 21 in Tokyo. Observations were done in six North American intensive care units.

Among the more memorable passages in this wide-ranging text is a quote from a doctor who, after declaring a patient brain dead,...