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.
