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What does 'dead' mean?

These are among the wide-ranging questions explored in a new special report, ("Defining Death: Organ Transplantation and the Fifty-Year Legacy of the Harvard Report on Brain Death,") published with the current issue of the Hastings Center Report. The special report is a collaboration between The Hastings Center and the Center for Bioethics at Harvard Medical School. Editors are (Robert D. Truog), the Frances Glessner Lee professor of medical ethics, anaesthesiology & pediatrics and director of the Center for Bioethics at Harvard Medical School; (Nancy Berlinger), a research scholar at The Hastings Center; Rachel L. Zacharias, a student at the University of Pennsylvania Law School and a former project manager and research assistant at The Hastings Center; and (Mildred Z. Solomon), president of The Hastings Center.

Until the mid-twentieth century, the definition of death was straightforward: a person was pronounced dead when found to be unresponsive and without a pulse or spontaneous breathing. Two developments prompted the need for a new concept of death, culminating in the definition of brain death proposed in the Harvard report published in 1968.

The first development was the invention of mechanical ventilation supported by intensive care, which made it possible to maintain breathing and blood circulation in the body of a person who would otherwise have died quickly from a brain injury that caused loss of these vital functions. The second development was organ transplantation, which "usually requires the availability of 'living' organs from bodies deemed to be 'dead'," as the (introduction) to the special report explains. "Patients determined to be dead by neurologic criteria and who have consented to organ donation . . . are the ideal source of such organs, since death is declared while the organs are being kept alive by a ventilator and a beating heart."

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