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

In "Twice Dead: Organ Transplants and the Reinvention of Death", Margaret Lock “explores the way in which developments in medical technology have forced a reconsideration of the recognized boundaries between life and death, and how these debates reflect deeply held social values and political interests” (pg. 2). Lock examines these boundaries and how they affect social values and politics through a comparison of organ transplants in Japan and in Western countries, such as the United States and Canada. In describing the Japanese response, Lock writes, “The majority of Japanese with whom I have talked about brain death dismiss arguments that reify Japanese tradition” (pg. 5). On the other hand, “in North America, discussion about brain death has been limited for the most part to a small group of doctors and an even smaller group of lawyers and intellectuals,” though the debate rarely focuses on “the contribution to culture” (pg. 7). Finally, Lock establishes the “living cadaver” as a category to describe those who suffer brain death yet are kept alive by artificial means (pg. 1). This category plays a crucial role in her argument.Discussing the conflict over brain-death as a category in Japan, Lock argues, “The culture of tradition is self-consciously put to work to aid those opposed to the recognition of brain death” (pg. 11). In the West, however, acceptance of brain-death was not a foregone conclusion as it forces one to consider what defines a person, either their physical living body or their consciousness (pg. 37). Lock writes, “Cerebral death confronts us with yet another ambiguous life-form that until recently was imaginable only in science fiction. The determination of cerebral death is made on the basis of an irreversible loss of consciousness” (pg. 119). This goes further to define the limits of what qualifies as death, either physical or social. In the West, concepts of brain-death limit death to a physical, quantifiable event, whereas in Japan, death exists as a social occurrence involving the relationships of the person and their family (pg. 183). The machinery that prolongs life also plays a role in defining the limits of humanity. Lock writes that the machinery of artificial respiration displaces the personhood of the patients , though in Japan, “some people may conceptualize machine and human as working in partnership, creating an animated hybrid that can overcome all odds” (pg. 370). Further, examining the role of organ transplant in a gift system, Lock cites Marcel Mauss, who concluded, “all gifts carry reciprocal expectations, and gift exchange is a means of establishing lifelong commitments that create the structure of social institutions and their hierarchies” (pg. 315). This creates a host of problems in Japanese society, where gift giving involves culturally ingrained practices that recipients cannot follow through on since the donor is deceased. Even when the donor is not anonymous, the recipient fears lifelong obligation to the family that they cannot repay. Even in the West, organs are fetishized, imbued with personality about the “gender, ethnicity, skin color, personality, and social status of their donors” (pg. 320). Even the process of keeping an organ alive apart from the body defies traditional conventions of the body.

I was very satisfied with the purchase. The book was labeled used but practically looks new. It also shipped and arrived in time for my class so it was a plus.

Margaret Lock discusses how organ transplant interests fostered the notion of brain death in North America and Japan. Until recently, Japan did not accept brain death as a sufficient criterion of death, even when the Japanese had all the technology and medical skills to carry out organ transplantation. By contrasting the muted discussion about brain death in North America with the heated, well informed public debates in Japan, Lock makes readers uncomfortable. Are people declared brain dead in America really dead, or do neurologists simply assume that they are dead to allow transplantation to take place? When does death occur anyway; is it a process or an event? Should physicians determine death with technological guidelines, or should death be defined by the people who are the most implicated, like relatives? Lock does not provide easy answers to those questions but her exhaustive research indicates how a different consensus about brain death emerged in the East and the West.This book is a masterpiece of social research that does not succumb to cheap moralizing. Lucidly written, it is solidly grounded in anthropology but widely accessible. I strongly recommend it to anyone with an interest in medicine or anthropology.

Margaret Lock propose une lecture historique et anthropologique, aiguë, fournie et contrastée, des débats ayant entouré les nouvelles définitions de la mort en contrepoint des avancées technologiques en matière de transplantation, et du lien indéfectible qui les unit. Humanisme, utilitarisme, cynisme et mercantilisme sont évoqués et la dichotomie Est-Ouest (en l'occurence Japon vs. USA) est dégagée en détails et avec sensibilité.