50 years ago: Organ transplant doctors redefine death

While the world--including this blogger--was thrilled by the Apollo 11 lunar landing in July 1969, an event of arguably greater significance--literally a matter of life and death--took place in Madrid. As reported by the British newspaper The Guardian, July 19, 1969:

Madrid, July 18--Organ transplant specialists from around the world have reached agreement here on a new definition of death.

Delegates to the first international transplant symposium in Madrid agreed to define death as the moment when the brain ceases to perform its vital functions and fails to react to medical stimuli.

The conclusion, announced today after last night's closing session, was far from unanimous, but it is expected to form the basis for new legislation in many countries.

The doctors rejected the proposal of defining death as the moment when the heart stops beating, because they felt a heart should be in good working order for a successful transplant.

The medical panel's recommendation that death be defined in neurological terms was approved in a heated debate in the final session. Other conditions imposed by the doctors were that the doctor signing the death certificate should not form a part of the team involved in a transplant operation and that the dead or moribund patient should not be capable of breathing without the help of medical devices.

The consensus of the symposium was that the failure of the brain to react and the cessation of vital brain activity should be irreparable, with the absence of any clinical reaction to customary medical tests.

The panel advised, however, that a final decision on death should be made only on the recommendation of qualified experts after they had conducted a series of internationally approved medical tests, including the electro-encephalograph.

They further warned that such tests should be carried out on a potential donor over a minimum of 24 hours.

The surgeons warned that the criteria should be applied only with considerable reservation in the case of children and that they were not applicable in cases involving drugs.

This conference took place less than 20 months after the first successful human heart transplant. Physicians had previously been hesitant to perform heart transplants, because under the definition of death which had long been in place--cessation of the heartbeat--performing a heart transplant necessarily meant involved removing the heart from a living person, thus killing the donor. In order for surgeons to perform heart transplants without killing people--and to have a heart that was in good working order--it was necessary to define death as being something other than cessation of the heartbeat, thus redefining the donor as dead.

It's worth noting that the adoption of the definition of death as cessation of brain function and reaction was "far from unanimous," and was "approved in a heated debate." This indicates that the definition of death as "brain death" was not obvious, and was more political than scientific, created to salve the consciences of doctors.