Births of Death: When the World Defined Death for Organ Donation and Transplantation

Wan-Zi Lu, University of Chicago

Legal bureaucrats across the globe have set regulations for organ donation and transplantation since this medical technology diffused across the globe in the mid-twentieth century. But the institutionalization of transplantation has confronted conflicts between medical definitions and public acceptance. Before physicians procure organs from deceased donors, the major sources of organ donation, brain death pronouncement is a precondition. However, as brain-dead patients appear warm and breathing, the concept of brain death has been denied and negotiated in multiple countries, and these rejections of brain death as death hinder the practices of organ donation for transplants. What factors shape the adoption of a novel definition of death? How do nation-states take the roles of defining deaths for medical practices while facing countervailing opinions with cultural and spiritual roots? To answer these questions, the author conducts sequence and statistical analysis based on an original dataset. The first analysis examines the selection, reordering, and postponement of the sequences to account for how the temporal orders of adopting bodily giving policies do not follow the logical sequences for facilitating medical practices. The gap between the timing of laws and the introduction of transplant practices offers additional evidence for the contestation surrounding defining deaths that contradict with either public understanding or spiritual guidance. Statistical analysis shows that in political systems with more room for lobbying and party competition, the policymaking takes longer as different stakeholders participate in selecting and matching meanings to legitimize organ donation. By examining how nation-states legitimize novel (and culturally-contested) definitions of death for medical innovation, this paper builds on existing studies of diffusion and biopolitics. Modern nation-states serve as either a catalyst to settle the ownership debates among authorities with religious or scientific recognitions or a gatekeeper that claims its rights to govern health, medicine, and the body.

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 Presented in Session 42. Governing Health under Uncertainty