Cover Image: September 2010 Scientific American Magazine See Inside

When Does Life Belong to the Living? [Preview]

With thousands of people on the waiting lists for organs, doctors are bending the rules about when to declare that a donor is dead. Is it ethical to take one life and give it to another?















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Last Gift:
More than 8,000 individuals donated their organs upon their death in the U.S. last year. Here surgeons remove the heart, kidneys, pancreas, liver, lungs, eyes and some bones from a woman who has been declared brain-dead.
Image: Max Aguilera-Hellweg

In Brief

  • Transplant surgeons must wait for a specified period after death to extract a potential donor’s organs.
  • In these oxygen-starved moments, the organs decay, making a precise determination of the moment of death paramount. Still, the process of death may render organs unusable.
  • Ethicists have begun to question whether it is necessary for a patient to be fully dead before beginning transplant surgery.

More In This Article

Death used to be a simple affair: either a person’s heart was beating, or it was not. That clarity faded years ago when heroic medical technology started to keep hearts beating in­definitely. Although we have had decades to ponder the distinctions between various states of grave physiological failure, if anything our confusion has grown. When is it ethical to turn off a ventilator or remove a feeding tube? When does “life support” lose its meaning? And most critically, at what point is it acceptable to cut into a body and remove the heart that could save another life?

These issues are not academic. They raise questions about health care costs—is it worth using expensive machinery on a body that is for all intents and purposes dead?—as well as about dignity in end-of-life care. This year’s “death panel” subplot of the health care debate fed off the real fears people have about being taken advantage of when at their weakest.


This article was originally published with the title When Does Life Belong to the Living?.



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  1. 1. sparcboy 12:01 PM 8/19/10

    A train is coming down a hill and can't stop. You're standing by a switch. If the train goes to the left, it will kill one man in a car stalled on the track. If it goes to the right, where the switch is where you how you found it, it will kill 5 people in a car stalled on the track. Do you throw the switch to lose only one person or leave like it is and let 5 die?

    A person in the emergency room learns he only has a bad cold, but the doctors tell him he has the correct blood type to qualify him as a source for organs for 5 people in the hospital who will die without them. Does the doctor "throw the switch"?

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  2. 2. Lídia Luque in reply to sparcboy 12:18 PM 8/19/10

    Of course not.
    The difference is the following: The person you refer to is not death. He can think, feel. A person who is brain death is not a person anymore. He can not think nor feel. It is a body that can save someone else live, so let's make it possible.
    Sorry for my english, it is not my mother tongue.

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  3. 3. ralphskinner@hotmail.com 04:08 PM 8/19/10

    Excellent comment Lidia.
    For a view on this subject, readers might enjoy the book
    "Rethinking Life and Death by Peter Singer

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  4. 4. jack.123 06:20 PM 8/19/10

    Depending on which religion you believe in you can guarantee your place in heaven for giving up a few days in life,

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  5. 5. mikej77 10:23 PM 8/19/10

    We should also be looking at the lives that we propose to save.
    Control of medical costs means evaluating whether there is a reasonable return on a proposed procedure.
    Do we wish to pay to install new livers in alcoholics or new hearts in those destroyed by by destructive diets?

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  6. 6. sanbo 01:29 AM 8/20/10

    it is a kind of paradox of morality,sometimes there is no the best choice in our life.

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  7. 7. alejandroc19 in reply to Lídia Luque 10:25 AM 8/21/10

    Well put. Thats how it should be looked at. LOGICALLY.

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  8. 8. kgbduck in reply to sparcboy 12:49 AM 8/27/10

    Definitely leave the switch as it is; generally you can't be prosecuted for failing to do something (unless you assumed an affirmative duty to do so) but you can always be prosecuted for actively doing something. And though I only have hearsay knowledge on the subject, prison sucks.

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  9. 9. Apolloike 12:00 PM 10/22/10

    What is living,or what is dead? That's not merely an academic question,but a sort of ethical and moral issues. Is it legal to take one life and give it to another? Whether it essential for a patient to be fully dead before taking transplant surgery. While the potential organ donor,the doctors remove 'the dead patient' from life support and wait for two minutes to make sure the heart won't beat again. What go through the mind of transplant surgeon during these 120 seconds? All they have to do is to make a pray for R.I.P.(Rest In Peace) or countdown the seconds to trade-off about exchanging one person's life for another's? Donate whatever your organs can do at the final time and make one more effort to prolong another life. I think all the questions rely on the health care costs. After all, the family members still have to live on money as well.

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