Neomort

A term coined by Willard Gaylin in a 1974 Harper's Magazine article, neomort refers to an individual human who has suffered brain death but whose other biological capacities have been maintained on a respirator, possibly with cardiac assist. This entry explores the issues surrounding the potential use of neomorts as organ donors and for other purposes.

The traditional criterion of death had been irreversible cardiac arrest. So defined, death was compatible with the transplantation of certain organs, including kidneys and corneas. But the growing practice of cardiac transplantation rendered the traditional criterion no longer useful. In the past, cardiac transplantation involved the removal of the still-beating heart from one individual and the implantation of it into the body of another individual suffering from heart failure. If irreversible cardiac arrest were to remain the definition of death, cardiac transplantation would forever be an act of killing the donor. The plight of individuals suffering from failing hearts who could have their normal lives restored through cardiac transplantation prompted the redefinition of death in the 1960s.

Redefinition was necessary, for heart transplants must be made with the living heart, unlike other organs. This meant removing the beating heart from the donor and transplanting it into the receiving patient. Doing so, under the cardiac criterion of death, entailed killing the donor even if no brain function was present.

Legislation was developed to redefine death. In a remarkable show of unification, all 50 states passed the same legislation in short order. The model that “brain death” proponents advocated, now adopted in all 50 states, is the Uniform Determination of Death Act (UDDA) of 1986, Section 1, chapter 23-06-01. Effective as of July 1, 1987, this act reads as follows:

That widespread acceptance, however, did not signal an absence of criticism. First, based on various apocryphal accounts of individuals who, having been declared dead, revive, many have doubted that diagnosis of brain death that leads to cardiac transplantation is an unerring procedure. One critic likened it to execution of individuals later found, through DNA analysis, to be innocent of the crimes for which they were convicted.

Second, there was suspicion of the motives of those who advocated the brain death criterion over a previous “dead donor rule,” the permanent cessation of the functions of the prospective donor's heart. Despite a wide public support for increasing organ supplies, critics argued that elevating this laudable goal over the satisfaction of the then current criterion of death was an act that elevated pragmatic utility over our commitment to fight to preserve one another.

Third, the clamor for access to transplantable organs of patients suddenly confronted with the consequences of personal irresponsibility plus the indifference to prevention of a public health policy oriented toward cure rather than prevention, together with the financial rewards to transplant hospitals of such surgeries, places the dying in the service of the salvageable.

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