Commentary on Bagheri

- Masahiro Morioka

CIAS, Osaka Prefecture University, Gakuencho, Sakai, Osaka, 599-8531 Japan

International Network for Life Studies
Eubios Journal of Asian and International Bioethics 13 (2003), 6.
Bagheri et al.'s paper is based on the empirical data they have collected from Japanese students. Their paper is helpful to the discussion of brain death and organ transplantation. However, I think additional commentary is needed to complement their arguments.

First, they conclude that "giving correct medical information and proper public education can increase the social acceptance of organ transplantation from the brain dead in Japan," however, we have to think again what is the "correct medical information" about brain death. For example, physicians as well as the ordinary public do not necessarily know how long the heart of a brain dead person could continue beating. A recent paper reported that hearts of brain dead persons can keep beating after brain death for some months. The longest case was more than 17 years. In this case, the patient was medically diagnosed brain dead at the age of four, but has continued growing in the state of brain death (1). In Japan, the mother of a brain dead baby published a book, and wrote about devoted care for her brain dead baby. The baby had no brain functions or brain stem reflexes, but remained brain dead for about four years in a hospital (2).

Many books say that the heart beat of a brain dead person usually stops within a week, but they seldom refer to cases as above. When I give a lecture on brain death to students, I always give this "correct medical information" together with other basic information. After receiving this information, some of the students start changing their view of brain death and organ transplantation, and start thinking that a brain dead person might be considered "alive" in the state of brain death even if the patient does not have consciousness. In this case, contrary to Bagheri et al.'s anticipation, giving correct medical information would lead to decrease the number of organ donations. In my impression, the more the students acquire correct information, the more they refuse to think about this topic in a simplistic manner. They fall into a gray zone and the chaos of bioethical thinking.

Second, Bagheri et al. talk about "a veto power" of the family in Japan's Organ Transplantation Law, but in many countries, the family members have a "de facto" veto power as well. In many European countries and in the US, even if a brain dead person has expressed his/her will to donate, when the family members refuse organ donation, physicians often stop organ transplantation. This is not the specific problem to Japan. Bagheri et al. write, "in practice, the family is always the winner," but some family members experience hardships especially when the wish of brain dead person and that of the family are different. We know it from their memoirs. In these cases, the family is not "the winner." They are, in fact, sufferers of contemporary biomedicine.


1) Shewmon,D. Alan (1998) "Chronic 'brain death': Meta-analysis and Conceptual Consequences," Neurology 51:1538-1545.
2) Kamei Chisen (2002) Hidamari no Byoshitsu de. Medica Shuppan.

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