Inventing a new death and making it believable

This article shows how the concept of 'brain death' was created in order that the routinization of solid organ transplantation could take place. The concept permitted individuals diagnosed as brain-dead but whose respiration and heartbeat continued through technological assistance to be counted as no longer alive, and therefore organs could be retrieved from them without legal reprisals. It is shown how, because the condition of brain-dead bodies is ambiguous--they are at once dead and alive--discursive practices must be put to work in both medicine and law to justify their status as dead. Despite an apparent consensus within the medical world about the concept of brain death, disagreement remains among various countries about how best to make the diagnosis. Moreover, professionals working with brain-dead patients draw on a Cartesian split between mind and body in order to allow themselves to count such patients as dead; this maneuver is justified because the minds of brain-dead patients no longer function, although their bodies clearly remain very much alive. Without the legal fiction of brain death the transplant world would be severely hampered.