Has the leading science journal Nature launched a campaign to loosen the definition of death to expand the number of organs available for transplant? Currently US law states that "An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead."

But an editorial in the latest issue of Nature argues that it is impossible to see the bright line between life and death. Nowadays transplant surgeons are obeying the spirit of the law rather than its letter when they remove vital organs because experience has shown that they cannot guarantee irreversibility or that each and every function of the brain has ceased. Therefore, lawmakers and doctors should reconsider “rigid definitions of death”.

What is Nature up to? Oddly enough, although this issue has been raised recently in several journals and by the President’s Council on Bioethics, it has ignored these. Instead it pegged its editorial on a statement by “physicians, transplant surgeons and bioethicists” at the obscure Italian Festival of Health. These included the utilitarian British bioethicist John Harris and a Harvard Medical school proponent of abolishing the dead-donor rule, Robert Truog.

Nature does not propose a solution to the problem, but the concluding paragraph implies that it favours the abolition of the dead-donor rule because of the impossibility of defining death and the fact that doctors are said to routinely ignore the official guidelines. With so many people in need of transplants, why worry about casuistic definitions: “But concerns about the legal details of declaring death in someone who will never again be the person he or she was should be weighed against the value of giving a full and healthy life to someone who will die without a transplant.”

No doubt there will be more to come on this topic. Abolition of the dead donor rule could be the next big battle in bioethics. ~ Nature, Oct 1