Twice Dead: Organ Transplants and the Reinvention of Death (review)

In his 1759 Theory of Moral Sentiments, Adam Smith argues that the essence of civilization, and the mark of the civilized person, lies in our ability to empathize. We even empathize with the dead, who can have no feelings—so highly developed is our propensity for imaginative identification with others. Identification with the dead, Smith posits, leads to an apprehension of our own mortality, a condition of consciousness that is requisite for us to live as moral beings. He goes on to say that this empathy cannot be justified by reason, and is therefore the test case of the moral sentiment that defines the civilized person and civilized society. The dead have no feelings; they cannot be insulted or humiliated; and yet we weep at the desecration of graves and the mishandling of cadavers. We feel distress on behalf of the dead, who feel no distress of their own—and we feel impelled to take action, to make sure that the feelings of the dead are respected, our dead and everyone else's.

Smith did not invent this moral imperative, he was reporting it and was also working (along with many other people) to cultivate it. Today, imaginative identification with the sufferer, even the sufferer who cannot feel, remains a powerful source of the self, an unassailable touchstone. Or, more precisely, it serves as a part of the moral repertoire of bourgeois social identity. It also serves, more obliquely, as a troublesome moral imperative for social science.

This finely cultivated empathic impulse supplies half of the cultural logic that fuels Margaret Lock's Twice Dead, an anthropological consideration of the origins, present, and future of organ transplantation. To be sure, the moral obligation to empathize, and a finely cultivated habit of empathy, are not usually acknowledged as sources of modern anthropological and sociological scholarship. Social science wears its allegiance on its rhetorical sleeve: the language of the anthropological paper and monograph is all about clinical detachment and objectivity, about the disinterested observer and scholar.

The warp and woof of Twice Dead lie in the tension between objectivity and empathy. The book takes the form of a series of chapters (really separate papers) on the history and practice of organ transplantation, focusing on the contrast between North America and Japan. Between chapters, Lock supplies short vignettes that spotlight different aspects of organ transplantation, such as a family pressured to allow surgeons to perform an organ transplant on their infant daughter; a transplant recipient's unease at having someone else's organ in her body; a nurse's qualms about taking a "brain-dead" patient off life support; a physician's struggle to get permission to do a heart transplant; and the grief of parents of a "brain-dead" donor. Lock nicely lets the complexities of organ transplantation pile up. The issues are multiple and overlapping: What is death? an event? a process? Who has the authority to decide who is dead? doctors, courts, kin? and by what criteria? And what difference does technology make? By extension: What is life, or what constitutes a "human" life, or what constitutes a human "self"? What makes us truly human and truly alive?

Organ transplantation and the associated concept of "brain death" give rise to a series of moral conundrums. As Lock explores the differences between Japan, where organ transplantation has engendered much resistance and is only provisionally and insecurely accepted, and North America, where it has taken firmer hold, other questions arise. How do we account for such differences? Are they contingent political or historical differences, or deeply rooted cultural differences? (Lock suggests in some parts that cultural differences are contingent political and historical differences; in other...