In the R.O.C., "brain dead" is not a new term. A number of years ago many in the medical profession proposed this as the new definition of death. But it was only last July, when National Taiwan University Hospital surgeon Chu Shu-hsun performed the first heart transplant, that the "brain death" view truly became prominent.

With the impetus of the transplant, the Department of Health last September announced criteria for brain death. For a patient in an "irreversible" coma (whose coma is not caused by metabolic dysfunctions, drug poisoning, low body temperature, or other unclear factors), if in going through two "brain function reaction tests" and two tests to determine whether or not the patient is capable of breathing on his own, the patient has absolutely no reactions at all, then the patient may be judged as "brain dead."

Professor Chu explains, "Brain death is when all the brain cells are dead, and have lost all contact with the body, and have absolutely no chance of recovery."

Dr. Chu continues: "Brain death is a product of modern medicine." Fifty years ago there were no artificial respirators or heart stimulants; when brain functions stopped, breathing and heartbeat would quickly follow. Today a brain dead individual could be kept alive for one or two weeks.

Most in the medical community believe there are several advantages to declaring brain death. First, family members may know whether the loved one can really be saved or not. Second, the resources of the intensive care unit will not be wasted meaninglessly. And third, and most compelling, the organs of the deceased become available for transplant while they are still functioning.

From the viewpoint of donating organs, it is best that artificial life support to the brain dead person not continue for too long, for the organs may be damaged. Artificial respirators should not exceed 100 hours, while heart stimulants should be reduced or stopped.

Though the brain death concept has advantages, Taiwan University's Wang Cheng-yi, a professor of surgery and one of the directors of the curriculum on "medical ethics" there, cannot help but protest that the brain dead person, like any ill person, deserves the protection of modern medicine. "A doctor is not God; does he/she have the right to decide if a person should die a little sooner or a little later?"

Currently the Department of Health requires certification of brain death by two qualified specialists and the patient's original physician. Wang argues that there should also be a specialist in medical ethics in the group.

He also argues that organ donation should only be undertaken if the potential donor expressly indicated a willingness to do so while alive, or at the initiative of the family. Families should not be asked for donations, nor should brain death be declared to encourage the family to donate, and any scheme which suggests selling or trading must be prohibited. "One must absolutely not end a life for fame or fortune."

Another aspect that deserves attention is that, while most eyes are focused on the surgeon and the recipient, the real hero of a transplant is the donor who gave his or her life. Indeed, this view needs extolling all the more as the atmosphere for donation of organs is not good. Many people believe that corpses should be whole for the afterlife or next life, and a word from the local "Matsu Goddess" can undo all the explanations of a social worker, says Veterans General Hospital's Kwang Hui-chun, a social worker.

Some just cannot bear the thought of giving up the deceased, says Kwang. Her deep understanding of the emotional pains of the family means that, although she encourages them to "do something for society," the social workers' creed is not to coerce the reluctant.

Commonly held erroneous views also cause many to give up the intention to donate. For example, the father of nineteen-year-old Wei Hui-chu, whose heart was donated to Ts'ai Yu Jui-chu (and whose corneas and kidneys were also given), was scorned by neighbors, friends, and family when news got out. Some believed the family made the donations to get their medical bills paid. While these attacks hurt Wei deeply, he persevered in his intention. "I am already handicapped; I hope that others will not be like me, having to stay in pain."

But these good intentions brought little response. Of the five recipients of transplants from Wei Hui-chu, only the father of one of the cornea recipients came to pay respects. Her younger sister Wei Hui-ju lamented, "I don't expect them to thank my father for his decision; but I wish they would at least see her to let her know her sacrifice had some meaning. . . .

Otherwise, it seems too worthless for my sister!"

To transplant an organ or to donate one; to honor only one side is just not enough.

[Picture Caption]

In response to questions from social worker Kwang Hui-chun, Wei Hui-ju sadly recalled her sister's memory. (photo by Vincent Chang)

The lively young Wei hui-chu was pronounced "brain dead" after an auto accident; her organs were donated by her family in a difficult decision to help others. (photo courtesy of Wei Hui-ju)

he lively young Wei hui-chu was pronounced "brain dead" after an auto accident; her organs were donated by her family in a difficult decision to help others. （photo courtesy of Wei Hui-ju）