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Complexity of defining death: organismal death does not mean the cessation of all biological life
  1. Melissa Moschella
  1. Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
  1. Correspondence to Dr Melissa Moschella, Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, New York 10021, USA; moschella{at}

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Michael Nair-Collins and Franklin Miller are right to emphasise that, in order to deliberate responsibly about ethical and legal questions related to brain death and organ donation, it is crucial to answer the question of whether or not ‘brain death’i does indeed mark the biological death of the organism. Nonetheless, I disagree with the authors’ conclusion that brain death does not indicate the death of the human organism.

Death can never be defined in merely biological terms, because any biological conception of death relies on metaphysical presuppositions regarding what it means to be an ‘organism as a whole’ (ie, to possess organismal unity), rather than an aggregate of cells and tissues. Death is a change in substance—that is, a change from one type of entity to another (or multiple others)—not the cessation of all biological life. Organismal death occurs well before all of the organism’s parts irreversibly cease vital activity and decompose into inorganic matter. Biological life in some form can and usually does continue after organismal death at least for a time, with recent evidence indicating that animal cell networks continue to perform complex functions like stress response, immune response and inflammation response up to several days postmortem.1 With external support, many cells and tissues can continue to perform their functions ex vivo for long periods of time or even indefinitely.2 Henrietta Lax died in 1951, but cells derived from her cancerous cervical cells …

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  • i I use this term for convenience, while agreeing with the authors’ clarification that patients who satisfy the standard diagnostic tests for brain death can retain some hypothalamic function (p 10). I believe that the persistence of some hypothalamic regulation of sodium and osmolarity is compatible with my own rationale for the validity of the neurological standard of death.

  • ii Despite its shortcomings, I use this term for the sake of convenience to refer to what remains of a human organism (or of what used to be a human organism) after brain death.

  • iii I make no claims regarding the sufficiency or reliability of current diagnostic tests for brain death. Particularly in light of the recent story of Jahi McMath, I am inclined to think that, at least when dealing with juvenile cases, standard diagnostic protocols may be insufficiently rigorous.

  • iv Here I use the word ‘brain’ as shorthand for the entire central nervous system.

  • v For more details on the differences between brain-mediated integration and the mere coordination of cells and tissues independent of the brain, see Condic,2 p 13ss.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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