Crossing the Rubicon: Death in ‘The Year of the Transplant’

How death should be measured was a subject of intense debate during the late 1960s, and one in which transplant surgeons had a particular interest. Legislation required a doctor to first pronounce ‘extinct’ the patients from whom ‘spare parts’ were sought for grafting. But transplant surgeons increasingly argued the moment of death was less important than was the moment of establishing that a patient was beyond the point of no return in dying, at which time she or he should be passed to the transplant team. This raised concerns that people identified as being a potential source of organs might not be adequately cared for in their own right. In 1968 the World Medical Association issued an international statement on death at its meeting in Sydney, Australia following a debate between delegates about how and by whom death should be assessed prior to organ removal. Soon afterwards Australian surgeons performed two of the one hundred and five heart transplants carried out around the world that year, dubbed by the New York Times to be one during which an ‘international epidemic’ of such grafts were carried out. This essay examines debates about death and transplanting, then analyses the pioneering Australian heart transplants, in the context of the Declaration of Sydney and continuing international discussions about whether these operations were moral and legal.