Abstract

One result of routine use in intensive care units of the medical apparatus known as the artificial ventilator has been the creation of human entities whose brains are diagnosed as irreversibly damaged, but whose bodies are kept alive by means of technological support. Such brain-dead bodies have potential value as a supply of human organs for transplant. This article, drawing primarily on ethnographic data collected in intensive care units, examines why procurement of organs from brain-dead bodies has been fully institutionalized in North America for more than two decades, in contrast to Japan. It is argued that the basic medical discourse is essentially the same in both locations and that it is largely unexamined tacit knowledge formed from an amalgam of local values, discursive formations in law, medical guidelines, policy formulations and public commentary, that accountfor the difference. This situation, that has dramatically different effects on the transplant enterprise in the two locations, is not culturally determined and the respective dominant ideologies are widely disputed in both North America and Japan resulting in a situation of chronic flux.