Andrew Lyons’s defense attorney wasn’t the first person to cry murder when a transplant surgeon removed a heart from a brain-dead patient. In the earliest days of heart transplants, Shumway, the first U.S. surgeon to carry out the procedure, was continually harangued by the coroner in Santa Clara County, where he practiced. The coroner didn’t accept the brain-death concept of death and threatened that if Shumway went ahead with his plans to remove a beating heart from a brain-dead person and use it to save another person’s life, he would initiate murder charges.
Though the coroner had no legal ground to stand on and Shumway went ahead anyway, the press gave it a vigorous chew. New York heart transplant surgeon Mehmet Oz recalls the Brooklyn district attorney around that time making the same threat. “He said he’d indict and arrest any heart transplant surgeon who went into his borough and harvested an organ.”
The worry, explained Oz, was that someday someone who wasn’t actually brain-dead was going to have his heart cut out. There exist certain rare medical conditions that can look, to the untrained or negligent eye, a lot like brain death, and the legal types didn’t trust the medical types to get it right. To a very, very small degree, they had reason to worry. Take, for example, the condition known as “locked-in state.” In one form of the disease, the nerves, from eyeballs to toes, suddenly and rather swiftly drop out of commission, with the result that the body is completely paralyzed, while the mind remains normal. The patient can hear what’s being said but has no way of communicating that he’s still in there, and that no, it’s definitely not okay to give his organs away for transplant. In severe cases, even the muscles that contract to change the size of the pupils no longer function. This is bad news, for a common test of brain death is to shine a light in the patient’s eyes to check for the reflexive contraction of the pupils. Typically, victims of locked-in state recover fully, provided no one has mistakenly wheeled them off to the OR to take out their heart.
Like the specter of live burial that plagued the French and German citizenry in the 1800s, the fear of live organ harvesting is almost completely without foundation. A simple EEG will prevent misdiagnosis of the locked-in state and conditions like it.
On a rational level, most people are comfortable with the concept of brain death and organ donation. But on an emotional level, they may have a harder time accepting it, particularly when they are being asked to accept it by a transplant counselor who would like them to okay the removal of a family member’s beating heart. Fifty-four percent of families asked refuse consent. “They can’t deal with the fear, however irrational, that the true end of their loved one will come when the heart is removed,” says Oz. That they, in effect, will have killed him.
Even heart transplant surgeons sometimes have trouble accepting the notion that the heart is nothing more than a pump. When I asked Oz where he thought the soul resided, he said, “I’ll confide in you that I don’t think it’s all in the brain. I have to believe that in many ways the core of our existence is in our heart.” Does that mean he thinks the brain-dead patient isn’t dead? “There’s no question that the heart without a brain is of no value. But life and death is not a binary system.” It’s a continuum. It makes sense, for many reasons, to draw the legal line at brain death, but that doesn’t mean it’s really a line. “In between life and death is a state of near-death, or pseudo-life. And most people don’t want what’s in between.”
If the heart of a brain-dead heart donor does contain something loftier than tissue and blood, some vestige of the spirit, then one could imagine that this vestige might travel along with the heart and set up housekeeping in the person who receives it. Oz once got a letter from a transplant patient who, shortly after receiving his new heart, began to experience what he could only imagine was some sort of contact with the consciousness of its previous owner. The patient, Michael “Med-O”
Whitson, gave permission to quote the letter:
I write all this with respect for the possibility that rather than some kind of contact with the consciousness of my donor’s heart, these are merely hallucinations from the medications or my own projections. I know this is a very slippery slope….
What came to me in the first contact….was the horror of dying. The utter suddenness, shock, and surprise of it all…. The feeling of being ripped off and the dread of dying before your time…. This and two other incidents are by far the most terrifying experiences I have ever had….
What came to me on the second occasion was my donor’s experience of having his heart being cut out of his chest and transplanted. There was a profound sense of violation by a mysterious, omnipotent outside force….
…The third episode was quite different than the previous two. This time the consciousness of my donor’s heart was in the present tense…. He was struggling to figure out where he was, even what he was….It was as if none of your senses worked…. An extremely frightening awareness of total dislocation…. As if you are reaching with your hands to grasp something… but every time you reach forward your fingers end up only clutching thin air.
Of course, one man named Med-O does not a scientific inquiry make. A step in that direction is a study carried out in 1991 by a team of Viennese surgeons and psychiatrists. They interviewed forty-seven heart transplant patients about whether they had noticed any changes in their personality that they thought were due to the influence of the new heart and its former owner. Forty-four of the forty-seven said no, although the authors, in the Viennese psychoanalytic tradition, took pains to point out that many of these people responded to the question with hostility or jokes, which, in Freudian theory, would indicate some level of denial about the issue.
The experiences of the three patients who answered yes were decidedly more prosaic than were Whitson’s. The first was a forty-five-year-old man who had received the heart of a seventeen-year-old boy and told the researchers, “I love to put on earphones and play loud music, something I never did before. A different car, a good stereo—those are my dreams now.” The other two were less specific. One said simply that the person who had owned his heart had been a calm person and that these feelings of calm had been “passed on” to him; another felt that he was living two people’s lives, replying to questions with “we” instead of “I,” but offered no details about the newly acquired personality or what sort of music he enjoyed.
For juicy details, we must turn to Paul Pearsall, the author of a book called The Heart’s Code (and another called Super Marital Sex and one called Superimmunity). Pearsall interviewed 140 heart transplant patients and presented quotes from five of them as evidence for the heart’s “cellular memory” and its influence on recipients of donated hearts. There was the woman who got the heart of a gay robber who was shot in the back, and suddenly began dressing in a more feminine manner and getting “shooting pains” in her back. There was another rendition of the middle-aged man with a teenage male heart who now feels compelled to “crank up the stereo and play loud rock-and-roll music”—which I had quickly come to see as the urban myth of heart transplantation. My out-and-out favorite was the woman who got a prostitute’s heart and suddenly began renting X-rated videos, demanding sex with her husband every night, and performing strip teases for him. Of course, if the woman knew that her new heart had come from a prostitute, this might have caused the changes in her behavior. Pearsall doesn’t mention whether the woman knew of her donor’s occupation (or, for that matter, whether he’d sent her a copy of Super Marital Sex before the interview).