The astonishing way in which teams of cardiac surgeons, cardiologists, anesthesiologists, and physiologists have coordinated their efforts to effect clinical heart transplants has won world attention. But almost overnight these transplants have become a subject of bristling controversy. While the only survivor of five transplant cases made good progress pending release from Groote Schuur Hospital in South Africa, debate mounted everywhere over the moral and legal implications of recent medical and technological advances.

What distinguishes heart transplants from previous homogenous transplants (including skin tissue, bone tissue, corneal tissue, and kidney transplants) is that the donor must always die before his organ can be attached to another body.

Legal questions are fully as knotty as the ethical. What, for example, are the legal proprieties if next of kin refuse to honor a deceased person’s assignment of an organ for medical purposes? What possibility exists of a black market in human hearts—might the mafia promise overnight delivery with anybody its prospective victim? What complications are posed for wills and insurance coverage if a prospective donor bequeaths his organs for transplant and invites premature death? And, since some doctors find the point of death not in heart arrest but in absence of brain function (which permits removal of organs for transplant before irreversible damage sets in), may some patients be illegally considered dead? Ought the legal determination of the moment of death to be left to the preference of the medics?

Ethical concerns are no less vexing and sometimes overlap the legal. Will it make a difference if a doctor is convinced that no providential brain restoration is ever possible? Have ...

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