The Undead: Organ Harvesting, the Ice-Water Test, Beating Heart Cadavers--How Medicine Is Blurring the Line Between Life and Death

by Dick Teresi

Important and provocative, The Undead examines why even with the tools of advanced technology, what we think of as life and death, consciousness and nonconsciousness, is not exactly clear and how this problem has been further complicated by the business of organ harvesting.Dick Teresi, a science writer with a dark sense of humor, manages to make this story entertaining, informative, and accessible as he shows how death determination has become more complicated than ever. Teresi introduces us to brain-death experts, hospice workers, undertakers, coma specialists and those who have recovered from coma, organ transplant surgeons and organ procurers, anesthesiologists who study pain in legally dead patients, doctors who have saved living patients from organ harvests, nurses who care for beating-heart cadavers, ICU doctors who feel subtly pressured to declare patients dead rather than save them, and many others. Much of what they have to say is shocking. Teresi also provides a brief history of how death has been determined from the times of the ancient Egyptians and the Incas through the twenty-first century. And he draws on the writings and theories of celebrated scientists, doctors, and researchers—Jacques-Bénigne Winslow, Sherwin Nuland, Harvey Cushing, and Lynn Margulis, among others—to reveal how theories about dying and death have changed. With The Undead, Teresi makes us think twice about how the medical community decides when someone is dead.

Genres: Science, Nonfiction, Medicine, Medical, Death, Biology, History

370 pages, Kindle Edition

First published January 1, 2012

About the author

Dick Teresi is the coauthor of The God Particle and the author of Lost Discoveries: The Ancient Roots of Modern Science, both selected as New York Times Book Review Notable Books. He has been the editor in chief of Science Digest, Longevity, VQ, and Omni, and has written for The New York Times, The Wall Street Journal, and The Atlantic, among other publications.

Reviews

[Debra Hennessey · Rating 1 out of 5]

I thought it was biased and snarky. The subject deserves a better treatment.

[Maegan · Rating 5 out of 5]

Oh, dear. This book is written with a great deal of humor but the author raises some truly terrifying questions about the ethics of "Beating-Heart Cadavers" and a few horrifying questions about exactly when death occurs.
This leads to questions about whether or not the organ donation people are just a wee bit, shall we say, overzealous in their efforts to take from the almost dead. I think the most horrifying question in the entire book is whether or not a "dead" person is truly dead at organ harvesting. The author seems to feel that anaesthetic is a really good idea at harvest time while he is scoffed at by the medical profession.
The author raises further ethical questions about exactly when it is okay to harvest organs from one person to give them to another, and whether "brain dead" is really "dead."
In conclusion, if they're not going to knock me out, even when I'm "dead" I am not going to donate anything.

[Theresa · Rating 2 out of 5]

Supercilious, convoluted, and contradictory. The topic is a fascinating one, but it took a beating under this guy, who thinks taking an 'opposing minority' stance automatically makes him a better, broader thinker than the neuroscientists he attempts to oppose.

Certainly some interesting points, but on the whole, it was just needlessly snarky. Plus the author felt the need to remind the reader that he is a "science writer" about five times per chapter. Trust me dude, we know you're a science writer and not a scientist....or neurologist.


Well: it would seem this book has made me cranky, would be the short of it. Hmpf.

[Jenny Brown · Rating 5 out of 5]

I love books that make us challenge assumptions and think. And does Teresi ever do that in this book. I spend much of my day reading and analyzing research that makes crystal clear the points that Teresi is making here, that doctors are often woefully ignorant about the practice guidelines they are supposed to follow, and that those guidelines are too often set by those who have a financial or philosophical stake in a particular outcome related to the guidelines. So I have no trouble at all believing that what Teresi describes in this book exists--a medical culture corrupted by the need to find fresh, viable organs to the point that poeple are being declared dead when they actually aren't. All so surgeons can get their hands on a nice warm kidney, liver, lung or heart.

That said, I've also seen the other side of this issue, which is elderly people whose organs are of interest to no one being kept alive by the same doctors at huge expense to their families and the state, tortured with worthless medical treatments long past the time you'd put a dog out of its misery even when they and everyone who cares for them would prefer that they be left alone to pass on. Being allowed to die when very little of your body works at all is not necessarily a bad thing. But the issue is that there should be a CHOICE and what Teresi documents is that in the current environment where organ donations are highly prized (and big business) many people are not being given that choice.

This book was particularly interesting to me because, though I don't know Teresi, I live in the same region and know or knew some of the people he discusses at length in these pages, including a friend who died of a massive stroke and a local funeral director (whose son coached my son's football team.) That made what he wrote even more vivid to me. Knowing other people who share Teresi's admiration for Lynn Margulis also made me more prone to listen to his arguments and take them seriously even though they conflicted with some of my own opinions.

There are too few people in this world willing to examine orthodoxies the way Teresi does here. His book deserves to be read and taken seriously. I'm giving it to those who will be making decisions about me when my organs become more important than the rest of me.

If Mr. Teresi is reading this and would like a free lunch, I'd love to take him out to a nice one in Amherst some day. He's just the kind of person I most enjoy talking with.

[Kate Woods Walker · Rating 4 out of 5]

In a recent discussion, several people expressed shock that I--an avowed bleeding-heart liberal--am not an organ donor. Had I possessed the phalanx of facts presented in this buzzing-with-life piece of science reporting, I could have made my case, and then some.

The Undead, in eight well-packed chapters, examines the current state of medical thinking on just what makes a living body a "person" or a mere skin-covered meat case. You'll find much that surprises, with tangents that apply to more than just organ donation.

The chapters on netherworlds and near-death experiences will be of particular interest to believers, although author Dick Teresi maintains an objective, nonreligious voice throughout. The final two chapters do much to explain why even most altruistic soul would be wise to think carefully about living, and dying, well.

[Elizabeth · Rating 4 out of 5]

Teresi is not, as some people think, trying to roll back progress in transplantation. What he is doing is reporting from the front lines and doing it well. He has not forgotten, as so many reporters have, that his job is to tell the facts. Brain death is now accepted as death, but the subject is not nearly as clear as we would like to believe. And that is one of the reasons that anesthesia is not used during organ "harvesting." After all, if we acknowledged that the surgery might produce some kind of distress in the living cadaver, we might have to acknowledge that death is not so easy to define. The truth is, as it is in setting the definition of when life begins, we are placing lines in the sand so we may do what we wish with the body in question. This is Teresi's point and it would be more honest to acknowledge it than to create the impression, particularly among a public with little scientific literacy, that our definitions are unquestionably true.

[Maddie · Rating 1 out of 5]

Cool topic, but this guy is an asshole.

[Rock Angel]

i love controversy. This book elicited scathing criticism from the NY Times. Most major papers (like papers from LA, Chicago, or the Christian Science Monitor) just ignored it, which makes it a MUST-SEE (!)

2 favorable opinions:
*http://citypaper.com/arts/books/dick-...

http://www.theglobeandmail.com/arts/b...

The only paper besides NY Times that acknowledged this book even existed:
http://articles.boston.com/2012-03-19...

KR noted that "the press has abdicated its responsibility for investigative journalism":
https://www.kirkusreviews.com/book-re...

Maybe the most comprehensive take:
http://www.tnr.com/book/review/undead...

B4 I take my first look at the subject, I want to quote (aptly or inaptly) the top 3 popular quotes by Noam Chomsky:

“The smart way to keep people passive and obedient is to strictly limit the spectrum of acceptable opinion, but allow very lively debate within that spectrum - even encourage the more critical and dissident views. That gives people the sense that there's free thinking going on, while all the time the presuppositions of the system are being reinforced by the limits put on the range of the debate.”

“The whole educational and professional training system is a very elaborate filter, which just weeds out people who are too independent, and who think for themselves, and who don't know how to be submissive, and so on -- because they're dysfunctional to the institutions.”

“If we don't believe in freedom of expression for people we despise, we don't believe in it at all.”

1 more:
“Either you repeat the same conventional doctrines everybody is saying, or else you say something true, and it will sound like it's from Neptune.”


=====
totally unrelated but i shud read this:
http://www.theatlantic.com/past/docs/...

2012 investigative reports on the global tissue (not organ) trade:
http://www.icij.org/tissue

-----
read: chapter at p.17x, and the first 50+ pages

[Queenmangin · Rating 2 out of 5]

I am very interested in death and dying, both from a psychological standpoint and a physiological one. I thought this would be an interesting book as I work in a hospital and often see patients that come in and out from long term care and I wonder if what were are doing for them is the best that we can do. I thought that was the subject matter we would deal with in the book. About halfway through it became clear that the author was pushing an agenda. He states many times that he is being objective and only reporting the facts but he uses descriptions that are anything but objective. I don't think this author does a good enough job of presenting both sides of the organ donation equation and has a decidedly opposing view of the process. I agree, no one can pinpoint death, it is a mystery. But what we need to do is open up dialogue with the ones we love and talk about our options before it comes to a persistent vegitative state, etc. We keep more people alive now with more and more complex comorbities and we are spending an extreme amount of money and resources just to keep these people "alive". I think alive should also include the fact that these people, even if they could breathe without assistance are unable to regulate their temperatures, their blood pressures, unable to fight off the simplest of infections, unable to control their bodily functions which can easily lead to skin breakdown and infection, unable to turn themselves to prevent bedsores, unable to feed themselves and in some cases unable to digest their food, unable to clear secretions. Without a constant supply of medicines, antibiotics, suctioning, catheters, many of these patients would stroke out, give in to infection or aspirate. I'm not sure those people are really "alive" either. I didn't appreciate the author passing off this piece as journalism when he is clearly biased. And there is no positive statements about the importance of organ donation and I believe organ donation IS important.

[Danny · Rating 4 out of 5]

Dick Teresi is going to die. He'll be the first to tell you. But when the time comes, how will the doctors know that he's gone? That's the question at the heart of this book. Teresi dives head-first into the science of determining when a person is officially dead, and he doesn't like what he finds.

Near the beginning he claims, with upraised palms and wide-eyed innocence, that he is "merely a journalist reporting facts." But it quickly becomes apparent that if there is a pot, Teresi will be stirring it. He's a cantankerous tour guide through the medical establishment, and even if you don't like what he's got to say you're in for a wild ride.

His focus through much of the book is on organ donation, and the methods by which those organs are procured. He is suspicious of doctors who seem to rank the lives of some patients of the lives of others. He particularly warns that you should not die in Washington D.C. where the laws allow procedures "strangely similar to practices during the era of the European anatomy theaters." This is because if you're a visitor with no family nearby you may be volunteered for organ donation, the same way visitors in town were offered up for public autopsies in the Eighteenth Century.

He also discusses near death experiences, communication with people in persistent vegetable states, and how Ambien can occasionally wake people from comas.

Be prepared to take it all with a large grain of salt, but this is a fascinating look at a subject that many of us would like to ignore.

[Robynn · Rating 5 out of 5]

Everyone should read this book! Dick Teresi makes a complicated subject easy to read and easy to understand.

[Elizabeth Tarasevich · Rating 4 out of 5]

In my line of work I read a lot of books, and this is one that I think everyone should read. I don't usually make that sort of blanket recommendation, but in this case Teresi's book is a must for all those who have ever died or plan to do so. Teresi is a journalist, an objective guide who guides his readers through the netherworld of dying, near death and para-death. For most of us that world is housed in a clinical setting: the polish of waxed hospital floors, the murmur of monitors, the naked glare of artificial lights. We moderns seem to prefer death - ours and especially that of others - this way: cut off from the living and antiseptic. We also like to think that there is a world of difference between our dead selves and our living selves and that that difference is simply a matter of science, or one of the sciences perhaps biology. Or maybe it is medicine, perhaps neurology or cardiology. We know that WE are alive and the others are dead, That's something of a comfort for those who can leave the hospital or hospice, find their car in the parking garage and return home where, hopefully, there are enough left overs from last night's take out to make a meal.

Teresi rather abruptly shakes the scales from our eyes, and brings us to the bedsides of the nearly-dead, the brain-dead, and the persistently vegetative - all degrees of dead that modern medicine has little interest in differentiating. He also introduces us to the slimy-used car salesmen who charade as doctors but really only care about procuring still fresh organs from the bodies of those in of the dead or near-dead states. Organ donation is a $20 billion per year business, and because of their close affiliation with the medical and political arenas, those who deal in organs garner much more social cachet than, say, those who deal in pork rinds. Medical doctors and attendant health care workers also enjoy the prestige that comes with the false notion that they are the true arbiters of what constitute life, or a living state and what constitutes death or a dying state.

Teresi doesn't pretend to be something he is not - he is simply a journalist whose job is to investigate things and simply tell the story. After many months of research and contemplation on death and the death industry in modern America, that while death has a biological component, it isn't limited to it. Death also has spiritual and moral components which may prove to be much more significant, and better left to spheres of moral and religious philosophy. Spending time with those who experience near death, brain death or bona fide death and then resuscitation convinces Teresi that consciousness survives bodily death and the brain is not the locus of conscious activity (nor memory), as the medical profession would like to declare.

If nothing else this book forces you to think of death in new and interesting ways. It sheds light on the murky ethics involved in our almost exclusively clinical approach to death and the dying, and it helps us to understand the process as it effects the individual, and will, one day, effect us all. Highly recommended.

[Alex · Rating 3 out of 5]

Interesting, mildly informative; unreliable source of true information.

I enjoyed learning about some of the shadier parts of the organ harvesting and death-related industry in the US, as well as discovering just how corrupt and scientifically shaky some of the components are. If you don't know much about organ harvesting, hospices and other death-related industries in the states, this book provides an eye opening overview.

At the same time, the book is quite biased, and much of the science and math behind its claims is presented out of context, and often mis-represented. After checking a few of the harder to believe items presented as facts in the book, and coming up empty, I became very skeptical. Even with a generous and forgiving eye, it's hard to estimate whether the book is at all accurate in many of its claims.

I believe that the author's journalism background, and negative personal experiences, have led him to try to over-sensationalize components of what might have been both an entertaining and reliably informative book. I regret the cost to reliability.

[Carl · Rating 3 out of 5]

I thought that I knew what "dead" was, but after reading this book, I am not so sure. The common definitions of "dead" just is robust enough to insure that everyone of us goes to our final reward without fear of a painful organ harvest. We need to evolve an understanding of how to let donors give organs without having to be "declared dead." Treating donors as patients all of the way to the morgue, that using anesthetics for organ removal to insure that no one has any possibility of awareness, seems like a must.

[Bfg1971 · Rating 2 out of 5]

The Undead was ok. I was hoping for more of a Mary Roach-esque kind of book. Something with lots of Ripley's Believe It or Not type moments but The Undead was much more clinical than that. It was still an interesting read and gives great insight into the business of organ harvesting procurement and poses really interesting philosophical questions such as "What is the exact moment of death?"

It was a good book. It just wasn't quite what I was looking for.

[Matthew · Rating 4 out of 5]

My criteria for five stars is that is has to be very well-written, engaging, informative, and either capture my imagination or change my view on a subject. This book satisfies these criteria, and has me strongly reconsidering whether I want to be an organ donor and what I want in a living will.

[Jim Gleason · Rating 4 out of 5]

As reviewed by Steve Okonek:
An Op/Ed piece in the Wall Street Journal by Dick Teresi, “What You Lose When You Sign a Donor Card” (March 10-11, 2012) hardly served as a rousing endorsement of organ donation. Two medical ethicists, I correspond with, told me it’s created a stir among some transplant surgeons, and has apparently led to an undetermined number of folks questioning their willingness to become donors. Colleagues, who know I am a liver recipient, have asked me about it. Puzzled by the clamor over such a short article, I bought the book to get a better sense of Teresi’s arguments. Here’s what I found.

While the WSJ piece clearly focused on transplants, the book is much broader, covering the vagaries of death. The author posits that “the moment of death may come long after it’s been formally declared,” and that a primary reason for this is a hospital’s fixation on freeing up organs for transplant.

The first third of “The Undead” deals with the history of death and longevity. Teresi, who is no stranger to science writing having won numerous national awards, handles this very well. Many folks have an aversion to death – duh! We all appreciate and understand the difference between cardiopulmonary death and brain death, but historically these represent only the tip of the iceberg of ways that the ancients determined whether you were still around.

Teresi prances through a smorgasbord of outside the box death situations where the need to assess if someone is really, truly dead is critical. Papal camerlengo, near-death experiences, out-of-body episodes, botched executions, murder convictions for shooting a corpse are all detailed in a sometimes macabre fashion I occasionally found interesting and once even hilarious. But the author reserves his venom for the transplant industry. (Note: If you’ve received an organ from a living donor, where obviously no death declaration was involved, Teresi is a strong supporter, and you get a pass!)

Teresi writes, “My assumption was that the inexact art of death determination that had confounded doctors for millennia was a thing of the past, and that modern gizmos and gadgets had replaced crude instruments, old wives tales, superstitions and religious beliefs about when the soul departs. After a few months of research, it became apparent that few doctors are using such high-tech equipment (for the purpose of declaring death) and it doesn’t work.”

The crux of the author’s gripe is that the “Uniform Determination of Death Act (1982), which attempted to spell out brain death, isn’t uniform at all and gave the medical profession carte blanche to declare people dead using whatever they decide upon. Despite the law, the criteria throughout the country are all over the map. Lax utilization of electroencephalography (EEG’s) and inadequate monitoring of carbon dioxide are only two of the alleged shortcomings he points to. He is particularly harsh on the transplant clinics in Washington, DC, where donation after cardiac death (DCD) is apparently common.

One of the safeguards I learned at CTDN training was the requirement that the doctor declaring a patient deceased be clearly separate from the transplant team. Teresi recognizes this but suggests that OPO’s have made significant inroads into ICU’s and that there is no effort by OPO’s to provide informed consent. He offers no specific cases.

Fair is fair, and if laws need bolstering in the face of new technologies or haphazard enforcement, they must be fixed. But I’m at a loss to cite any litigation against an OPO or transplant hospital that involved a hasty declaration of death simply to procure organs. You won’t find any in the book – just hypotheticals. Teresi’s description of OPO employees as “organ wranglers” pushing ICU’s to declare is tasteless and unfounded. His noting that donor families receive no monetary consideration for their decision while OPO’s are flush with transplant money is hardly breaking news. But if one accepts Teresi’s argument that doctors can have a monetary incentive to declare 8 patients dead for transplant, what about the doctor caring for the potential donor? Doesn’t he/she have an obvious financial incentive as well – to keep the bill-paying patient alive? With my Pirates of the Caribbean hat on, it’s clear that not only do dead men tell no tales. They don’t pay medical bills!

The author spends a good deal of space on issues such as pain possibly suffered by the donor during organ recovery, so don’t miss his e-mail correspondence with his local OPO found in the notes section.

In my vision of a perfect world I’d hope that the ruckus Teresi creates would simply blow over. But the day I finished his book, my newspaper prominently played a story about an Argentinean woman who found her baby alive in a coffin in a morgue nearly 12 hours after the girl had been declared dead. Most of the attending medical staff had been suspended pending an investigation. Apparently no transplant was involved, but it perfectly reflected Teresi’s thesis about the blurring line between life and death. I don’t think this topic will go away.

[Annie Montanus · Rating 5 out of 5]

This book changed me. It really did.

[Amanda Kendall · Rating 1 out of 5]

Incredibly biased. There’s no illusion of balance at all. Teresi is very clearly against organ transplantation and habitually jumps to conclusions at odds with the experts, with absolutely no sound reasoning, and snarked at the opinions of people in the scientific community that had any kind of grounding in fact and biology rather than wild speculation.

[Taylor Almeraz · Rating 2 out of 5]

I think my problem with this book was that Dick Teresi, while consistently reminding us that he's a scientific reporter and is just reiterating facts, takes such a jaded and unconvincing tone that it diminishes the actually interesting points he's trying to make.

It came across to me that Teresi lacked quite a bit of objectivity and made quite a number of comments that insinuated he believed anyone who falls on the side of brain death to be a modern-day murderer.

I think this could have been a fascinating book with a more convincing argument if Teresi managed to not be so personally involved in convincing us and if there had been a more cohesive structure within chapters, as opposed to small 1-2 page stories without any clear or definable links to one another. Honestly, reading this just felt like I was being lectured by an antagonising uncle, which ultimately made this read uncomfortable, with delivery undermining the entire validity of the conversation.

[Clark Hays · Rating 2 out of 5]

I usually don't review books I can't finish, but I'm making an exception for this one. It's a fascinating topic, and Teresi seems to be a fine writer, but he comes off as a jerk in this book. Just not someone I wanted to spend a few hours with, much less someone with a point of view I might come to value. I put it down the first time after reading the section on page 31 about Robert Trivers being interviewed by Bill Lawren. The line, "how much pussy is this interview going to get us?" followed by a snarky comment set a really unpleasant tone for me. I put it down for a month. But the book was a gift, so I started again. Four pages later, Teresi takes a pointless swipe at vegetarians. That was enough for me. I'm sure he has much to say about an interesting topic, but I'd rather save my reading time for someone who doesn't grate on my nerves.

[Holly · Rating 3 out of 5]

Very interesting topic. I have always been a supporter of organ donation, but understand that it's an individual's choice. The author asked some really good questions about how doctor's know when someone is really dead, i.e.: cardiac/pulmonary death, brain death, coma vs. PVS, etc., and if transplant doctors may be more likely to jump the gun on declaring someone dead so they can get to the organs faster. Are they interested in saving the patient in front of them at that point, or the 2-6 people that could be saved with their organs? It seems like there is definitely a grey area depending on the hospital/doctors you are dealing with. I do think it would be beneficial to make the default setting on your medicare card to be an organ donor, and you can opt out if you wish, instead of the other way around like it is now.

[Megan Hex · Rating 4 out of 5]

I certainly didn't agree with everything in this book, and I'd find it surprising if everyone did. I agreed with a lot, however, and found all of it interesting. A couple points I'd like to talk about:

- Discussion of prisoners, motorcyclists without helmets, etc. as "compulsory donors" as a form of punishment: This put me in mind of the Murder Act 1751, where criminals in the UK were dissected after execution as a form of punishment (which later dissuaded non-criminals from donating their remains to science, since it was viewed as punitive, which in turn led to body-snatching and so forth).

- We are badly prepared for non-religious guides to mortality. Nothing tells us how to live our lives with the knowledge that we must someday die.

[Matt · Rating 1 out of 5]

Should have stayed a magazine article. Teresi makes a decent point that the human body is very resilient. It is very difficult to tell whether someone is dead. However, I could have done without his condescending tone. I feel he belittled the reader with his poor arguments and he belittled many seemingly respectable theories. He should have cut all the conspiracy theories and the poorly reasoned, poorly argued rants against... I don't know, all intelligent people? Academia? Who knows what Teresi's problem is, I just know his book stinks as a result.

[L V · Rating 2 out of 5]

I get why this book is important, and the information is fascinating and terrifying, but something about it was not satisfying, which, paired with an almost desperate, forced sense of humor towards the material, left me unsettled and nervous (perhaps that was the intent, so in that case, it's excellent). It's a bold look at death, but personally I felt a lot of dread during my time with this book, and the tone, not the information, was the culprit. The information presented, however, is effective and well worth the read.

[Catherine · Rating 4 out of 5]

A report from the former editor of Omni magazine on end-of-life and after-life care of our bodies that motivated me to tear up my donor card and to get moving on those pesky living will/power of attorney types of documents. As I read this soon after reading "Knocking on Heaven's Door" I will become increasingly reluctant to have medical intervention with every decade that I pass. Gets most interesting in the last three chapters (the history of death bored me a bit).

[Victoria Hess · Rating 3 out of 5]

This was a very interesting book for the science behind when someone has died. But the author seems to have an agenda. He appears to be opposed to the standards of death as applied to those who might be organ donors. He says in the final chapter that he is just a journalist, but as such he should allow his readers to reach their own conclusions. I am glad I read it, and yes, it made me uncomfortable, but part of that was the author's pretty obvious opinions.

[Joy · Rating 3 out of 5]

610 Teresi 03/2012 OPL.End notes 40pgs.Selected bibliograpgy 4pg.Index 15 pg.
If you plan to donate your organs, or loved one's,demand to be anesthetized before/during harvesting p152!
Recently read, 'Life Everlasting'- nonfiction by a naturalist,undertakers of the animal world, green burial- also fiction 'Thing about Thugs'-Victorian body-snatchers-ressurectionists.

[Sally · Rating 4 out of 5]

A science journalist's eye-opening examination of today's brain dead criterion of death: it's origins, purpose, contradictions, and effects on patient care. Declaring patients in an "irreversible" coma to be legally dead also has implications for other coma patients, which are sobering. Recommended.

[Shana Yates · Rating 2 out of 5]

Interesting, but it often felt less scientific and more like the author had a very particular viewpoint he was trying to get across. A pity, because the facts themselves are interesting enough to be imparted with less obvious bias. Either way, some very interesting details about how imprecise we are with determining when death occurs.