RAISING THE DEAD: ORGAN TRANSPLANTS, ETHICS, AND SOCIETY.

RAISING THE DEAD: ORGAN TRANSPLANTS, ETHICS, AND SOCIETY. Ronald Munson. 304 pp. Oxford University Press, 2002. Can$48. ISBN 0195132998 This novel-like publication, based on case presentations yet with monographic characteristics, outlines in a detailed descriptive fashion complex problems of the science of organ transplants, related ethical-social values, including cost considerations and relevant distributive justice issues. The format and contents of each presentation are enjoyable, clear and could be easily utilized at seminars or other teaching sessions with medical students, residents and academic teaching staff. In addition, the language of the presentations is lucid and easily understandable by the public at large. This will likely encourage and enhance our societal intellectual interests and virtuous ethical desire in search of the truth in evolving science, technology and therapeutics to which we have the right of access and the right to know, adding positive contributions to our organ donation process. The book is divided into several chapters, dealing with the specifics of different organ transplants, such as liver, heart (both adult and neonatal), kidneys, and xenotransplantation. It describes in a positive way the science and technology of stem-cell research, including some of our present clinical therapeutic considerations. The criteria for donor selection, including definitions of death and brain death are well presented and explained. These criteria are based on scientific physiological and moral definitions accepted both in North America and universally. In some regions this is affected by cultural and religious values, but these are usually respected. The issue of selling organs is also mentioned, but it is not practised in Western countries and in democratic societies. As expected, the organ donation process is very painful to families, relatives and friends of a donor. In light of that, special behavioural and consultative approaches are recommended as mandatory. They require specialized personnel, trained to handle these problems. Each patient requiring organ transplantation is carefully assessed, based on the severity of illness, indications for transplantation, selectivity or prioritization process and availability of a suitable donor. This is reinforced by detailed statistical analysis for each organ transplant group, analysis that also includes the length of the waiting list, associated mortality, comorbidity and final outcome. It is further subdivided into regional analysis, which gives the reader some idea of how the issues of organ transplantation are managed across the country. Since most of the collected information in this book came from major centres in the United States, discussion of the practice of organ transplantation in our Canadian system is not included, but the applicability of this process in Canada is obvious. Occasionally among certain groups of our society or in certain regions, the notion of preferential selectivity, based on social or economic status, creates strong criticism and anger. The author has analyzed this issue in comparison with biological and statistical data associated with the recipient-donor matching process and has concluded that usually preferential selection does not exist. The other controversial problems mentioned in the text are related to concomitant illness such as uncontrolled alcoholism in liver cirrhosis or undetected localized hepatic malignant disease. The discussions provided in the text are thorough and will serve as an educational background for many readers. Of special, although limited, interest are discussions of anencephalic newborns, heart transplantation in newborns for life-threatening congenital heart disease and the use of xenotransplantation. These difficult issues will continue to be at the forefront of scientific challenges. In summary, this text is a valuable and much needed contribution to the scientific literature. It is unique, since it effectively combines clinical science with ethical principles, including distributive justice. It could be used as an educational reference for medical students, residents and others, including medical ethicists. It will also have an impact on public opinion and may enhance the donor awareness programs and organ donation process in Canada. Jaroslaw Barwinsky, MD Professor Emeritus Department of Surgery, Cardiac Surgery University of Manitoba Winnipeg, Man.

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