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Producer's blog: In search of the threshold between life and death

By Vince Sturla
Dateline NBC producer

Vince Sturla is the producer of Dateline NBC's "A Matter of Time." Click here to read the transcript.

When does a person die? At what specific point does the transition take place from life to death? Of course we know the precise moment when death occurs if there's been massive, instantly fatal trauma — a gunshot or car accident. But what if there's been a heart attack or a stroke? In those cases, a doctor told me, "We don't really know the exact time when a person dies." Is it when the heart stops? But there are documented cases of people who have been brought back to life after their heart has stopped and can recount events and conversations that took place when they were "dead." So does death occur 5 minutes after cardiac arrest, or 20?

It's not merely a theoretical question, as our report, "A Matter of Time," makes abundantly clear, and the stakes are particularly high when it comes to organ donation.

Most of the time, doctors procure organs from donors who have suffered "brain death," which has a clear, distinct, legal and medical definition. If a person has been declared brain dead, it's been determined there is no brain function. A death certificate is issued even if the heart and organs are being kept alive through artificial means until they can be removed and transplanted to a patient who needs them. It's strange to think that a person could be in a hospital, in a bed, connected to a ventilator but dead for hours, even days before the organs are harvested. There is nothing vague about these procurement operations. The transplant team comes in, the donor is disconnected and organs removed--all in a matter of minutes. But according to the U.S. Department of Health and Human Services in 2006,there were approximately 92,000 Americans waiting for an organ transplant but only 7,379 brain dead donors. That's one donor for every 12 patients. It's estimated that by the end of 2006, 6,570 people died waiting for an organ transplant.

 During the mid-90s,the transplant community started looking at coma patients, who still had some brain function, as a potential source for organ donations. These patients were categorized as "Donation After Cardiac Death,"or DCD. The label simply means the patient becomes a donor after a decision is made by their doctors or families to withdraw artificial life support, and the patient's heart stops. In 1995, there were just 64 DCD donors (1.2 percent of all dead donors). By 2006, that number had increased tenfold to 645. Most people don't even know there are now two separate categories of donor candidates. But those who do often see a vast ethical difference between the two. In the medical community, it's becoming a polarizing issue. Good people have strong, yet opposing opinions about the ethics of harvesting organs from coma patients. Should a life—no matter how diminished—be brought to an end? Should a life be artificially sustained when others could be saved?

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