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Recently, the Korean government passed a controversial bill approving organ transplants from brain dead patients, much to the opposition of hard-line conservatives and religious groups. This came after legally recognizing brain death as medical death when an organ transplant is needed. There have been many well publicized articles and related stories about brain death and organ transplants, however, only a few describe what brain death is exactly and how it differs the from medical death that we generally refer to as death, leaving the general public in scientific darkness.

In this article, instead of taking a personal side with the moral issue of organ transplant, I have added more biological facts, though the overview is quite generalized and limited, to what the general public knows about brain death so people can objectively decide for themselves.

As we all know, the brain is the most important organ in our body since it voluntarily and involuntarily controls every part of our body and mind. It is responsible for all activities and the functions of internal organs, while ruling over all mental aspects such as thought, consciousness, senses, emotions and memories.

Anatomically, there are four principle parts of the brain _ the brain stem, diencephalon (thalamus and hypothalamus), cerebrum, and cerebellum. The cerebrum is the largest and occupies most of the cranium. The brain stem, like the stalk of a mushroom, leads to the spinal cord. The cerebellum is located posterior to the brain stem. And the thalamus and hypothalamus are located at the top of brain stem within the cerebrum.

Each part has its own specialized role while each is functionally related to the others. Among many other functions, the major roles of each part are as follows: The brain stem acts as a relay station for sensory and motor impulses to the brain and regulates consciousness, arousal, heartbeat, and breathing. The cerebrum primarily interprets sensory impulses, controls muscular movement, functions in emotional and intellectual processes. The cerebellum mainly controls subconscious skeletal muscle contractions required for coordination, posture, and balance. The thalamus serves as a relay station for many sensory impulses to the cerebrum and interprets pain, temperature, emotions and memories, while the hypothalamus controls the autonomic nervous system and articulates with the pituitary gland for production of hormones.

Microscopically, billions of neurons (nerve cells) that make up the brain along with all the nerves throughout our body make our everyday life possible through various chemical, electrical and physiological activities. Therefore, if there is minor damage in one area in the brain, the consequences are tremendous and many crucial functions will be affected. Once damaged, unlike skin cells, brain cells cannot be revived or replaced to resume its original function. If the damage is severe, death is inevitable. In brain death, all four parts of the brain are badly damaged from severe physical trauma. As a result, all control centers responsible for vital bodily functions are destroyed and become defunct. The damage is irreversible and the patient falls into a comatose state. In Korea, automobile/motorcycle accidents (50 percent) and cerebral hemorrhage (bleeding in the brain) (22.8 percent) account for most brain death cases. Gas poisoning also is significant on the list. Nowadays, with the development of technologies and various resuscitation techniques, machines are able to maintain the functions of vital organs such as the heart and lungs (controlling a patient's heartbeat, pulse, blood pressure, breathing and body temperature), although organs can only hold out for a limited time. Two to four weeks is the maximum in most cases.

A similar case that we sometimes hear of is a patient who is in a ``vegetative' state (medical term _ Persistent Vegetative State or PVS). Such a patient is in fact very different from the brain dead. Unlike brain death where all areas of the brain is completely destroyed, the plant man, as it is sometimes called, retains a partially functioning brain, specifically the area of the brain stem.

Therefore some of their vital functions such as breathing and heartbeat are still functional and maintained on their own without the help of machines, though such a person has no consciousness, senses, memories or emotions. Unlike the brain dead, PVS patients can live for years.

More commonly, when we say death, it usually means medical death. Medical death is recognized once functions of all three organs, heart, lungs and brain, completely cease. This is the only criteria that doctors follow as well as being what the law currently accepts as the definition of death. Brain death can be viewed as a process leading to medical death. That was the reason why brain dead patients whose vital organs become functional even with the help of machines were not accepted as medically dead up to now and brought so much controversy. Under the current law, PVS patients are not considered medically dead as opposed to brain dead for the organ donation, since they can breathe on their own (and are thus a living being), though many people believe they too should be included on the list just like the brain dead.

In the cases of brain death in which the patient can only live two weeks to a month maximum, why was there so much controversy. One reason is due to the possibility of organ transplant. Thousands of people die because of the failure of various internal organs such as the heart, lungs, liver, pancreas and kidneys. In present medicine, organs from the brain dead are the most ideal for organ transplants since organs must be fresh.

Though many scientists are now trying hard to find a way to supply new organs for humans through DNA cloning and artificial organs, they have not yet had much success, despite expectations. For now, organ transplant is the best option that present medical technology can offer to save lives of the terminally ill.

However, as with other countries, there is much too high a demand for the organs than the supply. In Korea, according to studies, there are more than 2000 brain death cases every year and the number is on the rise. Last year alone there were 57,584 patients who registered for the transplant while only 14,985 brain dead patients were willing to have their organs donated to people needing them. This means, due to the organ shortage, those who cannot receive matching organs are doomed to die.

Though both moral and ethical questions have not yet been satisfactorily answered for the very definition of death and the legitimacy of collecting organs from a person whose heart is still beating (though it is beating with the help of machines), brain death will be accepted for organ transplant from February 9th of this year. The government has already disclosed strict guidelines for the selection of beneficiaries and heavy penalties for illegal organ trafficking to ensure the benefits to as many patients as possible.

This means, at least for the time being, there will be more organs available and more innocent lives will be saved through organ transplant. This will no doubt give more hope to patients in hospital beds for it provides more opportunities for a second chance at life that previously was not possible.

This will also mean a lot to currently healthy Koreans since they too may need an organ transplant in the future.

For the new millennium, it seems this act of love and compassion by the donors will be more frequently possible in Korea. Though it is only a beginning, it is good to see how the Korean government is going to uphold and preserve the respect for human life ahead of any ideologies or philosophies.