Conjoined Twins Reveal What Would Happen If One of Them Died

Conjoined twins are an extremely rare phenomenon, occurring in approximately one out of every 50,000 to 200,000 births. These twins are born physically connected to each other and often share organs or vital bodily systems. But while the science of conjoined twins has been studied for centuries, one of the most emotionally and ethically challenging questions remains: what happens if one twin dies while the other is still alive?

This isn’t just a theoretical question. Conjoined twins themselves have opened up about this scenario, revealing the biological, emotional, and medical consequences of such a devastating event.

What Conjoined Twins Say

Modern conjoined twins Carmen and Lupita Andrade, who are joined at the torso and share several internal organs including a circulatory system, have been candid about this subject in interviews. According to them, if one of them were to die, the other would not survive for long.

In their own words:

“We share a bloodstream, so eventually sepsis will kick in, and obviously, within hours or days, the other one will die.”

This is not just speculation—it’s grounded in medical reality. If one twin dies, their body immediately begins to decompose. Because conjoined twins often share blood vessels, bacteria and toxins from the dead twin’s body can rapidly enter the bloodstream of the living twin. This leads to sepsis, a life-threatening condition where the body is overwhelmed by infection.

The Biological Domino Effect

The main risk after one twin dies is the spread of infection and toxins. When cells break down after death, they release harmful substances into the bloodstream. If that bloodstream is shared, the surviving twin essentially becomes the host for both their own biological functions and the decomposing processes of their sibling.

Depending on how the twins are joined, other dangers can also emerge:

• Circulatory collapse: Blood may flow from the surviving twin into the deceased twin’s body, leading to a dangerous loss of blood volume.

• Organ failure: Shared organs like the liver or lungs may begin to shut down, putting extreme stress on the surviving twin’s body.

• Immune system overload: The sudden influx of foreign substances and dead tissue can overwhelm the immune response, leading to septic shock and, without intervention, death.

Can Emergency Separation Save the Surviving Twin?

In some cases, emergency surgical separation is possible and has been attempted in hospitals around the world. However, the outcomes are unpredictable and highly dependent on how much the twins share internally.

For example, in a case reported in Indonesia, one twin had already died, and surgeons attempted to separate the other twin in an effort to save their life. Although the operation was successful in technical terms, the surviving twin died two months later from cardiac complications. In another case involving conjoined twins joined at the chest and abdomen, one twin was stillborn, and doctors performed a rapid separation. Thanks to swift action, the living twin survived.

But emergency separations carry immense risks. The surgeries are complex, and the surviving twin is often already in a critical state due to infection or organ stress. If vital organs like the heart or brain are shared, separation may not be possible at all.

Historical Examples: The Case of Chang and Eng

The most famous conjoined twins in history, Chang and Eng Bunker—who were born in Siam (now Thailand) in 1811—lived for over 60 years and had families of their own. They were connected at the chest by a ligament and possibly shared some liver tissue.

When Chang died of a stroke in 1874, Eng died just hours later. Though Eng had no obvious medical condition at the time, he was so physiologically and emotionally connected to his brother that survival without him may have been impossible. Some medical historians believe Eng suffered from circulatory failure or simply could not recover from the shock of Chang’s death.

Emotional and Ethical Questions

Beyond biology, the death of one conjoined twin raises profound ethical and psychological questions. Is it right to perform a risky surgery that could potentially end both lives? How does one twin process the death of someone who was literally part of their body? Who has the authority to consent to separation when one twin is dying?

Ethics boards, medical professionals, and families often have to make fast and difficult decisions. In some high-profile cases, such as the UK twins known as “Jodie and Mary,” courts intervened to authorize separation knowing it would end one life to potentially save the other.

Conclusion

The death of one conjoined twin is not only a tragic event—it’s a medical emergency with little room for error. As Carmen and Lupita have shared, the surviving twin is at immediate risk due to shared blood, organs, and the cascading effects of infection. Whether through emergency separation or hospice care, the outcome is often grim.

Though rare, the lives—and deaths—of conjoined twins continue to challenge our understanding of medicine, ethics, and the profound connection between two individuals who were born as one.