Catholics and Organ Donation
A significant issue in organ donation is whether the donor is dead or alive. Before death, a person out of love and charity may donate organs not necessary for continued life and health, i.e., under usual circumstances, one of two kidneys, one lobe of the liver, one lobe of one lung, blood, and bone marrow. At the time of donation precautions must be taken to preserve and protect the life and health of the donor. Informed consent of the person donating the organ and benefit to the life or health of the person receiving the transplant are required.
Organs at normal body temperature vary as to how long they can withstand absence of circulation and respiration until damage is severe enough to make them unsuitable for transplantation. Without circulation, the heart and liver are damaged in about 3-5 minutes; kidneys, in about 30 minutes. For organs to be useful for transplantation, circulation and respiration are required until a short time before removal of the organs. Thus, it is a beating heart that is excised for transplantation.
Through the ages death was known as the state of the body without life—empty, a corpse—cold, blue, rigid. As discussed above though, in such a state the remains would not provide organs suitable for transplantation. Hence, because of interest in organ transplantation, a different way of calling someone dead developed. Now, the organ transplanters are taking living, healthy organs, e.g., heart, lungs, kidneys, pancreas and intestines from those who have been declared "brain dead." Although it is done under the guise of legality, the medical and moral issue is, "Are the donors dead before excision of organs?"
The condition of the body after someone has died is different from the clinical condition after a declaration of "brain death," which is based on alleged absence of all functioning of the brain. When such declaration is made, the life of the patient is supported with a ventilator. The ventilator moves air (oxygen) into the lungs. The ventilator only moves the air. Most other machines are mainly sensing and displaying information coming from the living body. Exchange of oxygen and carbon dioxide occurs in the lungs and throughout the body via circulation. The heart is beating without the aid of technology or medication. There is a recordable blood pressure. When the knee is tapped, a knee jerk can be present. Color is normal, but when pressure is applied to the skin, it will blanch. Color will return to normal within a few seconds after pressure is removed. The clinical condition of someone declared "brain dead" is biologically and medically easily distinguished from the findings after death.
*Where can one go for guidance in these serious moral matters of determination of death and organ donation? The Catholic Church has provided guidance. The Catholic Catechism 2296 states, "[I]t is not morally admissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons."1
The position of the Catholic Church is based on the following, beginning with the Council of Vienne, 1311-1312: "Moreover, with the approval of the said council, we reject as erroneous and contrary to the truth of the catholic faith every doctrine or proposition rashly asserting that the substance of the rational or the intellectual soul is not of itself and essentially the form of the human body, or casting doubt on this matter. In order that all may know the truth of the faith in its purity and all error may be excluded, we define that anyone who presumes henceforth to assert, defend or hold stubbornly that the rational or intellectual soul is not the form of the human body of itself and essentially, is to be considered a heretic."2 This position was reaffirmed by the Fifth Lateran Council, 19 December 1513.3 The Catholic Catechism 365, citing the Council of Vienne, states that "[t]he unity of soul and body is so profound that one has to consider the soul to be the 'form' of the body. . . ."4
Pope Pius XII in 1957 in an Address to Anesthesiologists stated: "But considerations of a general nature allow us to believe that human life continues for as long as its vital functions—distinguished from the simple life of organs—manifest themselves spontaneously or even with help of artificial processes."5
In the same Address Pope Pius XII stated: "In case of insoluble doubt, one must resort to presumptions of law and of fact. In general, it will be necessary to presume that life remains, because there is involved here a fundamental right received from the Creator, and it is necessary to prove with certainty that it has been lost."6 (Emphasis added.) Also, Pope Pius XII in an Address about corneal transplantation, stated "Public authorities and the laws which concern the use of corpses should, in general, be guided by these same moral and human considerations, since they are based on human nature itself, which takes precedence over society in the order of causality and in dignity. In particular, public authorities have the duty to supervise their enforcement and above all to take care that a "corpse" shall not be considered and treated as such until death has been sufficiently proved."7
Pope John Paul II in 1991, to a Group on Organ Transplants, stated: "Furthermore, a person can only donate that of which he can deprive himself without serious danger or harm to his own life or personal identity, and for a just and proportionate reason. It is obvious that vital organs can only be donated after death."8
Pope John Paul II to the Participants of the 1989 Pontifical Academy of Sciences stated: "The problem of the moment of death has serious implications at the practical level, and this aspect is also of great interest to the Church. In practice, there seems to arise a tragic dilemma. On the one hand there is the urgent need to find replacement organs for sick people who would otherwise die or at least would not recover. In other words, it is conceivable that in order to escape certain and imminent death a patient may need to receive an organ which could be provided by another patient, who may be lying next to him in hospital, but about whose death there still remains some doubt. Consequently, in the process there arises the danger of terminating a human life, of definitively disrupting the psychosomatic unity of a person. More precisely, there is a real possibility that the life whose continuation is made unsustainable by the removal of a vital organ may be that of a living person, whereas the respect due to human life absolutely prohibits the direct and positive sacrifice of that life, even though it may be for the benefit of another human being who might be felt to be entitled to preference."9
In the same Address Pope John Paul II stated: "Death can mean decomposition, disintegration, a separation (cf. Salvifici Doloris, n. 15; Gaudium et Spes, n. 18). It occurs when the spiritual principle which ensures the unity of the individual can no longer exercise its functions in and upon the organism, whose elements left to themselves, disintegrate."10
Pope John Paul II in Evangelium Vitae, (n. 15), stated: "Nor can we remain silent in the face of other more furtive, but no less serious and real, forms of euthanasia. These could occur for example when, in order to increase the availability of organs for transplants, organs are removed without respecting objective and adequate criteria which verify the death of the donor."11
It follows that the question must be asked: Are criteria that are used objective and adequate to verify the donor's death when a heart and other organs are taken for transplantation? That is, is life no longer present when the heart is beating and there is a recordable blood pressure, normal temperature, normal salt and water balance and many internal organs and systems are functioning and maintaining the unity of the body?
The statements of Pope Pius XII, Pope John Paul II, the Council of Vienne, the Council of the Fifth Lateran, and the Catechism of the Catholic Church, combined with knowledge of biology, biochemistry, medicine, jurisprudence, and theology make clear to us that the unity of the body is present until excision of organs. At the very least, if the separation of the body and life cannot be verified, or if there is doubt about the separation of the body and life, organ excision is morally prohibited and should not be allowed.
Contradictory Declaration in the Charter for Health Care Workers
The Charter for Health Care Workers was published in 1995,". . .at the initiative of the Pontifical Council for Pastoral Assistance to Health Care Workers."12 The Congregation for the Doctrine of the Faith "... approved and quickly confirmed in its entirety the text of the Charter submitted to it," including Number 87: "In order that a person be considered a corpse, it is enough that cerebral death of the donor be ascertained, which consists in the 'irreversible cessation of all cerebral activity.' When total cerebral death is verified with certainty, that is, after the required tests, it is licit to remove organs and also to surrogate organic function artificially to keep the organs alive with the view to transplant."
This statement is confusing and misleading in at least these ways:
1. How can someone be "considered" a corpse? Either someone is a corpse or someone is alive, and not a corpse.
2. What does "cerebral" mean? Does "cerebral" refer to cerebrum, cerebral cortex. cerebral hemispheres (cerebral cortex and basal ganglia), the entire brain or something else?
3. Is cerebral death different from death?
4. What is meant by "irreversible?" "Now, irreversibility as such is not an empirical concept and cannot be empirically determined. Both destruction of the brain and the cessation of its functions are, in principle, directly observable: such observations can serve as evidence. Irreversibility, however, of any kind, is a property about which we can learn only by inference from prior experience. It is not an observable condition. Hence, it cannot serve as evidence, nor can it rightly be made part of an empirical criterion of death." To regard irreversibility of cerebral (or brain) functioning, function or functions (at best, a deduction from a set of symptoms) as synonymous or interchangeable with death is to commit a compound fallacy: identifying the symptoms with their cause and assuming a single cause when several are possible.13
The reference cited by the Charter is to a statement at the close of the 1985 Pontifical Academy of Sciences meeting. However, at the beginning of the 1989 meeting in an Address to members of the Pontifical Academy of Science, Pope John Paul II cautioned about the dangers of terminating a human life even though someone else may appear to need an organ to escape death.
The Charter for Health Care Workers, no. 87, does not express principles stated by two Councils of the Catholic Church, Pope Pius XII and Pope John Paul II. Why did the Charter choose not to refer to these?
* After death, tissues, e.g., corneas, heart valves, bone, skin and connective tissues may still be useful for transplantation. Note that these are tissues, not organs, and may be taken only after death because excision of these would otherwise cause mutilation or death.
1 Catechism of the Catholic Church, no. 2296.
2 Council of Vienne 1311-1312.
3 Fifth Lateran Council, 1512-1517.
4 Catechism of the Catholic Church, no. 365.
5 Pius XII to an International Congress of Anesthesiologists, Nov. 24, 1957, The Pope Speaks. Vol. 4. No. 4 (Spring 1958). 393-398.
7 Pius XII, to the delegates of the Italian Association of Cornea Donors and the Italian Union for the Blind, May 14. 1956 in AAS 48 (1956) 464-465.
8 John Paul II. to the participants at the first International Congress on the Transplant of Organs, June 20, 1991, in Insegnamenti XIV/1 and L'Osservatore Romano. N. 25-24, June 1991.
9 John Paul II. Pontifical Academy of Science. Declaration on the Artificial Prolongation of Life and Determining the Precise Moment of Death. 14 December. 1989, n. 5, L'Osservatore Romano. N. 2, Jan. 8, 1990, 8, II.
10 John Paul II. Pontifical Academy of Science. Declaration on the Artificial Prolongation of Life and Determining the Precise Moment of Death. 14 December 1989, n. 4, L'Osservatore Romano, N. 2, Jan. 8, 1990,8, II.
11 John Paul II, Encyclical Evangelium Vitae no. 15.
12 Charter for Health Care Workers, no. 87. 1995.
13 Byrne. P.A., O'Reilly, S., Quay, P.M., and Salsich. P., "Brain Death—An Opposing Viewpoint," Journal of the American Medical Association 1979:242:1985-90.
See also: Evers. J.C. and Byrne, P.A.. "Brain Death —Still a Controversy." The Pharos 1990 Fall: 10-12: Byrne, P.A., O'Rielly, S., Quay, P.M., and Salsich, P., "Brain Death—The Patient, the Physician, and Society" [published errata appear in Gonzaga Law Review 1983/84: 19(3):476). Gonzaga Law Review 1982/83: 18(3): 429-516. Quay. P.M., "Utilizing the Bodies of the Dead, " St. Louis University Law Journal 1984; 28(4):889-927.
Byrne. P.A., Colliton, W.F., Diamond. E.F., Duncan, R.F.. Fangman, T.R., Kramper, R.J., et el. "The Physician's Responsibility Toward Sacred Human Life," Linacre Quarterly 1986 Nov: 14-21: Byrne, P.A. and Nilges, R.G.. "The Brain Stem in Brain Death: A Critical Review," Issues in Law and Medicine 1993: 9(1):3-21: Byrne. P.A., Evers, J.C., and Nilges. R.G.. "Anencephaly —Organ Transplantation." Issues in Law and Medicine 1993: 9(1):3-33.
The four authors of this article are: Paul A. Byrne, M.D., a Board certified Neonatologist in Toledo, Ohio who has studied and published on "brain death" and related topics for more than 20 years. He is a Clinical Professor of Pediatrics at the Medical College of Ohio: Richard G. Nilges, M.D., Emeritus Attending Staff (Neurosurgery), Swedish Covenant Hospital. Dr. Nilges's retirement from the active practice of neurosurgery was hastened by pressures from organ transplanters to obtain organs quickly. Since retirement he has continued to write and lecture on "brain death" and related topics. Dr. Nilges resides in Valparaiso, Ind.; Fr. George M. Rinkowski, a Catholic priest retired from parish work in Toledo. He remains very active in consulting in moral matters and making himself available when a priest is needed by a critically ill patient; Walt F. Weaver, M.D., Board Certified in Cardiovascular Disease. As a Fellow of the American College of Cardiology, he served as Secretary, 1983-84. In 1980 he was Chairman of the Board of Governors and was a member of the Board of Trustees, 1980-84. As a practicing cardiologist, he was formerly involved in heart transplantation. Knowledge and information about organ transplantation hastened his retirement from the active practice of cardiology. He is Chairman of the Ethics Committee of St. Elizabeth Hospital in Lincoln, Nebraska. © The Homiletic & Pastoral Review, 86 Riverside Dr., New York, N.Y. 10024, (212) 799-2600.
© The Homiletic & Pastoral Review, 86 Riverside Dr., New York, N.Y. 10024, (212) 799-2600.
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