The Catholic Church and Organ Transplantation
Paul A. Byrne, M.D.
The position of the Roman Catholic Church is based on the following:
Pope Benedict XVI gave the following teachings on November 7, 2008. These have been separated by paragraphs and a few clarifying sentences have been inserted in Italics.
“[F]ree giving is vital to a correct conception of life.”
“[R]esponsibility of love and charity exist that commits one to make of their own life a gift to others, if one truly wishes to fulfill oneself.” “To make of their own life a gift” cannot include causing one’s own death which would be suicide.
“Lord Jesus has taught us, only whoever gives his own life [for my sake] can save it (cf. Lk 9: 24).” “For my sake” is in the Gospel and is inserted back into the quotation by His Holiness to emphasize the focus of the teaching of Pope Benedict. Give for the sake of Lord Jesus.
“The body of each person, together with the spirit that has been given to each one singly constitutes an inseparable unity in which the image of God himself is imprinted.” The body and the spirit (corpora et anima) of each person is “an inseparable unity” during the entire time on earth. The body is the Temple of the Holy Spirit. One must not impose death or shorten the life of the person by mutilation of the body.
“[I]t is necessary to put respect for the dignity of the person and the protection of his/her personal identity in the first place. As regards the practice of organ transplants, it means that someone can give only if he/she is not placing his/her own health and identity in serious danger, and only for a morally valid and proportional reason.” Pope Benedict is clearly teaching about “respect for the dignity of the person and protection of his/her personal identity” and “. . .one can give only if he/she is not placing his/her own health and identity in serious danger.” (My underlines.)
“The possibility of organ sales, as well as the adoption of discriminatory and utilitarian criteria, would greatly clash with the underlying meaning of the gift that would place it out of consideration, qualifying it as a morally illicit act.”
“Transplant abuses and their trafficking, which often involve innocent people like babies, must find the scientific and medical community ready to unite in rejecting such unacceptable practices. Therefore they are to be decisively condemned as abominable.” (My underline.)
“The same ethical principle is to be repeated when one wishes to touch upon creation and destroy the human embryo destined for a therapeutic purpose. The simple idea of considering the embryo as “therapeutic material” contradicts the cultural, civil and ethical foundations upon which the dignity of the person rests.”
“It often happens that organ transplantation techniques take place with a totally free act on the part of the parents of patients in which death has been certified. In these cases, informed consent is the condition subject to freedom, for the transplant to have the characteristic of a gift and is not to be interpreted as an act of coercion or exploitation.” (My underline.) The Holy Father spells out “death has been certified.” The Holy Father can use death as only true death. “Informed consent” is required to be considered to make a gift. It is helpful to remember, however, that “the individual vital organs cannot be extracted except ex cadavere.” The Holy Father clearly teaches that “individual vital organs cannot be extracted except ex cadavere.” “Ex cadavere” is Latin which translates as a stone cold cadaver—dead, truly dead.
“[I]ndividual vital organs cannot be extracted except ex cadavere, which, moreover, possesses its own dignity that must be respected.” The Holy Father has inserted that a corpse has dignity. I ask, can it be licit to remove so much of the corpse, e.g., bones, ligaments, tendons, heart valves, etc?
“In these years science has accomplished further progress in certifying the death of the patient. It is good, therefore, that the results attained receive the consent of the entire scientific community in order to further research for solutions that give certainty to all. In an area such as this, in fact, there cannot be the slightest suspicion of arbitration and where certainty has not been attained the principle of precaution must prevail.” There is no consensus of the leading nourologists in the USA Neurology Jan 2008), thus the entire scientific community does not agree; further “brain death” is not evidenced based (Neurology July 2010).
“[I]n these cases the principal criteria of respect for the life of the donator must always prevail so that the extraction of organs be performed only in the case of his/her true death (cf. Compendium of the Catechism of the Catholic Church, n. 476).” The Compendium continues, “The act of love which is expressed with the gift on one’s vital organs remains a genuine testimony of charity that is able to look beyond death so that life always wins. The recipient of this gesture must be well aware of its value.”
“A medical transplantation corresponds to an ethic of donation that demands on the part of all the commitment to invest every possible effort in formation and information, to make the conscience ever more sensitive to an issue that directly touches the life of many people. Therefore it will be necessary to reject prejudices and misunderstandings, widespread indifference and fear to substitute them with certainty and guarantees in order to permit an ever more heightened and diffuse awareness of the great gift of life in everyone.”
This teaching is updated and preceded by the teachings of the Council of Vienne, 1311-1313: “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.”[i] This position was reaffirmed by the Fifth Lateran Council, 19 December 1513[ii]. 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. . . .”[iii]
Pope Pius XII stated in an Address to the Italian Medical-biological Union of St. Luke (Nov. 12, 1944):
“In forming man, God regulated each of his functions, assigning them to the various organs. In this way, he distinguished those which are essential to life from those which contribute only to the integrity of the body, however precious be the activity, well being, and beauty of this last. At the same time, God fixed, prescribed, and limited the use of each organ. He cannot therefore allow man now to arrange his life and the functions of his organs according to his own taste, in a manner contrary to the intrinsic and immanent function assigned them.”[iv]
Pope Pius XII in an address in 1956 stated, “The physical organism of “the man” is one complete whole in its being. The members are parts united and bound together in their very physical essence. They are so absorbed by the whole that they possess no independence. They exist only for the sake of the total organism and have no other end than that of the total organism”.[v]
In 1957 in his 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.”[vi]
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.”[vii] (Underline 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.”[viii]
In 1991 Pope John Paul II to a Group on Organ Transplants: “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.”[ix]
Pope John Paul II said to the Participants of the 1989 Pontifical Academy of Sciences: “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.”[x]
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.”[xi]
Pope John Paul II stated in Evangelium Vitae (n. 15): “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.”[xii]
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?[xiii]
Pope John Paul II addressed the 18th International Congress of the Transplantation Society on August 29, 2000[xiv]. The Holy Father stated that the decision to donate organs:
[R]equires that individuals be properly informed about the processes involved, in order to be in a position to consent or decline in a free and conscientious manner. . . . Naturally, an analogous consent should be given by the recipients of donated organs.
[V]ital organs which occur singly in the body can be removed only after death, that is from the body of someone who is certainly dead. This requirement is self-evident, since to act otherwise would mean intentionally to cause the death of the donor in disposing of his organs.
[T]he death of the person is a single event, consisting in the total disintegration of that unitary and integrated whole that is the personal self. It results from the separation of the life-principle (or soul) from the corporal reality of the person. The death of the person, understood in this primary sense, is an event which no scientific technique or empirical method can identify directly.
[T]he “criteria” for ascertaining death used by medicine today should not be understood as the technical-scientific determination of the exact moment of a person’s death, but as a scientifically secure means of identifying the biological signs that a person has indeed died.
It is a well-known fact that for some time certain scientific approaches to ascertaining death have shifted the emphasis from the traditional cardio-respiratory signs to the so-called “neurological” criterion. Specifically, this consists in establishing, according to clearly determined parameters commonly held by the international scientific community, the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity. [Emphasis by authors. The Holy Father said “considered,” not “is.”]
With regard to the parameters used today for ascertaining death–whether the “encephalic” signs or the more traditional cardio-respiratory signs–the Church does not make technical decisions. She limits herself to the Gospel duty of comparing the data offered by medical science with the Christian understanding of the unity of the person, bringing out the similarities and the possible conflicts capable of endangering respect for human dignity.
Here it can be said that the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology.
This Address by Pope John Paul II implies that the Holy Father believed that there was only one neurological “criterion” for “the complete and irreversible cessation of all brain activity,” that has been “rigorously applied.” It must be pointed out that there is no one neurological criterion. There is no global consensus in diagnostic criteria[xv] and still unresolved issues.[xvi] None of the criteria have been evaluated for “complete and irreversible cessation of all brain activity.” None have been “rigorously applied.” It is noteworthy that the Holy Father has never used the term “brain death” in any publicized statement.
The Holy Father pointed out the requirement for the donor and recipient to be properly informed. This would have to include information about the differences in the many disparate criteria and how one could be declared dead by one, but the same identical person at the same time is living according to different criteria.
In Evangelium Vitae (86), the Holy Father suggested that one way of nurturing a genuine Culture of Life is the donation of organs, performed in an ethically acceptable manner. A manner that is ethically acceptable is one that corresponds to the Natural Moral Law and its four axioms: (1) Good ought to be done, and evil must be avoided. (2) Good may not be withheld. (3) Evil may not be done. (4) Evil may not be done that good might come of it.
Thus the harvesting of organs in a manner that would bring about the debilitating mutilation or the death of the donor would not be ethically acceptable. The human authenticity of such a decisive gesture requires the individuals to be properly informed about the processes involved, in order to be in a position to consent or decline in a free and conscientious manner.
To be properly informed, the person considering organ donation should be educated about the nature of vital organ transplantation. In particular, he should be advised that prior to excision, his heart is healthy and capable of normal circulation and respiration, but after any vital organ necessary and required to live has been removed from his body, he will die.
Freedom consists in the liberty to exercise one’s free will in accordance with right reason, which seeks good and avoids evil. To murder oneself or another can never be in accord with right reason.
Thus adherence to the restrictions already stipulated and prohibitions imposed by God Himself in the Natural Moral Law precludes the transplantation of unpaired vital organs, an act which causes the death of the donor and violates the Fifth Commandment of the Divine Decalogue, Thou shalt not kill (Deut. 5:17).
[i] Council of Vienne 1311 – 1312.
[ii] Fifth Lateran Council, 1512 – 1517.
[iii] Catechism of the Catholic Church, no. 365.
[iv] Pius XII, Address to the Italian Medical-biological Union of St. Luke, Nov. 12, 1944
[v] 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.
[vi] Pius XII. To an International Congress of Anesthesiologists, Nov. 24, 1957, The Pope Speaks, Vol. 4, No. 4 (Spring 1958), 393 – 398.
[viii] 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.
[ix] 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.
[x] 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, 8,11.
[xi] 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, 8,11.
[xii] John Paul II. Encyclical Evangelium Vitae no. 15.
[xiii] Byrne, PA, O’Reilly, S, Quay, PM, and Salsich, P. Brain Death–An Opposing Viewpoint. Journal of the American Medical Association 1979; 242:1985-90.
Evers JC and Byrne PA. Brain Death—Still a Controversy. The Pharos 1990 Fall:10-12.
Byrne PA, O’Rielly S, Quay PM, 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 PM. Utilizing the Bodies of the Dead. St. Louis University Law Journal 1984;28(4):889-927.
Byrne PA, Colliton WF, Diamond EF, Duncan RF, Fangman TR, Kramper RJ, et el. The Physician’s Responsibility Toward Sacred Human Life. Linacre Quarterly 1986 Nov:14-21.
Byrne PA and Nilges RG. The Brain Stem in Brain Death: A Critical Review. Issues in Law and Medicine 1993;9(1):3-21.
Byrne PA, Evers JC, and Nilges RG. Anencephaly—Organ Transplantation: Issues in Law and Medicine 1993;9(1):3-33.
[xiv] John Paul II. Address to the 18th International Congress of the Transplantation Society, August 29, 2000.
[xv] Wijdicks EFM. Brain death worldwide: Accepted fact but no global consensus in diagnostic criteria. Neurology 2002 January 8;58(1):20-25.
[xvi] Swash M, Beresford R. Editorial: Brain death: Still-unresolved issues worldwide. Neurology 2002 Jan 8; 58(1):9-10.