On Organ Donation
TUESDAY, MAY 7, 2019
Note: A reader sent in the query below, which we thought deserved a careful reply by a reliable bioethicist.
Question: My nurse friend says that major organs can’t be donated unless donors are alive, thus anaesthetic is given at the time of retrieval. If this is correct, then organ harvesting itself would bring about the donor’s death, right? Wouldn’t this be a kind of euthanasia? I told her the Church would never approve this. But from all I’ve heard, the Church does approve of organ donation, even praises it. Can you shed some light?
If by major organs your friend means vital organs, then her statement is ambiguous. Vital organs are organs that people need to stay alive (e.g., heart, paired kidneys, paired lungs, liver, colon). In U.S. medicine – as well as in most countries of the world – their donation is putatively governed by the “dead donor rule” (DDR). This means, or should mean, that vital organs are only harvested from dead bodies. Although opposition to the DDR has been growing for more than a decade (see 1, 2, 3,4), the rule still universally prevails in transplant medicine.
Catholic moral teaching on organ donation also affirms the DDR (see CCC, nos. 2296, 2301; John Paul II’s Evangelium Vitae, nos. 15, 86; Ethical and Religious Directives for Health Care Services, 6thEd., 2018, nos. 29, 30, 62-64).
It also teaches, as you rightly say, that organ donation can be a good thing. In fact, John Paul II taught that when performed in an ethically acceptable manner it was an example of “everyday heroism.”
To understand the Catholic teaching, then, it’s important to unpack what we mean by an “ethically acceptable manner”.
Since donating vital organs would cause one to sacrifice or seriously impair bodily functions necessary for life or stable health – that is, would compromise what moral theology refers to as functional integrity– it would not be morally licit, since by choosing it we would violate the duty we have to care for our own bodily life.
But it would also be wrongful if one foresaw that donating a non-vital organ would cause one to fail in some already-existing duty. For example, if one has care for a disabled child, and donating an organ (say, a single lung) would make that care difficult or impossible, one should not donate the organ unless one is morally certain that others reasonably can carry out the child’s care. Otherwise, it would be unfair to the child.
It would also be morally wrong if one donates organs for transplantation involved in the establishing or transmitting of personal identity (e.g., ovaries, testicles, brain); as well as when the reasons for donating are morally trivial (e.g., my girlfriend has always wanted a blue eye, and I have two of them); finally, if free consent of the donor or proxy is lacking; or if there are reasonably accessible and less harmful alternatives (e.g., use of bovine organs); or if the donation is being motivated by the desire for economic advantage; in these cases it would ordinarily be wrongful to choose to be a donor.
As for dead donors, all organs in principle, including once-vital organs, may be harvested subject to the following three conditions: 1) donors should be certifiably dead; this determination should be made by competent clinicians in accordance with responsible and accepted scientific criteria; to prevent any conflict of interest, physicians who determine death should not be members of corresponding transplant teams; 2) the donor or his proxy should give free consent; and 3) the intention for using the organs should be upright (e.g., there would be no plan to transplant organs involved in the transmission of personal identity).
Brain death debate
I said above that the DDR putatively governs organ donation in the United States, and that most everyone agrees with this.
Your friend’s comments, however, raise an important debate in bioethics, one being pursued in earnest primarily by Christian scholars.
It’s the question of whether ventilated brain dead individuals are in fact humanly dead; is neurological death an adequate definition of human death?
For organs to be useful for transplantation, they need sustenance up to the time of their removal. Thus, brain dead bodies are kept on mechanical breathing machines (ventilators) ensuring that oxygenated blood is circulated to the organs until transplant teams are ready for them.
For many years, nobody seriously questioned whether brain dead bodies might be living human beings; they just assumed that if the brain was destroyed, the body could not continue to live.
But in 2001, the chief neurologist at UCLA Medical Center, Alan Shewmon, a committed Catholic, published startling research on ventilated brain dead bodies. He demonstrated conclusively that these bodies are sometimes able not only to respire (with the help of ventilation), but to assimilate nutrition, heal from wounds, fight infections, respond to stress, maintain homeostasis, grow proportionally, and even gestate unborn babies. In other words, they acted very much like living human bodies.
If we accept sound Christian anthropology, wherever there exists a living human body, there subsists a living human person, however disabled he may be.
Shewmon’s evidence led him to conclude – and with him many notable scientists and philosophers, including Catholics (e.g., Josef Seifert, Nicanor Austriaco) – that some ventilated brain dead bodies are living human beings, who, wrongly considered to be dead, are killed when their organs are harvested for transplantation.
I’ve provisionally concluded that the evidence at least raises reasonable doubts; and in the face of such doubts, we are morally obliged to treat them as if they are alive unless and until the doubts are dispelled.
Interestingly, there will be a conference soon in Rome sponsored by the John Paul II Academy for Human Life and the Family on this very question; Shewmon is one of the presenters.
Prominent Catholic bioethicists and centers in the United States oppose Shewmon’s conclusions. Unfortunately, some of them insist that those who raise serious doubts about the adequacy of the neurological criteria are unfaithful Catholics. This is because John Paul II said provisionally in a 2000 address that “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.”
But if in the light of new empirical evidence, we question a provisional judgment of a pope, especially when that judgment is made in a realm – such as medical science – over which he has no divinely mandated authority, it is certainly not unfaithful.
*Image: Saint Cajetan Comforting a Dying Man by Sebastiano Ricci, 1704 [Pinacoteca di Brera, Milan, Italy]
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E. Christian Brugger
Dr. E. Christian Brugger is a Professor of Moral Theology at St. Vincent de Paul Regional Seminary in Boynton Beach, Florida, where he lives with his wife and five children. He was dean of the School of Philosophy and Theology at University of Notre Dame Australia, Sydney, and a Theological Consultant to the Doctrine Committee of the USCCB. He is the author of The Indissolubility of Marriage and the Council of Trent