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Organ Donation and Determination of Death

 

Prof. Charles Ryan, Johannesburg

 

Introduction:

 

The first successful transplant of a heart was done here in South Africa in December 1967. Since then organ transplants have become almost commonplace. The religious and moral implications of these rapid advances in technology need serious attention.

 

The Source of Organs:

1. Taking organs from dead bodies.

Pope Pius XII established a basic attitude in 1956 by saying:

    "…The body was the abode of a spiritual and immortal soul, an essential constituent of a human person whose dignity it shared. Something of that dignity remains in the corpse."

However he also recognizes that :

    "It also follows from this that a person may will to dispose of his body and destine it to ends that are useful, morally irreproachable and even noble (among them the desire to aid the sick and suffering)."

In 1991 Pope John Paul II said:

    "We should rejoice that medicine, in its service to life has found in organ transplantation a new way of serving the human family, precisely by safeguarding the fundamental good of the person. This splendid development in not, of course, without its dark side. There is still much to be learned through research and clinical experience, and there are many questions of an ethical, legal and social nature which need to be more deeply and widely investigated."

The Church teaches clearly that organs may never be taken from dead bodies without prior consent from the dead person, or consent from the responsible survivor.

 

2. Organs transplants from living persons:

 

Pope John Paul II made it clear that it is noble and praiseworthy to undergo surgery and donate an organ, but the organ must be one that someone ‘can deprive himself (of) without serious danger or harm to his own life or personal dignity’. The donation must be limited to paired organs (e.g. kidneys) or parts of organs (e.g. a lobe from the liver).

 

The Latin version of the Catechism of the Catholic Church (September 8th, 1997) says clearly:

    "Organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good that is sought by the recipient."

It must be stressed that in all cases of donor transplants, either from dead or living donors, all appearance of commercialism must be avoided. In 2000 Pope John Paul II said:

    "Any procedure which tends to commercialize human organs or to consider them as items of exchange or trade must be considered morally unacceptable, because to use the body as an ‘object’ is to violate the dignity of the human person."

3. Other Sources of Transplant Organs:

 

Artificial mechanical hearts have already been transplanted, although with very limited success.

 

Transplanting material from other animal species (Xenotransplantation) is being explored. The transplantation of baboon hearts has been tried without success, but the use of organs from pigs that are genetically modified is emerging as technically possible. At present the risks involved would appear to be disproportionate to the possible benefits.

 

However, the practice, which is already relatively common in some countries, of producing human embryos for experimentation and transplantation has been clearly condemned as immoral:

    "This moral condemnation (of abortion) also regards procedures that exploit living embryos and foetuses - sometimes specifically ‘produced’ for this purpose by in vitro fertilization - either to be used as ‘biological material’ or as providers of organs or tissue for transplants in the treatment of certain diseases. The killing of human creatures, even if carried out to help others, constitutes an absolutely unacceptable act."

Determination of Death:

 

It is never moral to remove a vital organ from someone who is still alive. Therefore it is essential to be able to determine the point of death. Pope John Paul II has defined death as "the total disintegration of that unitary and integrated whole that is the personal self".

 

The traditional cardio-respiratory criteria for death are not always useful in cases where modern technology in involved. When the complete and irreversible cessation of all brain activity - often referred to as ‘brain death’ - has been established, it can be accepted as an indication that the ‘total disintegration’ of the Pope’s definition has taken place. In practice this is established by a series of "Brain Stem Tests".

Pope John Paul II summarizes:

    "… whether the ‘encephalic’ signs or the more traditional cardio-respiratory signs (are used) 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 human life."

Conclusion

The sacredness and inviolability of innocent human life, and the nobility of the human body are indisputable basic principles, but the as yet unknown developments that will take place in biotechnology in the future will make further clarifications on ethical and moral implications necessary.

 

 

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