18 August 2008

Re-Post: The Hidden Moral Dangers of Organ Donation

Due to the increased interest in this topic spurred by the NEJM article posted immediately below, I have decided to re-post my first effort on organ donation:

Donors often give the very gift of preserving the life of those who receive their organs. Even in a selfish and secular society the act of organ donation is universally praised and honored. So, what can possibly be wrong with such an act of selflessness?

Unfortunately, the state of moral education and scientific knowledge among most of us is such that we remain unaware of several moral and physical dangers to the donor, and by participation, the donee.

First, and most importantly, what is unknown to many is that organs are often and routinely taken from patients who are still alive; very often the organs taken are necessary to preserve the "donor's" life. The main problem here is that the medical community relies upon a definition of death that is not really death.

The concept of "brain death" is key to mass scale, successful organ donation. And the concept of "brain death "means that a person is considered dead who is not really dead.

What is "brain death"? That is an interesting question, and one that scientists continue to change--always to make the definition more subjective and lenient.

In a 2001 article in Catholic World News, Are Organ Transplants Ever Morally Licit?, co-authors Bishop Fabian Bruskewitz, Bishop Robert Vasa, and several Catholic physicians discuss the moral and scientific considerations of organ donation. In it, they also lay out the shifting history of the definition of brain death:

Between 1968 and 1978, thirty sets of criteria for "brain death" were published. Many more sets of criteria have subsequently appeared. Each succeeding set of criteria has tended to be less strict than the previous ones. However, no matter the differences, none have declared any other preceding criteria to be obsolete nor does any criterion for "brain death" state that it is equivalent to true biologic death of the person.

American law has accelerated the multiplication of brain-related criteria for the definition of death by giving the physician the authority to determine death. Every transplant center agrees that death is whatever and whenever a doctor says it is. The Uniform Determination of Death Act (UDDA) states that the determination of death must be "in accordance with accepted medical standards." Therefore the law, not medicine, gives the physician the authority to determine his own criteria. These indiscriminate standards of judgment have given physicians excessive and unrestrained power.

The article explains also how when a person is "brain dead", his heart, lungs and other vital organs are still functioning. Blood still flows. In fact, this state of affairs is necessary to ensure that the organs to be donated are still living and thus able to be successfully transplanted. Otherwise, only the most coincidentally fortunate set of circumstances where a transplant team happened to be at the patient's side at the moment of real death and a very rapid and successful surgery would have any chance at all to enable organ donation. The lie that death means the cessation of brain activity is proven by our own histories in the womb:

During the first six weeks of pregnancy our body lives without a brain and hence our human life does not begin with the human brain. Certainly, the embryo is alive but his life is not bound to the functioning of his brain. Therefore, the thesis of brain death being the actual death of the person which ties human life inseparably to a functioning brain goes against this biological fact: the development of the embryonic body proves that the brain cannot be simply the seat of the human person's life or soul. To hold the opposite view, you have to defend the position that the human soul is created or enters the body only after the human brain is formed.

Secondly, there is so much pressure on people to donate organs without adequate information about the realities of the procedures involved that many "donors" are not really donors at all. Donation requires consent to the gift. Many people, including Catholics, have no idea they are signing up to have someone kill them to harvest their organs. It sounds harsh, of course, but it is often exactly the case. It is fundamental moral theology that one cannot do evil in order that good come from it. One cannot purposely end their own life or seriously mutilate their body, nor ask others to do so, in order to prolong the life of another.
From the Catechism of the Catholic Church:
2296 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 sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as a expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons.

Note that what I have covered here are organ donations that require the death of the donor. There are other, superfluous organs, like kidneys, for example, that do not kill the donor. Moreover, tissues such as tendons, valves, etc., can be obtained easily after death.

This is a serious issue that has failed to resonate with Catholics largely because of ignorance. If you, or someone you know, has agreed to donate organs, filled out an organ donor card on a driver's license, or executed certain kinds of living wills or powers of attorney, there is still time to become informed and reconsider that decision.

And finally, if it is immoral for a person to donate organs in such a way that it brings about their mutilation and death, then there are also serious moral implications for one who receives such organs. A person may not knowingly participate in, or encourage the sin of an another. If anyone has a personal concern here, I urge you to seek the advice of your confessor.

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