Organ Donation Highly Controversial
This week a Swiss law redefining organ donation went into effect. The change, criticized by Human Life International Switzerland, the Union of Catholic Swiss Physicians, the Swiss Hippocratic Society and the Swiss Society for Bioethics, redefines clinical death as occurring after a mere five minutes. This issue is as much a moral as a scientific one.
Did You Know?
The Catholic Church has yet to issue a document on organ donation, but she says it is never licit to donate vital organs of a living person if the extraction will cause death. Nor is it ever permitted to donate the human brain. If the person is already dead, of course the lenses of the eyes, etc. may be donated. (Living donors are allowed to donate a non-vital organ, such as a kidney, and it may even be heroic to do so.)
The Church is willing to work with scientists to find adequate means to determine ever more quickly when death occurs, but it is a complicated and difficult problem. The trend in “brain death” criteria is clearly to reduce the requirements for declaring the person dead with the obvious benefit of freeing up more organs.
Determinant Factor is Always Brain Death
Controversy swirls today around brain death, but it takes the brain stem longer than 5 minutes to die even when the heart has stopped. Formerly Swiss law allowed organ harvesting after ten minutes. In truth, brain death is more complicated and varies patient to patient.
Yet Swiss organ “experts” now allege after a mere 3 minutes, clinical death can be determined. Saint Pope John Paul II set as a minimum requirement of clinical death the ceasing of all brain function (in the cerebrum, cerebellum and brain stem). Given the controversy, recent attempts to reduce requirements for declaring brain death are clearly unacceptable.
The United States was the pioneer for neurological criteria for determining brain death and remains at the forefront. The Uniform Determination of Death Act requires two elements to determine clinical death; cardiopulmonary death. Here the doctor usually pronounces a patient clinically dead, because each case is different.
Swiss Want Organ Donation – At What Cost?
The previous cardiopulmonary medical definition of death left organs in such a non-oxygenated state of deterioration that they could not be used for transplantation. Brain death definitions all feature a person whose heart is still beating and lungs still working to keep the body/organs oxygenated. The argument used is that machines are keeping the body “alive” with ventilators and cardiopulmonary machines, but the brain is dead and so the person is as well and so the vital organs for transplantation are taken from a “corpse”. However, some point out if a person is dead, it is impossible for a corpse to exhale, i.e. the brain is still sending out electrical impulses and one is not truly dead if the lungs and heart are still functioning, albeit via a machine.
A paper by Dr. Robert Sade mentions the same, donors are often not truly dead. For instance, as techniques like heart resuscitation improve – the heart has been restarted even as late as 15 minutes or longer after cessation — the definition of death becomes increasingly blurred. And what about the many occasions we have heard where people awake from comas after a number of years? Did they “rise from the dead”?
Swiss organ donations are low, 123 this year alone, which is perhaps why the ruling was changed, but at what cost? If there are so many unknowns in such a serious matter, and “moral certainty” of death is required according to Saint Pope John Paul II, isn’t it preferable to opt out of organ donation? It certainly is in Switzerland.
Final Thoughts on Organ Transplantation
We end with words from Pope Saint John Paul II’s address to the Transplantation Society’s 18th International Congress in 2000, on the separation of one’s soul from one’s body:
When can a person be considered dead with complete certainty? … [It is] an event which no scientific technique or empirical method can identify directly. In this sense, the “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 [emphasis ours].
Moral certainty is considered the necessary and sufficient basis for an ethically correct course of action. Only where such certainty exists, and where informed consent has already been given by the donor or the donor’s legitimate representatives, is it morally right to initiate the technical procedures required for the removal of organs for transplant.
Dr. Joseph Meaney, HLI Director of International Outreach and Expansion, contributed to this report.