May Catholics Donate Organs?

Caleb Beaver died when he was 16 years old on Christmas Day 2011. His death was caused by a congenital malformation in his circulatory system that was never diagnosed. His parents were devastated. They decided to donate his heart, kidneys, lungs, liver, and pancreas. Several months later, Caleb’s parents met the person who had received their son’s heart. They were able to hear the heartbeat of Caleb’s heart inside the recipient, who was very grateful to them. Although the meeting did not do away with their pain, it did offer them some consolation. Caleb’s parents could from now on cherish the thought that their son’s death was able to give life to another person.1

Organ donation can certainly be a supreme act of generosity. Saint John Paul II gave his support to organ transplantations in his encyclical Evangelium Vitae:

A particularly praiseworthy example of such gestures is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope. (86, emphasis added)

Notice that the Holy Father was very careful to insist on the ethical principles that must guide the technical process of organ transplants.

kidney transplant

 

Ethical Requirements for Organ Donation

1. Organ Donations Must Be Voluntary

In the case of organ transplantation from a live person, the first ethical principle is that the donation must be totally voluntary, free of any type of coercion. We again refer to Saint John Paul II regarding this important principle:

Above all, this form of treatment is inseparable from a human act of donation. In effect, transplantation presupposes a prior, explicit, free and conscious decision on the part of the donor or of someone who legitimately represents the donor, generally the closest relatives. It is a decision to offer, without reward, a part of one’s own body for the health and well-being of another person. In this sense, the medical action of transplantation makes possible the donor’s act of self-giving, that sincere gift of self which expresses our constitutive calling to love and communion.2

 

2. Organs May Not Be Sold

This first ethical principle implies the absolute prohibition of organ sale. The prospect of making money out of organ donations can be especially tempting for poor people and for those people who are rich enough to buy such organs and have them transplanted into their bodies or the bodies of relatives. This lucrative business is a direct affront to the human dignity of all those involved. It reduces the human body to a mere bundle of organs, tissues, and bones. In his characteristic personalistic and profound anthropology, the Pope warns against this travesty:

In effect, the human body is always a personal body, the body of a person. The body cannot be treated as a merely physical or biological entity, nor can its organs and tissues ever be used as items for sale or exchange. Such a reductive materialist conception would lead to a merely instrumental use of the body, and therefore of the person. In such a perspective, organ transplantation and the grafting of tissue would no longer correspond to an act of donation but would amount to the dispossession or plundering of a body.3

 

3. Both Donor and Recipient Must Be Respected

The third principle is in reality implicit in the one just stated. The dignity of the donor and of the recipient must always be respected. This implies that both of them must be given the best medical attention possible, no matter what their economic or social status happens to be.

 

4. The Donation Must Not Seriously Harm the Donor or Recipient

Finally, it must be emphasized that the donation must not cause grave harm to the donor or to the recipient. Great care must be taken to make sure that no vital or other important organs (such as a cornea, for example) are transplanted before death. The Holy Father expresses this ethical principle thus:

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.4

The phrase “a just and proportionate reason” means that the privation of a donor’s organ is not detrimental to his overall health and does constitute a vital help to the recipient.

The last sentence “It is obvious that vital organs can only be donated after death” leads us to the difficult bioethical issue of organ transplantation of vital organs (such as the heart) from dead persons to living persons. It is evident that the central ethical issue in this type of organ transplantation is the definition of death, which has become a topic of dispute among physicians and bioethicists in recent decades due to the advancement of medical technology.

 

What Does the Church Teach on Organ Donation from Dead Patients?

Organ donation from dead patients is a difficult issue because it involves the definition of the moment of death or rather the medical certainty that death has indeed occurred. For an organ donation from a dead to a living patient to be licit, the deceased must have previously given his consent and he must be truly dead. Here is where the problem begins because the definition of the moment of death, especially “brain death,” is still hotly debated.

question mark chalkboard

The obvious danger is that “brain death” is defined in such a lax manner so that organs which are still fresh may be harvested from patients who have not truly died but still have some brain activity. This is why the U.S. Conference of Catholic Bishops in its Ethical and Religious Directives for Catholic Health Care Services, Sixth Edition (64) requires that the physician who determines that death has occurred must not be part of the group of physicians that perform the transplantation. In this way, a conflict of interest can be avoided.5

Saint John Paul II addressed this issue in his Address to the 18th International Congress of the Transplantation Society on August 29, 2000. We transcribe in summary fashion the pertinent paragraphs:

4. The unique dignity of the human person implies that vital organs can be removed only after death. It is helpful to recall that [theologically speaking] the death of the person is a single event, consisting of the separation of the soul from the body.

[Medically speaking] the death of the person is an event which no scientific technique or empirical method can identify directly. However, human experience shows that once death occurs certain biological signs inevitably follow, which medicine has learnt to recognize with increasing precision and has called the “neurological” criterion.

5. This “neurological” criterion 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 has died.

With regard to this criterion, the Church does not make technical decisions. She limits herself to the moral evaluation of decisions made regarding medical data. This neurological criterion if rigorously applied, does not seem to conflict with morality nor with a correct view of the human person.

Therefore a health-worker responsible for ascertaining death can use these criteria to arrive at a moral certainty, which is necessary and sufficient for an ethical course of action. If, in addition, the donor or his legitimate representatives have previously provided his informed consent, then it is morally right to initiate the removal of organs for transplant. (Emphasis added.)

Moral certainty means that the moral agent is more certain that his course of action is the correct one than any other course of action. It is a certainty that is less than metaphysical certainty, which is absolute certainty (for example, that the whole is greater than its parts). Yet it is sufficient for moral decision-making and subsequent actions.

 

Patients Already Connected to Life Support

HLI Educational Advisor Dr. Felipe Vizcarrondo has made the point that when brain death has been ascertained by the standard criteria (i.e., the total and irreversible cessation of all cerebral activity, including the brain stem), the patient is usually on life support. If life support is withdrawn and cardiorespiratory function does not respond spontaneously, the patient may be declared dead. However, there is debate among physicians and ethicists as to the level of time sufficient for moral decision and action – the length of time that absence of spontaneous cardiac and respiratory activity is required in order for the person to be declared dead.

female patient on life support

HLI does not commit itself to a concrete length of time. It limits itself to laying out the correct ethical principles that should guide medical activity. In this case, the re-establishment of life support to maintain the organs fresh for transplant is ethically permissible. But again, the assessment that death has indeed taken place can only be declared once complete brain death as well as cardio-respiratory death criteria are evident.

In sum, the standards for complete brain death are recognized by many in the scientific community and are verifiable. Sadly, this concept of total brain death is still debated. But if the physician ascertains complete brain death and cardio-respiratory death by the standard accepted criteria (the irreversible and complete cessation of the entire brain, including the brain stem, which is responsible for cardio-respiratory activity), he can call the patient dead. The physician, as a moral agent, is making an ethical decision based on the information available at this time.

Saint John Paul II concludes his moral assessment of the definition of complete brain death by cautiously stating:

Therefore, a health-worker professionally responsible for ascertaining death can use these criteria in each individual case as the basis for arriving at that degree of assurance in ethical judgement which moral teaching describes as “moral certainty.” This 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.6

 

Summary

According to Church teaching, living Catholics (and any other people of good will) may donate organs to other people who really need them, provided:

  • They do so out of their own free will without any type of coercion or lucrative incentive.
  • Organ sale must be absolutely prohibited. It turns people’s bodies into mere commodities.
  • The donor and the recipient must be treated with the best medical care possible.
  • The donation must cause no serious harm to the donor nor to his recipient.
  • The benefit provided to the recipient must outweigh the donor’s privation of his organ.
  • In the case of vital organs, they can only be performed after the donor’s death.

According to Church teaching, Catholics and other persons of good will who are truly dead and who have previously and freely expressed their desire to donate organs can do so only if their death has been determined by the most accurate medical parameters.

Concretely speaking, this means the irreversible and complete cessation of all activities of the entire brain, including the brain stem, which is responsible for cardiorespiratory activity.

human brain stem

The brain stem

The Church and morally upright physicians and bioethicists understand that in the case of patients connected to life support, there is still an ongoing debate as to the length of time that absence of spontaneous cardiac and respiratory activity is required in order for the person to be declared dead once disconnected from life support.

To avoid any possible conflict of interest, the U.S. Bishops have indicated that the physician who declares that the patient is dead must not be part of the team of doctors responsible for the transplantation.

In the last instance, it is up to the physician or physicians caring for the patient on life support to make the decision, scrupulously following the strict definition of death given above. The physicians must act in good faith in order to arrive at the best moral certainty possible. This moral certainty means that the moral agent is more certain that his course of action is the correct one than any other course of action. It is a certainty that is less than metaphysical certainty, which is absolute certainty. Yet it is sufficient for moral decision-making and subsequent actions.

 

Fr. Shenan Boquet, President of HLI; Brian Clowes, PhD, Director of Research and Training for HLI; and Felipe Vizcarrondo, MD, contributed significantly through their advice and expertise to the content of this article. The author is very grateful to them for their support.

 

Endnotes

[1] “Mother hears deceased son’s heartbeat again in donor recipient,” Associated Press and Fox News, October 23, 2015.

[2] Address of His Holiness Saint John Paul II to Participants of The First International Congress of The Society for Organ Sharing, June 20, 1991. No. 3. Emphasis in the original.

[3] Ibid., no. 4.

[4] Ibid. Emphasis in the original.

[5] United States Conference of Catholic Bishops (USCCB), Ethical and Religious Directives for Catholic Health Care Services, 6th ed., June 2018. No. 64.

[6] Saint John Paul II, no. 5



2 Comments

  1. Nuno on September 22, 2022 at 12:37 PM

    Why don’t you write about Benedict XVI discourse on the subject?
    Thank you anda God bless
    Fr. Nuno

    • HLI Staff on September 26, 2022 at 2:22 PM

      Dear Fr. Nuno,
      Greetings from HLI!
      I spoke with the author of the article in question. When the article was written, he was unaware that Benedict XVI had given an address concerning this topic, which is surprising, as Benedict is his favorite theologian. So, he expresses his humble apologies. John Paul II is his favorite philosopher, especially his theology of the body. It was very easy for him to quote JPII.
      The author has since become acquainted with Benedict’s address on the subject of organ donation!
      Have a blessed day.

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