That title is actually be a bit misleading, as it may suggest that I have all the answers for the Church’s stand on organ donation. I actually do not. And I cannot speak on behalf of the Church. But I do have some thoughts and suggestions that might give my faithful brethren and readers a jumping off point for further research. And this is important because many Catholics have no idea that there is anything possibly wrong with the current state of organ donation.
But there is.
First, let me quote some pieces from a recent editorial commentary in the Wall Street Journal. The commentary is written by Dick Teresi, author of The Undead: Organ Harvesting, the Ice-Water Test, Beating Heart Cadavers–How Medicine Is Blurring the Line Between Life and Death. As he says,
Becoming an organ donor seems like a win-win situation. Some 3.3 people on the transplant waiting list will have their lives extended by your gift (3.3 is the average yield of solid organs per donor). You’re a hero, and at no real cost, apparently.
But what are you giving up when you check the donor box on your license? Your organs, of course—but much more. You’re also giving up your right to informed consent. Doctors don’t have to tell you or your relatives what they will do to your body during an organ harvest operation because you’ll be dead, with no legal rights.
You might ask yourself why you might care that you or your loved one no longer have legal rights, so Mr. Teresi explains why. You don’t get any say in the tests used to determine your “death.” As long time readers know, the tests for brain death are sketchy, non-uniform, individualistic and subjective. He writes:
The exam for brain death is simple. A doctor splashes ice water in your ears (to look for shivering in the eyes), pokes your eyes with a cotton swab and checks for any gag reflex, among other rudimentary tests. It takes less time than a standard eye exam. Finally, in what’s called the apnea test, the ventilator is disconnected to see if you can breathe unassisted. If not, you are brain dead.
Hmmm, by this definition of brain death, I have personally as a lifeguard brought two people back from death. Because that is what CPR is: breathing for individuals who aren’t breathing for themselves. Mr. Teresi points out that even though such a person is now considered by organ harvesters as brain dead, they actually have much more in common with the living than the dead. Their organs still function, they still heal, control their internal temperatures, etc. And that is not all.
You might also be emitting brainwaves. Most people are surprised [note: shocked and disbelieving is more accurate] to learn that many people who are declared brain dead are never actually tested for higher-brain activity. The 1968 Harvard committee recommended that doctors use electroencephalography (EEG) to make sure the patient has flat brain waves. Today’s tests concentrate on the stalk-like brain stem, in charge of basics such as breathing, sleeping and waking. The EEG would alert doctors if the cortex, the thinking part of your brain, is still active.
But various researchers decided that this test was unnecessary, so it was eliminated from the mandatory criteria in 1971. They reasoned that, if the brain stem is dead, the higher centers of the brain are also probably dead.
My thought here is that the harvesting team does not actually want to know if the donor is dead yet. Nearly dead is close enough for them.
John Shea, M.D. has written for Catholic Insight:
Since 1968, vital organs, necessary for life, have been removed from patients for transplantation. Since then, this has been morally justified by the claim that the donor is “brain dead” or has suffered “cardiac death.” Brain death is defined as complete and irreversible loss of all brain function and cardiac death is declared two to five minutes after cessation of the heartbeat.
The moral problem is that the criteria used to declare that brain death or cardiac death has occurred are arbitrary, and open to continuing serious world-wide debate. They do not necessarily provide moral certainty that real death has occurred, and that such organ retrieval does not actually cause the death of the donor.
Many medical ethicists are concerned with this lack of certainty of an actual death in brain death cases. Are you comfortable placing the end of your life decision in the hands of these medical professionals? Is there reason to doubt their commitment to your best interests? Actually, yes, yes there is.
Organ transplantation—from procurement of organs to transplant to the first year of postoperative care—is a $20 billion per year business. Recipients of single-organ transplants—heart, intestine, kidney, liver, single and double lung and pancreas—are charged an average $470,000, ranging from $288,000 for a kidney transplant to $1.2 million for an intestine transplant, according to consulting firm Milliman. Neither donors nor their families can be paid for organs.
Mr. Teresi does not mention the big gifts which the donor hospital receives in all this exchanging of organs. But they do. Providing organs is a very lucrative business for hospitals.
In his WSJ article, Mr. Teresi informs us that the current criteria on brain death were set by a Harvard Medical School committee in 1968. In 1981, all 50 states adopted the Harvard brain death as a definition of death. It is enlightening to read a bit from that important Harvard commission (quoting from).
Secular attempts to define death in this regard have not been all that successful. Indeed, rather than use any sort of consistent biological or philosophical criteria, the concerns which seem to be driving definitions of death in the public sphere today are their relative expediency for procuring successful organ donation. This trend started decades ago when the now famous Harvard brain death commission moved us toward a neurological (rather than cardio-pulmonary) criteria:
Our primary purpose is to define irreversible coma as a new criterion for death. There are two reasons why there is a need for a definition: (1) Improvements in resuscitative and supportive measures have led to increased efforts to save those who are desperately injured. Sometimes these efforts have only a partial success so that the result is an individual whose heart continues to beat but whose brain is irreversibly damaged. The burden is great on patients who suffer permanent loss of intellect, on their families, on the hospitals, and on those in need of hospital beds already occupied by these comatose patients. (2) Obsolete criteria for the definition of death can lead to controversy in obtaining organs for transplantation.
As Peter Singer, an atheist philosopher at Princeton who rejects brain death as a criterion for bodily death, notes this as a remarkable moment of honesty in bioethics:
[T]he Harvard committee does not even attempt to argue that there is a need for a new definition of death because hospitals have a lot of patients in their wards who are really dead, but are being kept attached to respirators because the law does not recognize them as dead. Instead, with unusual frankness, the committee said that a new definition was needed because irreversibly comatose patients were a great burden, not only on themselves (why to be in an irreversible coma is a burden on the patient, the committee did not say), but also on their families, hospitals, and patients waiting for beds. source
A Catholic Moral Theology article drily states that “[t]oday we are still dealing with the incoherence of criteria for death driven by the need for organs.” Indeed.
So where does this leave faithful Catholics, trying to live our pro-life mandate? Pope Benedict has said
“The main criterion,” the Pope said, must be “respect for the life of the donor so that the removal of organs is allowed only in the presence of his actual death.”
The Pope is likely to have been referring to the L’Osservatore Romano article when he told the Transplant Conference, “Science, in recent years has made further progress in the determination of the death of a patient.” In the question of determination of death, the Pope cautioned, “there must not be the slightest suspicion of arbitrariness. Where certainty cannot be achieved, the principle of precaution must prevail.”
In the 1995 Encyclical Evangelium vitae (Gospel of Life), Pope John Paul commended organ donation as an unselfish gift of life, but he cautioned that the question of death must be answered by “moral certitude” in order for the gift to be morally legitimate. The Pope said that organs may only be removed after death – “that is, from the body of someone who is certainly dead.”
“Certainly dead.” The problem is that the medical profession which has a well-earned attitude for arrogance and expedience, is not at all interested in being certain of death. Not all doctors, of course, but enough with plenty of individual latitude in declaring death (and then making it so) to make people of faith and intellect think twice. And we should think twice. I never gave this any thought, was never aware of the controversies in organ donation until this very topic affected me personally. Until it took away someone I loved. Since then, I have been educating myself and trying to educate others. I’ve been collecting and sharing stories of supposedly “miraculous recoveries” by medically declared dead patients. I have a half dozen such stories still to publish.
The National Catholic Bioethics Center states that a properly diagnosed neurological death can only be determined following an evaluation of the entire brain, including the cerebrum, cerebellum, and brain stem in order to determine the complete cessation of all organized neurological activity. Of course, it also calls me “irresponsible” but it goes on to make my point, which is “that the neurological criteria must be rigorously and consistently applied and a judgment made of total brain death before a person is declared dead” — but that unfortunately is just not happening with consistency and assurance.
Therefore, I am going to heed and recommend Mr. Teresi’s advice. He ends his WSJ commentary by suggesting that prospective donors not sign away their rights, and thereby retain bargaining power. “If you leave instructions with your next of kin, they can perhaps negotiate a better deal. Instead of just the usual icewater-in-the-ears, why not ask for a blood-flow study to make sure your cortex is truly out of commission?”
To that extent, I encourage my readers to avoid signing donor authorizations that ipso facto sign away legal rights for you and your loved ones. Require the full tests suggested by the NCBC and do not allow a determination of death if the the cerebrum and cerebellum are not also evaluated. Determinations by brain stem activity alone are inadequate.
A living will specifying the criteria you wish used to determine your death, the manner and way in which your body both before death and after must be treated and specifying clearly that you are a Catholic who wishes to be treated in accordance with the teachings of the Church are all recommended. (There used to be a place for Catholics to purchase and download these materials, called Legal Lifeguard but something seems wrong with the site.)