For Catholics...if you were wondering

What the Church's position on organ donation is, here you go:

Catholic teaching on organ donation

By Rev. Larry Hostetter

In the April edition of the WKC the ethical implications of organ donation were raised. Given the importance of this matter, I would like to offer several clarifications from the perspective of Catholic moral teaching..

1. Organ and tissue donation is heroic and praiseworthy. As an act of charity, organ and tissue donation have repeatedly received magisterial support and encouragement. Indeed, Pope John Paul II in the encyclical Evangelium Vitae lists organ donation among "heroic acts," stating that, "A particularly praiseworthy example of such gestures is the donation of organs, performed in an ethically acceptable manner." (86) Equally clear in its affirmation of the goodness of organ donation are the Ethical and Religious Directives for Catholic Health Care Services, published by the National Conference of Catholic Bishops. Directive #63 states: "Catholic health care institutions should encourage and provide the means whereby those who wish to do so may arrange for the donation of their organs and bodily tissue, for ethically legitimate purposes, so that they may be used for donation and research after death." The teaching is thus clear: organ donation is morally permissible.

2. The donor must be dead before organs and tissue can be harvested. Equally clear in the church’s teaching is the insistence that respect for the life of a potential donor is maintained. In directive #64 of Ethical and Religious Directives we read: "Such organs should not be removed until it has been medically determined that the patient has died. In order to prevent any conflict of interest, the physician who determines death should not be a member of the transplant team." Clearly we should be concerned that organ donors will not have their lives interrupted prematurely. That the pope is also concerned with this question is seen in an address he gave to the Pontifical Academy of Science in 1989. In this address Pope John Paul states that given the difficulty of determining the moment of death there is a danger of prematurely taking someone’s life in an effort to gain a transplant organ. He called upon the academy, which is composed of eminent scientists from various disciplines, to examine this question.

This question attained a new urgency with the advent of technology that could keep a person’s heart and lungs functioning artificially. Traditionally death had been defined as the irreversible cessation of the heart and respiration. Now, new technology demands a more precise definition. While the traditional definition is sufficient in most cases, how does one determine death in the case of an individual on a ventilator? From this question arose the definition of "brain death" as the determination that death has truly occurred, making it possible to remove any organs for transplantation. As seen, however, in a recent letter to the WKC, the definition of brain death is not without controversy. Some question whether brain death is a valid determination of the death of a human being. After all, someone may be brain dead but continue activity associated with living, such as heartbeat and breathing.

3. The determination of death is left to medical experts. The reason the Pope consulted scientists on this matter is that it would be beyond his own expertise to scientifically answer the question, What is death? The Church, therefore, does not make any specific statement regarding the legitimacy of medically determined criteria for establishing brain death. This respect for the competency of science and medicine to answer questions in their own fields is a hallmark of Catholic medical ethics. This is seen as early as 1957 when Pius XII in "The Prolongation of Life" stated that the determination of death in such situations "does not fall within the competence of the Church." He stated that it is the physician who offers the final determination of death. (See, The Pope Speaks, 4: no. 4, 1958, 396-398.)

For this same reason, the present pope placed the question before the scientists of the Pontifical Academy of Science. What then were the conclusions of the Academy? The Academy stated that death occurs when "there has been an irreversible cessation of all brain functions, even if cardiac and respiratory functions which would have ceased have been maintained artificially." (See, Furton, Edward, "Reflections on the Status of Brain Death," Ethics and Medics, Oct. 1999, Vol. 24, No. 10, 3-4.) Hence, when the whole brain is dead, the person is considered dead, despite the fact that "residual cellular activity" may continue, either in the brain or other parts of the body. (Ashley, Benedict, Kevin O’Rourke, Health Care Ethics.’ A Theological Analysis, 4th edition, 1997, 403.)

The question remains, however, of the criteria for determining that brain death has occurred. This too is a medical question that should be decided by experts in the field. In Kentucky the definition of death is the same as that of the Academy, the "total and irreversible cessation of all brain function, including the brain stem." This must be verified by two physicians. (Kentucky statutes 446-400.) Various tests are conducted to make a determination that the brain no longer has the capacity "to integrate and coordinate the physical and mental functions of the body." (Furton, "Reflections," 4.) Again, the Church does not determine what those tests should be; that is left to the experts in the field of medicine.

Given these considerations, Catholics who desire to be organ donors upon their deaths should have no fear in performing such a charitable and heroic act. Edward Furton, the editor of the National Catholic Bioethics Center publication Ethics and Medics, offers the following conclusion: "Although no definitive judgment has been rendered, one may safely conclude that Catholic physicians may, in good conscience, employ brain death criteria in their determination of death. Similarly, Catholic patients may agree to give or accept organ transplants on the basis of these same criteria. If the Vatican should ever express reservations to the use of these criteria, it will likely be preceded by a widespread rejection of brain death by members of the medical community. There are voices calling for a rejection of these criteria today, but they would appear to be in the minority. (Furton, "Reflections," 4.)

Rev. Larry Hostetter, STD, is Assistant Professor of Religious Studies, Brescia University, Owensboro, KY