Brain Death and Organ Donation

A year or so ago, I renewed my driver’s license – something you only have to do every 8 years in Oregon. The clerk asked if I wanted to continue to be an “organ donor”.

I declined. I had learned some things about organ donation and brain death…and why the concept of brain death is important to the concept of (vital) organ donation.

At death, our faith tells us, the soul is separated from the body.  

The Church doesn’t “define” death – at least not in a clinical sense – because that is not really the Church’s job. In a sense, it seems that the Church assumes that we will have some common sense about what constitutes death; after all, it would not do to bury those who are not truly dead (something which has happened, of course)!  

On the other hand, secular society does have an interested in defining death in clinical terms. But how does secular law actually define death? And perhaps more importantly, why do we have the current legal definitions?

Currently, it seems there are two basic criteria for determining death: a neurological criterion (death of the whole brain, including the whole brain stem) and a cardiopulmonary criterion (permanent cessation of heart and lung functions) [1]. These criteria are relatively new, and it’s important that we understand why and how they came about. While there may be several factors involved, there is one glaringly obvious one when you take a look at the scientific literature on this issue: organ donation. In an article[2] from the New England Journal of Medicine we are told that (my emphases throughout this post)

Before the development of modern critical care, the diagnosis of death was relatively straightforward. Patients were dead when they were cold, blue, and stiff.   

Why would we change the definition of death? Because, the same authors tell us:

Unfortunately, organs from these traditional cadavers cannot be used for transplantation.

First of all, let’s take a quick look at the morality of organ donation. I’ll explore this more in later posts, but for now, let’s just read 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 an 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.

A quick scan of this short summary of a complicated topic suggests that there’s nothing wrong with organ donation, as long as the donor gives his consent and is not killed in order to take his organs. And so, most good Catholics, in my experience, know that “the Church says organ donation is okay”, and leave it at that.

But it’s just not that easy when you consider vital organs – vital, unpaired organs, like a heart or a liver, for example. And when you consider the redefinition of death.

The fact is, redefinitions of death have been going on ever since organ transplants have become more and more possible and successful. The redefinitions stem from a desire to make use of the organs of a recently deceased person in order to save the lives of living patients in need of transplants.  Crowe and Cohen (see footnote 1) noted that  modern times there are “new problems” associated with defining death  –

…in particular, the problem of defining when death has occurred in the age of ventilators and feeding tubes, and how the definition of death (both conceptually and in practice) shapes the possibility of procuring usable organs from the deceased.

Later in the paper, the authors add:

The reason that the definition of death and the ethics of organ procurement are so closely linked in the public imagination is that the source of cadaveric organs has always been the newly dead. A newly dead person fulfills two fundamental requirements for being a source of organs. First he is close enough to the living that his organs have not been so long deprived of oxygen as to become nonfunctional. Second, he is no longer an inviolable subject in the same way: the dead body can be mistreated or wronged, but the dead person cannot experience physical harm.

Now, as heart transplants in particular became more desirable and possible, another problem arose that resulted in research papers like the one just noted. The problem was this: the law requires that the donor of a vital organ – like a heart – be dead before the organ is removed. This is known as the “dead donor law”; and with a standard definition of cardiac death, heart transplants are not possible. Why? Because the definition requires irreversible stoppage of the heart beat and accompanying respiration. Another author noted:

It is impossible to transplant a heart successfully after irreversible stoppage: if a heart is restarted, the person from whom it was taken cannot have been dead according to cardiac criteria. Removing organs from a patient whose heart not only can be restarted, but also has been or will be restarted in another body, is ending a life by organ removal.[3]

  

And so, the concept of brain death emerged:

Forty years ago, an ad hoc committee at Harvard Medical School suggested revising the definition of death in a way that would make some patients with devastating neurologic injury suitable for organ transplantation under the dead donor rule.

 …The concept of brain death has served us well and has been the ethical and legal justification for thousands of life-saving donation and transplantations. Even so, there have been persistent questions about whether patients with massive brain injury, apnea, and loss of brain stem reflexes are really dead.[4]

You can visit the website of Life Guardian Foundation for stories of miraculous recoveries from “brain death” (and other good resources), and you can visit LifeSiteNews.Com for more on this issue (search for “brain death”). But there’s also a very logical way to look at this “brain death” problem that encompasses the pro-life stance of the Church. In an article written in 2001 by Bishops Bruskewitz and Vasa, along with several others, we find this statement:

In a paper entitled “Brain Death is Not Actual Death: Philosophical Arguments,” Dr. Seifert makes a dramatic argument when he writes:

“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.”[5]

So, does it make sense to determine death by cessation of brain function?

Well…maybe if you are out to harvest organs.

Otherwise, the concept of brain death comes across as rather arbitrary and not respectful at all of the dignity of the human person.

Stay tuned for more on this topic. In the meantime, I urge you to listen to this sermon (“May  We Donate Organs?”) on the topic of brain death and organ donation; it’s long, but worth hearing. I have also transcribed the sermon, and you may read the transcript here.

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[1]Crowe, S., & Cohen, E. (2006) Organ Transplantation Policies and Policy Reforms; available at  http://bioethics.georgetown.edu/pcbe/background/crowepaper.html

[2] Truog, R.D., & Miller, F.G. (Aug. 14, 2008) The Dead Donor Rule and Organ Transplantation, New England Journal of Medicine available at http://www.nejm.org/doi/full/10.1056/NEJMp0804474

[3] Veatch, R.M. (Aug. 14, 2008) Donating Hearts after Cardiac Death – Reversing the Irreversible, New England Journal of Medicine, available at http://www.nejm.org/doi/full/10.1056/NEJMp0805451

[4] Truog, R.D., & Miller, F.G. (Aug. 14, 2008) The Dead Donor Rule and Organ Transplantation, New England Journal of Medicine, available at http://www.nejm.org/doi/full/10.1056/NEJMp0804474

[5] Are Organ Transplants Ever Morally Licit? A commentary on the address of Pope John Paul II to the XVIII International Congress of the Transplantation Society,  by Bishop Fabian Wendelin Bruskewitz, Bishop Robert F. Vasa, Walt F. Weaver, Paul A. Byrne, Richard G. Nilges, and Josef Seifert  (Catholic World Report, March 2001)