May We Donate Organs?

Below, you will find my best effort at a transcription of the sermon that can be found at the link to AudioSancto. I have done some minor editing for clarity or to avoid repetition. I have also added links to articles mentioned. My apologies to the speaker for any errors.

http://www.romans10seventeen.org/audio-files/20101114-May-We-Donate-Our-Organs.mp3

Other posts of interest: "Brain Death and Organ Donation"

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May We Donate Our Organs?

Some 50 years ago, the moral theologian, Francis J. Connell, CSSR, was posed a question concerning embalming. Question:

 “In view of the modern opinion that apparent death may precede real death by a considerable period of time, what admonition should be given to our people  particularly to Catholic undertakers  as to how soon the process of embalming can be started after a person has apparently breathed his last.”

Answer:

"This is a problem of great importance in the US, where the embalming of the dead is a general practice. The main principal is this: the process of embalming may not be commenced until it is certain that life is extinct, for undoubtedly, if the person is still alive, the embalming process will directly cause death. Furthermore, mere probability, even very great probability, that death is insured will not justify the beginning of this process, for it is not permissible to do anything which even only probably will directly cause the death of an innocent person."

Now let's do a thought experiment. Suppose we were about to embalm somebody and as we begin to make an incision on the body, suddenly the corpse begins twitching and grimacing. In light of the moral principle stated by Fr. Connell, first, that the process of embalming may not commence until it is certain that life is extinct; and second, that it is not permissible to do anything which even only probably will directly cause the death of an innocent person. In light of those moral principles, does anyone think we should continue the embalming as scheduled?

Does anyone doubt that if we continued the embalming as scheduled, we'd kill someone?

Does anyone think the proper thing to do would be to give the corpse an anesthetic so he'd  quit twitching, and then continue the embalming?

Now let's do another thought experiment. Suppose we were asked to embalm someone in another room. And when we arrived, we see the person is actually breathing with a ventilator. He has a heartbeat, has wounds which are healing, and is producing urine.

In light of those moral principles, first that the process of embalming may not begin until it is certain that life is extinct, and second that it is not permissible to do anything which even only probably will directly cause the death of an innocent person...in light of those moral principles, would anyone agree to do the embalming as requested?

Does anyone doubt that if we continued to do the embalming, we would actually be killing someone?

It's just pretty basic "thou shalt not kill" 5th commandment stuff. If we keep all this firmly in mind, we already know everything we need to know to understand the moral problem we're going to look at today. What we'll do first is review and comment on an article and then before we close we'll quickly consider some comments on this same topic by members of the magisterium. It's not hard to understand at all; we already know all the principles needed.

Let's take a quick look at an article... [Aug 14 2008 New England Journal of Medicine]:

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

Well, death is death; it's not like some new event in human history. Why would this change?  

The authors are about to answer that question.

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

There are at least two important bits of information here. First, that a traditional cadaver, which we'd commonly call a dead man, is cold, blue, and stiff. Second, that organs from a traditional cadaver – that means a dead man – that is to say the organs from a dead man – cannot be used for transplantation. A dead man, a traditional cadaver, is cold, blue, and stiff, and his organs cannot be used for transplantation.

Let's continue with the article.

"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."

Let's pause for a moment and unpack that. First off, what is the dead donor rule? The dead donor rule states that patients must be declared dead before the removal of any vital organs for transplantation. Well, that sounds like the same basic idea as the principals for embalming [from the quote above]: “the process of embalming may not be commenced until it is certain that life is extinct, for undoubtedly, if the person is still alive, the embalming process will directly cause death”.

So the dead donor rule states that someone must be declared dead before the removal of any vital organs, because obviously if the person is still alive, the removal of vital organs will directly cause death. [As the previous quote states:] “Furthermore, mere probability, even very great probability that death has ensued would not justify the beginning of this process, for it is not permissible to do anything which even only probably will directly cause the death of an innocent person".

And of course, as we've already heard, the diagnosis of death used to be relatively straightforward; patients were dead when they were cold, blue, and stiff. Our authors refer to this patient as a traditional cadaver, and they point out that organs from a traditional cadaver cannot be used for transplantation. So some 40 years ago, a committee at Harvard Medical School suggested that we "change the definition of death in such a way that there would be organs available for transplantation." And that is where the concept of brain death comes in.

It gets worse.

"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."

Whoa. What are we talking about there? What do we mean there are persistent questions about whether dead patients are really dead? I'm not putting words in their mouth here. If there were any question at all, to say nothing of persistent questions, whether someone is really dead, then we've got real problems. Probability, even great probability that death has ensued will not justify the beginning of this process, it's not permissible to do anything which even only probably will cause the death of an innocent person.

Now the authors are going to explain why there have been persistent questions about whether or not so-called brain-dead patients are really dead.

"There have been persistent questions about whether patients with massive brain injury, apnea, and loss of brain stem reflexes are really dead. After all, when injuries are entirely intracranial, these patients look very much alive. They are warm and pink; they digest and metabolize food; excrete waste; undergo sexual maturation and can even reproduce. To a casual observer, they look just like patients who are receiving long-term artificial ventilation and are asleep. The arguments about why these patients should be considered dead have never been fully convincing."

The authors explicitly state, "These patients look very much alive, they're warm and pink, they digest and metabolize food, excrete waste..." And then they state that "the arguments about why ...have never been fully convincing...". Now that has to qualify as one of the great understatements of all time.

Death means that the soul has left the body. That's what it means. The soul has left the body.  When our Lord and Savior Jesus Christ died on the Cross, that meant his soul left his body. That's what happens when we die; our soul leaves our body. That's what death is. That's why a traditional cadaver is cold, dead, and blue. The real question is how anyone for even one second could be convinced that someone who was warm and pink, could digest food and excrete waste, and reproduce, and looks just like a sleeping patient receiving artificial long-term ventilation, is actually dead. Perhaps someone might object that these authors are exaggerating about the conditions of these so-called brain-dead people.

Let’s refer to a few other sources. Here's another quote from the New England Journal of Medicine, this time the March 7, 2002 issue, page 786.

"Some persons who reliably defined as brain-dead have clinically significant residual functioning as evidenced by electro-encephalographic activity, unexpected survival, attempts to sit up, reproducible eye-opening in response to pain, head movements in response to stimulation. Most perplexing, children who have been given a diagnosis of brain death continue to grow, and pregnant women have delivered healthy infants up to 4 months after having been given a diagnosis of brain death." [The quote is from a book review in the NEJM, available online here.]

Is this some kind of sick joke? Would that it were! Are we talking about dead people here? Isn't that what we're supposed to believe, that brain dead people are, well...dead? Because if we're supposed to believe that brain dead people are dead, then can someone please explain how it is that dead children can "continue to grow"? Can someone please explain how a dead woman, a woman who has been dead for 4 months can give birth to a healthy child? Can someone please explain how dead people can have "attempts to sit up"? Can someone explain how dead people can have "reproducible eye opening in response to pain? Can someone please explain how dead people can have "head movements in response to stimulation"? Can someone please explain how it is that "some persons reliably have clinically significant residual functioning as evidenced by unexpected survival..."

Unexpected survival… Just exactly what did these people unexpectedly survive? A fire? No. A terrorist attack? No. A plane wreck? No. No, what these people unexpectedly survived was death! Death! They unexpectedly survived death. Dead people survived death. Death's unexpected all right. Seems to me that's the point of Easter.

Here's another example. Charleston, West Virginia, May 27, 2008:

“A Virginia family was shocked but relieved when their mother ... woke up after doctors said she was dead. 59-year old Mrs. Thomas was being kept breathing artificially, with no detectable brain waves for more than 17 hours. The family were discussing organ donation options for their mother when she suddenly woke up and started speaking to the nurses."

Does this sound like the behavior of a traditional cadaver? Or consider this case – it's described in the Journal of California Nurses for Ethical Standards – in which a brain dead patient put his arm around the assisting nurse as he was about to have his heart removed for transplant. A dead man. Put his arm around the assisting nurse when he was about to have his heart removed. Does this sound like the behavior of a cold blue stiff traditional cadaver?

Consider this from the New England Journal of Medicine: this is a book review of a book called Brain Death.

With respect to diagnosis, for example, the book Brain Death states that the observation period can certainly be shortened if a recipient is waiting, and that a second opinion is not recommended because it may jeopardize harvesting of organs (14:25) [repeats]

So the important thing is not whether or not the donor is actually dead. No, the bottom line is, let's not do anything to jeopardize the harvesting of vital organs. A second opinion is not recommended...now there is a high standard of morality. It would be interesting to know what kind of money is at stake here.

Returning to the original article:

"The arguments about why these patients should be considered dead have never been fully convincing. The definition of brain death requires a complete absence of all functions of the brain, yet many of these patients retain essential neurologic functions."

Did they just say that the brains of some brain dead people retain some functions? Yes they did. In other words, not only is a brain dead person not dead, in many cases neither is his brain. They continue:

"Some have argued that these patients are dead because they are permanently unconscious, which is true, but if this is the justification then patients in a permanent vegetative state who breathe spontaneously should also be diagnosed as dead, a characterization that most regard as implausible."

I don't think "implausible" is the right choice of words there. "Outrageous" or idiotic might be a little more appropriate.

"Others have claimed that brain dead patients are dead because their brain damage has led to the current cessation of the organism as a whole. Yet evidence shows that if these patients are supported beyond the acute phase of their illness, which is rarely done, they can survive for many years."

Dead people can survive for many years. What's going on with our language? If you pay attention to these kinds of things, abortion and all these subjects, the language starts getting played with. Words matter. If I play with the words up there at the altar, nothing's gonna happen. Language matters. That's the Word became flesh. Let's remind ourselves that traditional cadavers do not survive for many years; they're done surviving because they're now dead. In fact, in the case of a traditional cadaver, if we don't embalm it, we have to bury it quickly because it starts to decompose.

Back to our authors:

"The uncomfortable conclusion to be drawn from this literature is that although it may be perfectly ethical"[well… it isn't] "to remove vital organs for transplantation from patients who satisfy the diagnostic criteria for brain death, the reason that it is ethical cannot be that we are convinced that they are really dead."

Well, my dear faithful, no one needs a medical degree from Harvard to recognize that brain dead people are not dead. They're not traditional cadavers. Once we remove their vital organs, then they become traditional cadavers, and then they will become cold, blue, and stiff.

It gets worse. As if the situation with brain dead donors isn't horrific enough, now our authors are going to address the issue of a type of cardiac death donor.

"Over the past few years, our reliance on the dead donor rule has again been challenged, this time by the emergence of donation after cardiac death as a pathway for organ donation. Under protocols for this type of donation, patients who are not brain dead but who are undergoing an orchestrated withdrawal of life support are monitored for the onset of cardiac arrest. In typical protocols, patients are pronounced dead two to five minutes after their heart stops beating, and the organs are expeditiously removed for transplantation. Although everyone agrees that many patients could be resuscitated after an interval of 2-5 minutes, advocates of this approach to donation say that these patients can be regarded as dead because a decision has been made not to attempt resuscitation."

Let's translate that into ordinary English. Now we're talking about patients who are not even brain dead, they're on life support, and with a surgical team waiting nearby the life support is removed and once the heart stops beating, you wait for 2-5 minutes…I see, searching about this, that at Children's Hospital in Denver, they wait a whopping 75 seconds with infants. And then their organs are removed. Their organs are removed in spite of the fact that "everyone agrees that many patients can be resuscitated after an interval of 2-5 minutes. But advocates of this approach to donation say that these patients can be regarded as dead because a decision has been made not to attempt resuscitation”.

Words matter. The authors continued:

"This understanding of death is problematic at several levels. The cardiac definition of death requires an irreversible cessation of cardiac functioning, whereas the common understanding of irreversible is 'impossible to reverse' [because that's what it means] in this context, irreversibility is interpreted as a result of a choice not to reverse. This interpretation creates the paradox that the hearts of patients who have been declared dead on the basis of the irreversible loss of cardiac function have in fact been transplanted and have successfully functioned in the chest of another."

Did you just hear that? People who have been declared dead… they've been declared dead through an irreversible loss of cardiac function, that heart won't function. They cut it out, and it's beating in somebody else's chest.

The authors:

"Again, although it may be ethical to remove vital organs from these patients, we believe that the reason it's ethical cannot convincingly be that the donors are dead."

That clause we can agree with. My dear faithful, again, no one needs a med degree from Harvard or anywhere else to recognize that saying these sort of cardiac death patients can be regarded as dead simply on the basis of a decision not to attempt resuscitation no one can think that this isn't evil. These sort of cardiac death patients are not traditional cadavers like the so-called brain dead patients, they are simply not dead. They're not dead, they're alive, and in all cases like this, the surgical team removing the organs is killing them. Period, close the book.

Let's turn to the teachings of Bishops Bruskewitz and Vasa, co-authors. This is found in an article entitled "Are Organ Transplants ever Morally Licit?  A Commentary on the Address of John Paul II to the 18th International Conference of the Transplantation Society”. Bishops Bruskewitz and Vasa et al:

"People must fully comprehend that when they agree to be organ donors they give transplant surgeons a license to terminate their lives. When healthy vital organs are taken in accordance with the legal common practice of medicine, the donor is killed. The donor is treated and prepared for surgery in a way similar to any living patient going to the operating room. After removal of healthy vital organs, what is left is an empty corpse. 

“Such removal is ethically unacceptable. It is the removal of the organs that changes the living person to a dead one. It is unethical for transplantation surgeons to continue performing such procedures that mutilate a living human body. These procedures treat the donors as if they were artificially sustained biologic entities rather than human persons worthy of dignity and respect. The removal of a healthy unpaired vital organ suitable for transplantation from someone who has been declared legally dead brain dead, but is not truly biologically dead, is not ethically acceptable. Evil may not be done that good might come of it."

But they haven't told us anything we didn't already know after considering the question about embalming, have they? It's a question of natural law. “The removal of healthy unpaired vital organs suitable for transplantation from someone who has been declared legally dead brain dead, but is not truly biologically dead, is not ethically acceptable.”

Okay. If we can't cut organs out of brain dead people, can anything be cut out of truly dead people, traditional cadavers, corpses, and used for transplantation?

"After death, tissues such corneas, heart valves, bones, connecting tissues, may still be useful for transplantation. Note that these are tissues, not organs, and may be taken only after death because excision of these would otherwise cause mutilation or death." [inaudible reference]

As Bishops Bruskewitz and Vasa clearly teach,

"All men of good will must properly understand and explicitly follow the applicable theologic and moral laws. These laws are no unpaired vital organ can be morally removed from a living human person. There should be no commercial traffic in human organs. People, especially the young, must fully comprehend that when they agree to be organ donors, they give transplant surgeons a license to terminate their lives."

Let's get practical. What does this mean for those of us who are trying to be faithful soldiers in the Church Militant and thereby save our immortal souls? It means that we do not sign any kind of organ donation agreement on the back of our driver’s license or anywhere else. It means that no matter what our medical condition and how dire the straits we find ourselves, we do not accept any sort of transplant organ cut out of one of our brain dead or cardiac dead brothers or sisters. For those in the medical community, it means that no matter what it may cost us personally and professionally, we must put these sort of procedures in the same moral category as tubal ligations, abortions, and contraception; evil may not be done that good may come of it. These types of organ donor patients are not dead. They're alive. And healthy vital organs are taken out of organ donors in accordance with the common legal practice of medicine, the donor is killed. Is killed. These new definitions of death are nothing but lies. They're lies from the person standing behind this culture of death, lies from the one who's a liar and a murderer from the beginning. They're lies. They're killing our brothers and 

sisters.

Let us pray...