Cadaveric organ donation, the taking of organs from a deceased person and transplanting them into a live person, has seen many advances in the past years. What once had the perception of being a rare medical procedure has now become routine in expectation of care rendered. While many Christian denominations and so-called charitable organizations encourage cadaveric organ donation, the similarities to outright euthanasia are not to be ignored. A proper Christian ethical perspective needs to recognize that cadaveric organ donation ought to become rare in occurrence and only then after all other options for the receiver of the organs and the care of the donor are exhausted.
The increasing regularity of cadaveric organ donation points to what should be an obvious conclusion – increasing numbers of people are ill and have organs that are failing. In fact in 2003 there were 82,884 patients on an organ recipient waiting list. Of that number, 7.5% died waiting for an organ. Of those that received an organ 18,649 (or 73% of all recipients) received their organs from cadaveric donors. Those that receive a lung or heart transplant have a survival rate of 67% in the first year after receiving their organ replacement. The survival rate declines to 46.5% after three years and seems to level off at 44.3% after surviving for five years. Those that require a repeat transplant do not typically survive three or more years.
If numbers of such significant quantity indicate that the population is in ill health, or at least in declining health, what is being done to improve the health of our population? While there can be congenital and environmental causes of many disease process leading to organ failure, the choices often determine to a large extent how healthy an individual will be. Alcoholism, a major contributor to several liver diseases, and chronic obstructive pulmonary disease (COPD), a disease found typically in tobacco abusers, are two conditions brought on by lifestyle choices. Other diseases that affect function of organs are diabetes (pancreas, kidneys, and eyes), hypertension (kidneys, lungs, and heart), and obesity (all organ systems) which each have at a base level a choice made by the disease sufferer. If smoking tobacco is avoided, the occasion for lung disease is greatly curtailed. If alcohol consumption is minimized or even avoided then the risk of liver disease is also greatly reduced. Several publicly known lawsuits and advertising campaigns illustrate the public awareness that lifestyle choices do indeed affect health.
There is with the large number of persons waiting for replacement organs the necessary corollary suggesting a shortage of available organs. With that shortage there is increased pressure to find and procure organs suitable for transplantation. Most organs are taken from people who have died though some, such as kidneys and lobes from lungs or the liver, can be used from living donors. When one of the 59 Organ Procurement Organizations (OPO) identifies potential donors, it sends a team to that donor to evaluate the potential of the organs being considered for transplant. After appropriate testing to ensure functionality and compatibility of the donor organs, they are removed by surgeons under sterile conditions just like any other type of surgical procedure.
How are donors identified? At least 42 states and the District of Columbia have what is known as “required request laws” which mandates that hospitals must have policies and procedures in place to inform families about organ donation. The families and patients are under no obligation to donate. Many drivers’ licenses have a place in which a person can make his wishes known about organ donation as well.
The increasing mandate for policies and procedures about family education and public tools such as driver’s licenses has led to a shift in society. Dr. Andreas G. Tzakis, a liver surgeon, says, “Recycling our organs is becoming part of our culture. Indeed, Judith P. Swazey, a medical ethicist and co-author of Spare Parts says, “we’re trying to keep people alive indefinitely.” A nurse taking care of a donor patient at the University of Miami observes that, “Everyone makes it seem like transplants just happen and the organs appear from nowhere.” Our culture has grown so used to the idea of recycling organs that it has started to expect replacement organs almost instantaneously. In our society of instant gratification, we become alarmed if organs for transplantation are not available after a diagnosis has been made. Organ transplantation has become the “penicillin” of the current era.
If the economy of organ replacement has a demand then more pressure is required to secure a viable supply. Where should that supply be obtained is generally understood. How that supply should be obtained is not so easily understood and poses the ethical dilemma. Obviously, organs are obtained from a person when that person dies and then his organs are transplanted in another individual. In fact the policy of the USNO gives a minimum standard in which procurement of organs should occur. “…The Host OPO is responsible for identifying evaluating and maintaining the donor, obtaining consent for the removal of organ; verifying pronouncement of death and organ allocation.”
What then constitutes a condition of death? Traditionally, the stopping of the heart and lungs has been the measure of cessation of life and the onset of death. But if a transplant team were to wait for that condition then the functionality of the organs desired for transplantation may be adversely affected. The health of the individual waiting for the desired organ may irreparably decline as well. A variation of the non heart beating criteria is the Pittsburgh Protocol. The Pittsburgh Protocol declares death after the heart has stopped effectively beating for two minutes. Of course, many argue that this protocol is short sighted in that many questions are left open – is the patient really dead? Is it ethical to intervene just to maintain health of the other organs? Are dying patients treated less aggressively if they are identified as donors?
This leads to a different determination of death – brain death. Brain death occurs when the functions of the brain cease and the organs of the now supposedly deceased are kept functioning through artificial means such as mechanical ventilation and pharmacological interventions. This is now a very familiar determination of death in Western culture.
A problem with brain death as a determination of death is that a temptation arises to declare a patient dead when only higher brain functions appear to be lost. J. Savulescu opines, “…What matters is our mental functioning, our mental lives, and that treatment which keeps our bodies alive (including our brain) can be stopped because mental life is so impoverished…The reason why we withdraw these medical treatments is because life in the significant sense has ceased. Our biography, as James Rachels once described it, has closed.” Understandably, if such an interpretation of allowable brain death were to become common practice then the availability of potential organ donors would exponentially increase. The increase could come from Alzheimer’s patients, patients declared mentally incompetent, vegetative state patients, brain damaged patients, etc. Of course, such an obtuse definition becomes even more unsettling in the realization that a wedge is easily inserted to open the definition to broader interpretations that could include populations such as death row inmates and prisoners sentenced to life without parole. Their debt to society leaves them with no opportunity to live beyond their current condition and therefore “life in the significant sense has ceased.” A comparison to Nazi Germany would not be unwarranted to describe the conditions necessary to use the “biography” version of brain death.
Another perspective to increase the supply demanded in organ replacement involves the disposition of the declared dead. One very troubling trend associated with this perspective is the call for mandatory availability donor organs from all declared dead. According to John Harris, “people would…soon get used to the idea, particularly if there were to be a concerted campaign of education and argument.” Harris continues his thought by saying,
It…seems appropriate to consider mandatory availability of cadaver organs. The public interest in saving the lives of fellow citizens at risk is at least as urgent and as important as the public interest which justifies court ordered postmortem examinations. Moreover it is…less damaging to civil liberties and less compromising of individual autonomy than – for example, compulsory jury service…For although both jury service and postmortem examinations have justifications in terms of protection of the lives and liberties of citizens so of course does the automatic availability of cadaver organs.
Another argument for mandatory organ donation claims that “it is…morally unacceptable for the relatives of the deceased to deny utilization of the cadaver as a source of transplantable organs. Their only claim upon it is as a temporary memorial of a loved one, inevitably destined to decay or be burned in a very short time.” The reasoning continues by insinuating that because of the increase in sickness and longer waiting lists for organs than those that do not need the organs any longer, due to death either real or impending, should give those organs freely. This is a danger to anyone who becomes ill because he then is a donor by default thereby making subjective selection for procurement a real plausibility. Coupled with the cessation of mental function and hence life as a death criteria, every human being then is added to the supply of healthy organs and suddenly the waiting list for those organs decreases dramatically.
What is a proper Biblically-based evangelical Christian response to these concerns? More precisely, within what framework of understanding do we construct a response? Some philosophies supporting cadaveric organ donation use stewardship as a basis for the Christian response. Others use an understanding of one kind or another of love and all the different facets that type of philosophy entails.
A Christian perspective should seek to exclude some factors and include others. The main and really only factor for inclusion is to determine if and how God will be glorified in the process of organ donation. This criterion must become the standard by which all the determining factors are measured. Those to be considered include but are not be limited to the salvation experience of the prospective donor, salvation experience of the decision makers, circumstances involved in the current condition of the prospective donor, emotional state of the decision makers, and expected coping with the coming stages of grief and loss. It is not the intent here to examine these but rather to point to the issue of organ donation as pertains to a Christian. How does a Christian approach it in regard to modern secular society’s ambitions and the obvious parallel to euthanasia?
When a potential donor is identified the family has enormous pressure to make decisions quickly and in rapid succession. The horror and grief of tragedies that are often violent occurrences such as automobile accidents or shootings, leave most people associated with donors pondering a simple question – why? The family is found asking, “What good can possibly come out of this tragedy?”
One answer that invariably arises is that of sacrifice for another. “Greater love hath no man than this, that a man lay down his life for his friends” (John 15:13) is often inappropriately given as a proof text to help placate the grief of the decision. The grieving decision maker will try to find solace by equating the supposed gift of an organ as a type of sacrifice. They see the loss of their loved one as an opportunity to help someone else live on. Ann Mongoven labels this as an imitation of the crucifixion of Christ and thus a subtle form of idolatry. Mongoven states that “the donor is Jesus-like in ontological status and power to save.” The Bible teaches that Jesus’ sacrifice is the only sacrifice in which one can hope to obtain eternal life. He says that His death is for His friends, those who knew Him. Almost all cadaveric organ donations occur anonymously. It is a very slim likelihood that the donor family would even know the recipient of the organ much less count him among friends. If it were truly a case of the donor sacrificing his life, it must be his own independent decision. He alone can lay down his life for a friend.
An argument for stewardship is also often given to assuage the grief-stricken decision makers. Stewardship presupposes that a condition of ownership or trusteeship exists. Are the organs of the prospective donors in a stewardship understanding with those making the decision to donate? The Bible makes more than one reference to a special understanding regarding how our bodies are special. “Let us make man in our image, after our likeness…” (Genesis 1:26) implies that our bodies have a similarity to that of God. 1 Corinthians 6:19-20 says, “What? know ye not that your body is the temple of the Holy Ghost which is in you, which ye have of God, and ye are not your own? For ye are bought with a price: therefore glorify God in your body, and in your spirit, which are God’s.” While the text is speaking of using our bodies in inappropriate relationships, the clear understanding is that our bodies are a temple. Being a temple means that respect, honor, and reverence should always be used in our relationships because God is indwelling and using His temple. Is a decision by a family to donate organs recognizing this relationship of the body to a temple of God? Our bodies, reflecting the image of God and a place of worship to God should be treated with more respect and courtesy. “…Be ye holy; for I am holy” is the call from 1 Peter 1:16, echoing calls for holiness from Leviticus. Would we make haste, in the guise of sacrifice, to destroy a holy temple, or desecrate the instruments therein, created for the worship of God?
The decision for organ donation is not an easy one. Many people may indeed benefit from transplanted organs of cadaveric donors. However, the ease at which our society has come to accept organ donation is alarming. There is a rising wanton irreverence for the sanctity of human life. People are persuaded into letting their loved ones essentially be put to death and their organs harvested so another’s sick loved one may live on, commonly with chronic illnesses of varying degrees.
Christians need to examine the issues of cadaveric organ donation. These medical procedures often have a sordid and troubling past. As a society, we do not even recognize that thousands lost their lives in facilities designed to experiment with bone transplants (among other more ghastly endeavors) in another attempt to normalize socially accepted euthanasia. A recent telephone book advertisement quotes a teenaged boy, “I am a normal teenager again. Nobody would even know I had a bone transplant if I didn’t show them my scar.” The advertisement goes on to state, “You have the power to donate life.” We must maintain awareness that every time an organ is transplanted someone has died. “The challenges to Christian communities, to bioethics, and to the general public converge on one central challenge that is relevant to all. That challenge is never to let organ donation become routine, even as it becomes more common.”
Christians must recognize the parallels that exist between cadaveric organ donation and euthanasia. This is only one of the topics in the complicated and convoluted discussion arena of life and death. We must first embrace our Christian worldview acknowledging God’s sovereignty and purpose for existence. Without this perspective society will only continue to encourage “everyone [to do] what [is] right in his own eyes.” (Judges 17:6 NKJV paraphrased)