Photo by Marcelo Leal on Unsplash

Commentary

Organ donation can be an “act of love” if ethical standards are upheld

The Catholic Church has long been in favor of organ transplantation, provided that it is performed in a morally acceptable manner. St. Pope John Paul II described organ transplants as a “great step forward in science’s service of man,” and Pope Benedict XVI described organ donation as an act of love.

In addition, the Catechism of the Catholic Church describes organ donation after death as “a noble and meritorious act and is to be encouraged as an expression of generous solidarity” (CCC 2296). The Catholic Church clearly approves of organ donation and transplantation, provided certain ethical standards are upheld. What are those ethical standards that we, as Catholics, need to be aware of?

The Dead-Donor Rule and Brain Death

According to the “dead-donor rule,” a person can donate an unpaired vital organ, such as the heart, only if the person is dead. Otherwise, removing the organ would cause the death of the person and that would be murder. This seems relatively straightforward, and Catholic ethicists agree with this rule.

However, things are a bit more complicated because not everyone agrees on the fundamental principle of the dead-donor rule: when is a person actually dead?

Prior to the availability of mechanical ventilation during the 1920s, the process of dying ended when individuals could no longer breathe on their own and the heartbeat ceased. The advent of organ transplantation pushed the need to determine death by other means to the forefront. Shortly after the first heart transplant, “brain death” became widely accepted as an alternative means of declaring death.

Simply stated, a person is dead with the irreversible loss of function of the entire brain, including the brainstem. Clinical criteria and confirmatory testing, such as cerebral blood flow studies, determine brain death. Once a person is declared dead using this so-called neurological criterion, organ donation can proceed. The dead-donor rule is honored.

Both John Paul II and Benedict XVI have given provisional endorsement of brain-death criteria, provided that the person is unequivocally dead. However, with further technological advances, a person who meets brain-death criteria can be medically supported for days, weeks, or in some rare circumstances, much longer. One particularly notable case involved a boy from Omaha who, at age four, was declared brain dead following meningitis and survived an additional 20 years with medical support. After he was taken off medical support, an autopsy revealed he had no brain tissue. In addition, numerous cases are reported in the medical literature of pregnant women who were declared brain dead and then medically supported while the baby continued to develop in the womb for weeks. One such case occurred in Omaha, where the brain-dead mother was medically supported for 54 days, after which her child was born.

So, where do we go from here? Both John Paul II and Benedict XVI have described organ donation as an act of love. Still, both also caution that the individual must be unequivocally dead before organs are taken. Brain-death criteria are widely accepted, yet with the advent of new technology, both secular and non-dissenting Catholic ethicists have raised legitimate concerns. For now, a Catholic in good conscience may donate his or her organs and healthcare workers may use these criteria. However, magisterial teaching in this area may need to be refined.

Organ Donation After Cardiac Death

Alternatives to brain death criteria have been proposed and used to obtain organs for transplantation. Donation after cardiac death (DCD) has been used with increasing frequency and currently represents between 10% and 20% of donated organs. Also known as the cardiopulmonary standard of death, these organ donors typically suffer severe neurological injuries but do not fulfill the brain-death criteria. Protocols vary, but typically consented donors are taken to the operating room, and life support is withdrawn. After removing the ventilator, the patient’s breathing and pulse are monitored. Once breathing ceases and the heart stops beating, the patient is observed for an additional short period and the organs are retrieved.

Catholic ethicists have raised concerns about this method of procuring organs. Using the cardiopulmonary standard to determine death in cases of donation raises the question of whether the donor has truly died. It is possible, if not likely, that the brain is still alive after 2-5 minutes of pulselessness. This creates the possibility of unintentionally breaking the dead-donor rule. Moreover, the degree of neurological impairment necessary to be a donor under this criterion is arbitrary.

Dr. Steve Doran is an Omaha neurosurgeon and bioethicist for the Archdiocese of Omaha.