BODY PARTS NEEDED Conclusion B

Conclusion B

As virtuous men pass mildly away,  


And whisper to their souls to go,  


Whilst some of their sad friends do say, 


"Now his breath goes," and some say, "No."

John Donne

There exists great ambiguity of the transition between life and death, and for practical and ethical reasons we, as a society, have had to define life and death, and we do it in various ways. The definition turns on various philosophical and theological issues focusing primarily about using people for the benefit of others, prior to their death. Many argue that the definition be adapted to facilitate doctors’ need to get human organs before they become unusable; dead.

Most organ donors on reading the phrase ‘after my death’ assume all life is absent. What it really means is that the person is comatose and apneic but in fact all other organs are working fine and that the removal of organs can begin with my heart spontaneously beating and blood circulating.

The  rationale for equating “brain death” with death remains controversial. Thus, information highly relevant for the potential donor’s moral decision making is systematically withheld. According to Dr Robert D. Truog, Professor of Child Anaesthesiology at Harvard University and director of ICU at Children’s Hospital, Harvard Medical School, Boston “ ‘brain death’ remains incoherent in theory and confused in practice.” He suggests that the only purpose served by the concept is to facilitate the procurement of transplantation organs

Assistant Professor of Neurology at the Ohio State University, Dr Robert M. Taylor, defines death as “the event that separates the process of dying from the process of disintegration” and emphasizes that “the proper criterion of death in human beings is ‘permanent cessation of the circulation of blood’. Dr Emmanuel Panagopoulos, assistant director of the 2nd Surgery Clinic at “Agios Savvas” Hospital in Athens  and Professor of Surgery at the University of Athens, explicitly states  that  “ ‘brain death’ is a process of death but not death”. Biological death is not a continuous process but an instantaneous event.

A person is dead if he shows:

·      irreversible cessation of circulation and breathing

·      irreversible loss of all the functions of the entire brain, including the brainstem.

Nonetheless, the  ‘brain death’ criteria is not universally accepted. The difficulties in diagnosing ‘brain death’ were shown in a 1989 study concerning doctors and nurses involved in the harvesting of organs for transplantation. The study proved that “only 42% of the doctors and 25% of the nurses correctly identified the legal and medical criteria for the definition of death, which revealed the confusion around the issue.” Furthermore,  a more recent study in 1999 presented to the Society of Critical Care Medicine demonstrated that “only 39% of pediatric attending physicians correctly defined brain death…

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Defining Death for the Purpose of Effecting Organ Transplantation:

Religious and Humanist Ethical Considerations

The concept of ‘brain death’ has come to be considered as a state of relative neurological inactivity and as an approximate diagnosis. Professor Shewmon writes that the diagnosis of death is not something that we can discover by any scientific method, but rather something we must choose, based upon our religious and philosophical values”. For the Christian human death is not a process but an instantaneous event during which the ‘logical soul’ leaves the human body.

The conclusion which follows the presentations of the above data is that the concept of ‘brain death’ is a construct which was basically invented for social reasons. Nonetheless could it not serve the Christian community well: ‘brain death’ would signal that one is no longer able to continue in a state of communication with God and all worship, adoration and honor will have ceased.

The Harvard criteria listed two reasons for trying to sort out brain function criteria for certification of death: (in determining an appropriate time for organ removal)

·      The burden of futile treatment.

·      The facilitation of organ donation.

According to Jim Hughes, a bio-ethicist at Trinity College in the United States, the idea of brain death has distinctly cultural, utilitarian origins.

Under the law and our general moral revulsion to the idea, killing somebody to take their organs out wasn’t acceptable until a person was declared dead. As a result a kind of a social compromise was constructed to serve the needs of the living.

There has been a small but growing collection of voices questioning whether the brain dead are really dead at all. One of those dissenters is Alan Shewmon, Professor of Neurology and Pediatrics at UCLA Medical School in the United States;
”Well, the term itself is kind of ambiguous from the start, because in one sense it could simply mean death of the brain as an organ, just like you can have necrosis or death of a finger, if you cut off the blood supply to it

It is clear that hearts can beat independently without brain function, and many other organs continue on their own, even without life in the remainder of the body. But what we’re talking about here is not just the functioning of individual organs or tissues, but a more unified holistic functioning. Many patients in the state of brain death… these patients are deeply comatose, permanently comatose but they’re still living human beings.

Those practices which hasten death or bring about the direct termination of life, in order to harvest organs for transplantation trivialize the human person and lead society down a slippery slope. Most of us would happily donate one of our organs after death, for the sake of another human being. But are we prepared to have our organs removed while the heart is beating and blood circulating; to be removed at the time of the so-called ‘brain death’? How was the term ‘brain death’ coined? Why all this controversy in the Greek and international medical community? Why do some doctors deny that ‘brain death’ is equated with the definitive biological death?

Since the concept of ‘brain death’ is not unanimously accepted by the national or international medical community many suggest that the equation of ‘brain death’ with death should be re-examined. And, that such reexamination be removed from any and all interests whatsoever.

The issue of organ harvesting for transplantation is important and calls for profound philosophical and theological reflection. Any intervention to remove a donor's organs before his/her definite death is unacceptable because it means taking the donor's life, even when this is done for the sake of curing another patient. Or does the end justify the means. Is there no longer any mystery of death?

By all means our life is the field of exercising our free will. In order for change to be meaningful for the Christian, indeed society, it must be definable and sustainable and making a positive difference. Dare we say it must be Spirit-led, yet in some circumstances radical, pushing us beyond our comfort zone, the status quo. Can we see the Lord’s leading in having us reanalyze our life moving along horizontal axis of man-to-man relations and agree with those whose motives are plainly humanist driven?

Can we Christians see as the goal, one of obtaining organs for transplantation only after a declared ‘brain death’ and where the heart may yet be living and the donors’ giving of an organ is as an expression of Christian love or simple altruism. Or is the proper criterion of death in human beings the permanent cessation of the circulation of blood, even if  adopting this criteria life saving organs can not be harvested causing death to waiting recipients?

"Life is a gift of God, but not one that belongs to the donor only. It also belongs to its receiver. Life is ours as well. It is the paramount field of exercising our free will. Life is not donated to us in order to live in selfishness and possessiveness, but is rather offered to us so that it can be so much our life that we can even offer it. This is the reason why we love and take care of our life more than anything else. This is done both with great caution, because it is God'’s gift, and in our free will, because it is our life. The best way to return it to God is by offering it to our neighbour." (Saint Macarius the Egyptian).

Dr. Sven Ljungholm
PhD Ethics; Human Values