Q: From the perspective of a concerned family member, it seems that the directives of the Church regarding organ donation are somewhat unclear. Knowing that not all organs can be morally transplanted or donated, such as the reproductive organs or those holding special personal identity, what organs can be donated upon death and in what clear and concrete circumstances? Can one set forth securely the organs which we/they wish to donate upon death by living will, advance directive or proxy licitly? -- I.D. Seattle, Washington
William E. May offers the following response:
Good theological reflection is always in accord with magisterial teaching. Blessed John Paul II affirmed that a beautiful act expressing the culture of life "is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope" ("Evangelium Vitae," No. 86). His teaching specifically on organ donation and transplantation from the dead will be seen below.
The Catechism of the Catholic Church teaches that those from the living are morally good so long as the dangers incurred by donor the donor are proportionate to the good sought for the recipient and those from the dead are noble and meritorious so long as valid consent has been given (No. 2296). The Ethical and Religious Directives for Catholic Health Care Services (ERDs) has similar teaching on organ donations from the living, specifying however that the donation will not sacrifice or seriously impair and essential functioning of the donor. It offers some important specifics on such procedures from the dead, e.g., only competent medical authorities ought to determine that a person has died, to avoid conflicts of interest the physician determining death ought not be a member of the transplant team (Directives, 62. 64).
Although all theologians loyal to the magisterium agree that organ donation and transplants from living donors are morally justified and are indeed noble and good actions so long as certain criteria are met, they differ however, in the reasoning they use to show this. The more common position was developed by Jesuit Father Gerald Kelly, the most important moral theologian from the 40s through the 50s. This view holds that such donation and transplantation is justified by the principle of fraternal charity or love when doing so is of great benefit to the recipient, with the proviso that the harm suffered by the donor is limited and morally acceptable.
It distinguishes between anatomical and functional integrity, maintaining that only the latter is essential for bodily and personal integrity. Thus Dominicans fathers Benedict Ashley and Kevin O'Rourke say: "The concept of functional integrity is the key factor in addressing the morality of transplants between living persons." They acknowledge that the donor runs a risk in giving an organ, but this is acceptable if it does not impair his own functional integrity (e.g., if he donates one kidney, his functional integrity is not impaired because he still has a functioning kidney). The transplant would be immoral if the organ's removal were to impair the donor's functional integrity (e.g., removing one's cornea to help another person see or removing both kidneys).
Germain Grisez and others think that organ transplants from the living can be justified by the principle of double effect. According to this principle an action having two effects, one good, the other bad, is morally good provided that the action is not morally wrong for other reasons, that the evil is not intended, that the evil is not the means to the good, and that there is a "proportionate reason" for tolerating or accepting the bad effect.
The morality of the self-giving of vital organs depends on how the acting person relates himself in his freely chosen act to the great goods of healthy functioning and life itself. If the harm (including the mutilation) suffered by the donor -- but in no way intended either by him or those involved in the transplant -- does not impair his functional integrity, the evil suffered is an unintended side-effect of an act of self-giving, a morally good act. However, were the donor's own functional integrity and hence his own health and life to be impaired, it would be wrong for him to choose to give it because the means he would choose, endangering his own health and life, is bad although intended for a good end, but one can never intend or choose evil for the sake of good to come.
Criteria for death
We saw earlier that the U.S. bishops' ERDs make it clear that only competent medical authorities have the right to determine that a person has died. Blessed John Paul II several times declared that the responsibility to provide the criteria for determining that a human person had died was within the competence of medical doctors and scientists. He accepted the scientific community's position that the criteria for determining this are (1) spontaneous cardiac and respiratory functioning and (2) the irreversible cessation of all functioning of the brain, including the brain stem, what he called the "neurological" criterion (his latest statement on the neurological criterion was given at an International Conference of Organ Transplant Specialists in August 2000).
In recent years there has been a serious debate among scientists regarding the validity of the "neurological" criterion. Several serious challenges, supported by evidence, have been leveled against it. This debate is continuing, but as of now the magisterium accepts the "neurological criterion" as providing moral certainty that a human person has died.
* * *
William E. May, is a Senior Fellow at the Culture of Life Foundation and retired Michael J. McGivney Professor of Moral Theology at the John Paul II Institute for Studies on Marriage and Family at The Catholic University of America in Washington, D.C.
[Readers may send questions regarding bioethics to email@example.com. The text should include your initials, your city and your state, province or country. The fellows at the Culture of Life Foundation will answer a select number of the questions that arrive.]