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The Ethics of Organ Harvesting and Transplant

First published by G3 Ministries


In 1968 in apartheid South Africa, a young black man named Clive Haupt suffered a brain bleed while picnicking with his family. He was admitted to a Cape Town hospital under the care of Dr. Raymond Hoffenberg. Later that night, Dr. Hoffenberg was approached by the transplant team and was asked to pronounce Haupt dead. Initially, Dr. Hoffenberg refused, as he was troubled at the thought of pronouncing someone with a beating heart dead. Reportedly, one of the transplant surgeons said, “God, Bill, what sort of heart are you going to give us?” This is because a heart from a biologically dead body very quickly begins to decompose and is unsuitable for transplantation. So, under considerable pressure, Dr. Hoffenberg pronounced Clive Haupt dead the following morning. Dr. Christiaan Barnard then harvested Haupt’s still beating heart and placed it in the chest of a retired white dentist, marking the world’s first successful heart transplant.

Surgeons around the world took notice. Whereas tissues (skin, bone, corneas) could be successfully transplanted from a corpse, successful organ transplants (heart, lung, liver, kidneys) would require that the organs involved come from people whose hearts were still beating and whose lungs were still oxygenating their blood: people still biologically alive. So, in August of 1968, an ad hoc committee of doctors at Harvard Medical School wrote a landmark paper that re-defined people in an irreversible coma as dead. They did this by the stroke of a pen: there were no tests, studies, or evidence that comatose people were dead. This was a utilitarian pronouncement, made to skirt the ethical and legal issues associated with harvesting organs from people who were still biologically alive.

In 1981, the ad hoc committee’s recommendations were codified into law as the Uniform Determination of Death Act (UDDA). It states that in order to declare someone legally dead, there must be irreversible cessation of cardiopulmonary function or irreversible cessation of all functions of the entire brain, including the brainstem. These definitions have allowed the science of organ transplantation to provide life-saving organs for thousands of people. But are the people declared “legally” dead under the UDDA actually dead?

The historic teaching of the church is that we are a body-soul unity. We are not an embodied soul or an ensouled body as in Plato or Aristotle. The Christian view is also different from the Enlightenment view that we are our brains, brains who operate and direct our bodies like machines. According to Scripture, “the body without the spirit is dead,” (James 2:26). Abraham “gave up the ghost” and died at a good old age (Genesis 25:8). Historically, death was defined by the departure of the spirit and was marked by the disintegration of the body, which explains Lazarus’ sister’s alarm at having his tomb opened, “Lord, by this time he stinketh: for he hath been dead four days,” (John 11:39).

Interestingly, the biological definition of death is “the loss of integration of the organism as a whole.” This definition also reflects the “dis-integration” of the body which begins when the spirit departs.

Clearly, people who have been pronounced legally dead under the brain death category of the UDDA, (who still have beating hearts) are not biologically dead and their spirits are still integrated in their bodies. There have been many cases of people who were declared “brain dead” awakening prior to their organ harvesting and going on to live normal lives. Zack Dunlap was declared brain dead in 2007, and recalls being extremely angry that he was unable to move or sign as he overheard doctors discussing harvesting his organs with his parents. Thankfully he managed to move before being taken to an operating room to be killed by organ harvesting.

The newer procedure of “donation after circulatory death” is equally problematic. In this technique, people who are not brain dead (but not expected to survive) have their care withdrawn in such a way as to harvest their organs before the loss of circulation makes them unviable. These people’s hearts are allowed to stop, and then doctors wait between seventy-five seconds to five minutes (depending on the transplant center) before starting the harvest surgery. Many medical professionals are uncomfortable with this because we know that people are routinely resuscitated after seventy-five seconds to five minutes of cardiac arrest. If you are capable of being resuscitated, your spirit has not departed and you are not yet dead. This is borne out by a recent case in Illinois, in which a young lady’s heart spontaneously resumed beating and she began gasping for breath during the removal of her kidneys. The county coroner determined that her ultimate cause of death was homicide.

Even worse, in a procedure called normothermic regional perfusion with controlled donation after circulatory death (NRP-cDCD), doctors are now taking people off life support, clamping off the blood flow to their brains to make them brain dead on purpose, and then resuscitating the rest of the body. According to the University of Nebraska protocol, “once blood flow to the heart is established, the heart will start beating”. This practice plays fast and loose with the “irreversibility” clauses of the UDDA, and has been banned in Australia, though centers in the US continue to pursue it.

Not every type of transplant is unethical. Living donation of a paired organ such as the kidney or a lobed organ like the liver are ethical because both the donor and the recipient remain alive after the procedure. Tissues such as corneas and heart valves can be donated after biological death, though there have been cases of organ procurement organizations harvesting tissues before the medical examiner could determine the cause of death. Thus, the families of these people were left without closure or justice, especially if the death was possibly the result of a crime.

Although the public is generally unaware that organ harvesting takes place before you are biologically dead, many doctors and bioethicists have been speaking and writing about these facts. Doctors Miller, Truog, and Brock wrote in the Journal of Medicine and Philosophy:

Nevertheless, scholars have argued cogently that donors of vital organs, including those diagnosed as ‘brain dead’ and those declared dead according to cardiopulmonary criteria, are not in fact dead at the time that vital organs are being procured(.) . . . This leaves the current practice of organ donation based on the ‘moral fiction’ that donors are dead when vital organs are procured.

Dr. Alan Shewmon, professor emeritus of pediatric neurology at UCLA medical school stated:

Just as cigarette ads are required to contain a footnote warning of health risks, ads promoting organ donation should contain a footnote along these lines: ‘Warning: It remains controversial whether you will actually be dead at the time of removal of your organs.’

Ethicist Dr. Michael Nair-Collins writes:

Appealing to the good consequences of organ transplantation in an attempt to justify the lack of transparency, if not outright obfuscation on which the transplantation enterprise rests, is not a very compelling argument.

In light of all this, what should Christians do? First, refuse to be a registered organ donor. If you are a registered organ donor, your organs will be taken, regardless of the objections of your family or your healthcare power of attorney. Second, because the 2006 revision of the Uniform Anatomical Gift Act (UAGA) allows even the hospital administrator to consent to donate an incapacitated person’s organs in absence of a specific refusal to donate, fill out a refusal to donate card. Some states have this on their drivers’ licenses, otherwise the HALO-voice healthcare advocacy organization has a life-affirming medical proxy kit and downloadable wallet card stating your refusal to donate.

Third, share this information with your pastor and your church. It has been over fifty years since the Harvard ad hoc committee changed the definition of death, and the silence from the church has been deafening. The only state with a religious exemption to the new definitions of death under the UDDA is New Jersey due to the strenuous efforts of the Jewish community. Recently, Catholic scholars have been addressing this issue, at least in scholarly journals.

Fourth, be aware that the Uniform Law Commission (ULC) is considering proposals to revise the UDDA in ways that will make it easier to declare someone brain dead, and more difficult for families to contest a brain death diagnosis.

The ULC is planning to release their model statute later this year, and is currently considering expert opinions and suggestions to assist them in this process. If you are a theologian, you are an expert on matters of life and death and should consider sharing them with a letter to the ULC.

Finally, be encouraged, our hope is in the Lord! I have found that most people just don’t know the facts on organ harvesting, but when they find out they care. Become an advocate of life from conception until natural death. Speak and pray against this injustice and together we will “deliver them that are drawn unto death, and those that are ready to be slain,” (Proverbs 24:11,12).

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