St James Cathedral - Seattle, WA

Saturday, September 15, 2012

Concerns with Organ Donation

What do you think about organ donation? As a devout Catholic, what I have to say might surprise you.

Here's what the Church teaches:

Organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as a expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons. (Catechism of the Catholic Church, No 2296)
A lot of people read the part that says "noble and meritorious act" and run with it. Well, after you've talked with me, you may not want to run too far. Yes, I have ethical concerns with organ donation; not the whole thing, but there are certain parts of it that call for a reflective pause and warrant a deeper look.

Before going any further, it's important to say that there are some wonderful things about organ donation. Organ donation has saved countless lives in many parts of the world.  From one donor can come the opportunity for several people to live. I commend anyone who truly understands what this means and wants to to do this.  It's a neat way to be more like Jesus Christ.

So what's the problem? Well, there's actually two of them: the issue of brain-death and the lack of informed consent.  I question if how we're doing this in the United States actually follows Church teaching.

The first concern: Brain-death. In the movies, a brain dead patient is shown in a hospital bed, attached to a ventilator (which keeps the body alive) while a continuous EEG shows no brain activity. Well in real life, it just isn't that simple, either medically or religiously.  According to our faith, does brain-dead mean the patient is dead? If so, can we say that with absolute moral certainty, the same way we say an embryo is a person?  Catholic theologians are not all in agreement about this.  The medical community isn't in agreement about brain death either.  There is established criteria for brain death, but it remains disputed among physicians, ethicists, and moral theologians. If the patient is truly brain dead, then why is anesthesia used when the transplant surgeon removes organs/tissues?  The patient can still feel pain?  I thought the patient was brain-dead?  Clearly, this alone shows that issue is NOT resolved.

The second concern: Informed consent. Most people really don't know what having the words "Organ Donor" on your driver's license really means. According to CORE, the organ procurement organization for Pennsylvania:

"In Pennsylvania, the words Organ Donor will be printed in green lettering on your driver's license. This is consent to donate organs and tissue. It is a legal document and your family cannot override your decision to donate."
Legal document? Decision to donate? Wait a minute. So at the end of your life, if you're family has a concern about what is happening, they are legally powerless to stop it?

Picture this: A tragedy has occurred and hours later you're laying in the ICU, completely dependent on the ventilator. The doctor is telling your immediate family that the care could be futile, and there is little to no chance for recovery and it's best to withdraw care.  Since you may die within 24 hours, the nurse is required to contact CORE without your family's permission. (Federal law requires hospitals to notify their organ procurement organization anytime a patient may expire.  The same law exempts organ procurement organizations from HIPAA and other privacy laws.) The representative from CORE comes to the hospital and says things like, "it's clearly what he would want since it's on his driver's license." The next thing you know, there's a transplant surgeon beside you and your organs are being harvested. If you weren't brain dead before, you certainly will be completely dead in a few moments. Sadly, most of your family doesn't even know you've been hospitalized. The ones who are present are still trying to figure out what the doctor meant by "little chance for recovery" and are wondering if the right thing had been done.

Was that over-dramatized?  Sure.  In reality, most physicians would never withdraw care without the family's full cooperation, and organ procurement organizations are really good about talking to families before proceeding.  But could something like this happen? The laws regarding organ donation are certainly set up that way.  It really concerns me that if "Organ Donor" on your driver's license is considered legal and binding, then the argument could be made that no one even obligated to talk with your loved ones before taking your organs.

Think about it this way. When planning to have surgery or medical procedure, the physician discusses the risks and possible complications (i.e. pain, infection, etc) as part of obtaining your consent. You should be able to ask questions and have a good understanding about what's going to happen. But when it comes to organ donation at the driver's license center, there's no opportunity for discussion. It's just blind consent; you are consenting for surgery by simply checking a box. The scary thing is, this is the one kind of surgery where the biggest risk is guaranteed to happen- your death.

Few people realize that two words on a driver's license can actually usurp the responsibility and authority your family have to speak on your behalf at the most vulnerable time in your life and you can't speak for yourself.  

If protecting your family from having to make your medical decisions during a crises is a concern, then there's a better way to do it.  Sit down with your family and complete a living will for health care. Review it with the person whom you designate to make medical decisions on your behalf.  Discuss it with your primary care physician.  You can even specify which organs/tissues you wish to donate and how you prefer them to be used.  Many complete their living will with the help of an attorney when completing their legal will. 
Please know that I'm not saying organ donation is wrong.  I'm not trying to persuade people from becoming organ donors, especially when there are so many dying as they wait on transplant lists.  I'm just tired of people being duped into agreeing to things without truly knowing what's going on.  This happens a lot, especially to Christians who just want to do the right thing.

Since the Church teaches that organ donation should occur after death and "it is not morally admissible to bring death of a human being," then great care should be taken to determine if someone is truly brain-dead, and there has to be some moral certainty about what brain-death means.  The Church also wants you (or your designate) to be able to give explicit consent, and what happens at the driver's license center is incredibly insufficient for this.

I'm not claiming to be an expert.  There are people much smarter than me, and people with more knowledge and/or first hand experience when it comes to organ donation.  But when so many experts disagree on an important life and death situation, we definitely have to proceed with caution!

This post was inspired by "Bioethics of Organ Donation," an article in Our Sunday Visitor on 8/9/2012.

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