By Br. Albert Duggan, O.P.

Organ transplantation can provide a second chance at life for many who are critically ill.  Whether transportable organs are taken from living or dead donors, there are a number of important moral questions to consider, and many people wonder what the Catholic Church teaches in this regard.

Since the advent of transplantation in the 1950’s, the Church has been supportive of the practice, provided that those involved take certain moral considerations into account.  Whether it involves living or deceased donors, transplantation witnesses to the genuine bond of charity that connects human beings to one another.  As long as the dignity of the donors is fully protected, the Church applauds and encourages the practice of organ transplantation.  Pope John Paul II even referred to organ transplantation as a generous gift of self in his 2000 Address to the Eighteenth International Congress of the Transplantation Society.

So where is the controversy? Different issues arise depending on whether organ donors are living or deceased.  When the donor is alive, the key considerations are that the he or she consents freely, and that his or her bodily integrity is preserved.  Obviously, the donor must give informed consent to donate an organ.  That is, he or she must be apprised of the nature of the procedure and be advised about the risks involved, including potential complications and financial costs that might be incurred as a result of the surgery.

An issue related to free consent is compensation for donors.  In some countries, for example, it is legal to sell a kidney, and there is real concern that such “markets” for organs and tissues can have a coercive effect—that is, people will donate without heeding the risks, solely for the money. Needless to say, this practice poses a serious threat to human dignity.  In the U.S., federal law prohibits donors from receiving any “valuable consideration” in exchange for donation, whether this is financial or material.  While it prevents gross abuses, some ethicists consider the current law too strict.  While making direct payments to patients for donating organs is wrong, it might be worth considering the merits of indirect compensation for the real costs associated with this generous and life-saving act, e.g., lost wages or uncovered medical expenses.

Organ donation must not harm the bodily integrity of the donor.  The Catechism of the Catholic Church says that it is “morally inadmissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons” (CCC #2296).  Moral theologians usually interpret a “disabling mutilation” as one that impairs an individual’s normal biological function.  One kidney can do the work normally done by two, so a kidney donor is not disabled by the procedure.  On the other hand, while it would be technically possible to donate a single cornea, the loss of vision in one eye would result in significant functional impairment, and so would not be permissible.

When organs are to be obtained from a person who has died, different moral considerations arise.  Because the donor is dead, maintaining functional integrity is no longer a concern.  It is possible to obtain many more vital organs and tissues from dead donor: heart, lungs, liver, pancreas, corneas, skin, etc.

However, the Church still insists on obtaining explicit consent from the donors or those who speak on their behalf (CCC #2296).  In the U.S., consent is obtained from a potential donor’s next-of-kin or by a designation on a person’s driver’s license.  In order to address shortages of organs, some countries have adopted a standard of “presumed consent,” wherein it is presumed that everyone is willing to donate his or her organs after death unless that person has specifically indicated otherwise.  While this approach increases the pool of transplantable organs, the explicit consent called for in the Catechism is lacking.

Another major concern in the case of deceased donors is ascertaining that the person has in fact died.  One may not harvest organs from a person whose death is imminent, even if death is certain to occur.  The Church does not object to using neurological criteria to declare a person dead (i.e., “brain death” instead of the traditional criteria based on breathing and heartbeat).  However, it is important to maintain the distinction between brain death and a persistent vegetative state.  In the latter case, some brain function remains, and the person is still very much alive, even if non-responsive.

The overarching principle in the Church’s teaching on organ donation is that it is a supremely generous and life-saving act, and should be encouraged.  Nevertheless, the potential benefits presented to the recipients do not justify violations to the dignity of the donors.  Whether the donor is alive or deceased, those involved must give proper consent, and steps must be taken to ensure that donors are not treated merely as means to an end.