In June, Catholic San Francisco published a feature story about a 2005 heart transplant surgery at the University of California Medical Center in San Francisco. The recipient of the transplanted heart was Father Joseph Bradley, a priest of the Archdiocese of San Francisco. This fascinating story provides an excellent opportunity to reflect on certain moral and medical issues pertaining to organ transplants and specifically a heart transplant.
Since its inception, organ transplantation has been guided by the overarching ethical requirement known as the " dead donor rule," which simply states that patients must be declared dead before the removal of organs for transplantation.
Therefore, the guiding ethical principle for organ transplantation is: While it is moral to take organs from a dead body to help a living person, it is not moral to take organs from one living person to give them to another, if one thereby causes the death of the donor. A person might decide, for example, to donate a kidney or part of one' s liver to another individual, motivated by charity and love for one' s neighbor. Such a gift is morally acceptable as the donor can continue to live with only one kidney or one lung or a partial liver.
In the United States, about every three to four organs that are surgically transplanted are recovered from deceased donors. What criteria are used to determine whether or not a donor of a heart is, in fact, dead? Traditionally both the legal and medical communities determined death when certain bodily functions ceased, especially respiration and heartbeat. This determination was generally referred to as cardiopulmonary criteria.
With the increasing ability of the medical community to resuscitate people with no heart beat or respiration, and with the widespread use of life support equipment which can artificially maintain body functions indefinitely, the need for a better definition of death became necessary.
Around 1970, the law began to accept the declaration of death on the basis of the irreversible and complete absence of all functions of the entire brain. In 1968, the diagnostic criteria of brain death became widely accepted after a committee at the Harvard School of Medicine proposed that the determination of death be made by neurological criteria.
In 1981, a presidential commission issued its landmark report " Defining Death: Medical, Legal and Ethical Issues in the Determination of Death." This report indicated that death is determined when the " whole brain" - the brain and brainstem - is no longer functioning. Today, physicians in all U.S. states may pronounce death when total brain function is determined to be permanently lost. Nevertheless, the traditional heart - based pronouncement is accepted as an alternative.
Today both the legal and medical communities, in addition to the definition of death defined by the cessation of cardiopulmonary function, use whole or total brain death as a legal definition of death. It is possible, then, to declare a person legally dead even if mechanical equipment keeps the body' s metabolic processes working.
After the release of the presidential report, the head of the prolife group American Citizens for Life stated that " legislation limiting the concept of brain death to the irreversible cessation of total function of the brain, including the brain stem, is beneficial and does not undermine any of the values we seek to support."
In his 1958 speech, " The Prolongation of Life," Pope Pius XII stated that death is determined by medical experts and this determination " does not fall within the competence of the Church." In 2000, the Pontifical Academy of Science upheld this point. Consequently, the Church leaves the question of what signs indicate death to medical experts.
John Paul II gave support to determining death by neurological criteria in a 2000 talk to the International Congress on Organ Transplants. The pope said, " the criteria adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology."
It is important to distinguish brain death from neurological conditions that render a person unable to communicate, for example, persons in a coma or in a permanent vegetative state. Although these individuals cannot exercise even the most minimal of human powers, they are still fully human and deserve the complete respect due to human persons.
John Paul II made this point clearly in his 2004 allocution about persons in a permanent vegetative state: " I feel the duty to reaffirm strongly that the intrinsic value and personal dignity of every human being do not change, no matter what the concrete circumstances of his or her life. A man, even if seriously disabled in the exercise of his highest functions, is and always will be a man, and he will never become a ' vegetable' or an ' animal.' "
The " Ethical and Religious Directives for Catholic Health Care Services" address the question of the donation of organs after death in numbers 63 - 65. These directives encourage Catholic health care institutions to provide the means whereby those who wish to do so may arrange for the donation of their organs and bodily tissues so that, after death, they may be used for donation or research.
Hospitals have very strict guidelines involving many disciplines, e.g., neurologists, cardiologists, ethics committees, and transplant teams, in making decisions with the family and surrogates in a decision to donate a heart, or any bodily organ. No coercion is ever used.
Only persons who are declared brain dead are potential heart donors. Patients or their legally - appointed agent for medical decision making, sometimes called a proxy or surrogate, can make an ethically appropriate decision to donate one' s heart to someone in need, once the patient has been declared brain dead using the appropriate neurological criteria. Candidates for such a transplant have a life - threatening deterioration of the heart and in the end stages of their disease they will die without effective treatment.
No treatment is as effective as a heart transplant for these patients. Father. Joseph Bradley is a living example!
Sulpician Father Gerald Coleman is vice president for ethics for the Daughters of Charity Health System.
