July 8, 2011

Be Our Guest / Dr. Paul A. Byrne and Fr. Peter Damian Fehlner, F.I.

Vital organ transplantation—not truly dead

This letter is in response to the “Making Sense Out of Biothethics” column by Father Tad Pacholczyk in the June 25 issue of The Criterion.

The Aug. 29, 2000, address of Blessed John Paul II is often quoted by those in support of obtaining vital organs for transplantation, but other statements by Pope John Paul II and a more recent statement by Pope Benedict XVI are ignored.

Blessed John Paul II wrote in “Evangelium Vitae”: “Nothing and no one can in any way permit the killing of an innocent human being, whether a fetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying.

“Furthermore, no one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly” (“Evangelium Vitae,” #52).

On Feb 11, 2003, the World Day of the Sick, Pope John Paul stated, “Every therapeutic procedure, all experimentation and every transplant must take into account this fundamental truth. Thus, it is never licit to kill one human being in order to save another.”

Pope John Paul’s address to the Pontifical Academy of Sciences on Feb. 3-4, 2005, included, “It is well known that the moment of death for each person consists in the definitive loss of the constitutive unity of body and spirit. Each human being, in fact, is alive precisely insofar as he or she is ‘corpore et anima unus’ (“Gaudium et Spes,” #14), and he or she remains so for as long as this substantial unity-in-totality subsists.”

Many in support of vital organ transplantation base their position on the Aug. 29, 2000, address by Pope John Paul: “This consists in establishing, according to clearly determined parameters commonly held by the international scientific community, the complete and irreversible cessation of all brain activity [in the cerebrum, cerebellum and brain stem]. This is then considered the sign that the individual organism has lost its integrative capacity.”

A survey of the leading neurological institutions showed that there is no consensus of the many—more than 30, probably 100, or even more—disparate sets of criteria (Neurology, January 2010).

Then, in the July 2010 issue of Neurology, it was published that “brain death” is not evidence based. Thus, for “brain death” can there be “clearly defined parameters commonly held by the international scientific community”? [“Evidence based is the modern standard that doctors are encouraged to follow; but it doesn’t exist for “brain death”!]

Many misconceptions about criteria for determining “brain death” revolve around “irreversibility.”

Irreversibility cannot be observed by a doctor like a change in function or even destruction of tissue or an organ. Thus, “irreversibility cannot serve as evidence, nor can it rightly be made part of an observable criterion of death.”

A presumption of irreversibility of a lack of brain functioning, even if “cerebrum, cerebellum and brain stem” are included, is insufficient grounds for removing a patient’s vital organs or for immediate autopsy, cremation or burial. Even though cerebellum is included, none of the many sets of criteria include evaluation of the cerebellum.

“Absolute” irreversibility of brain functioning, among other characteristics of a cadaver, reflects the fact of death. But such irreversibility can be known by us only if we already know the fact of death.

Death is the criterion of absolute irreversibility, not vice-versa. “Relative” irreversibility, viz., relative to our capacity to reverse the non-functional character of this brain, is not a criterion of death. If we are not sure of absolute irreversibility, then we are not sure that real death, as distinct from a clinical declaration of “brain death,” “heart death,” “as good as dead,” “soon to be dead,” etc., has occurred. Without such certainty, organ extraction cannot begin without violating the fifth commandment.

The declaration of Pope John Paul II is a conditional one that has not been met because there are no “clearly determined parameters commonly held by the international scientific community.”

Pope Benedict XVI on Nov. 7, 2008, specified: “Individual vital organs cannot be extracted except ex cadavere.” Pope Benedict made his teaching clear and specific by using Latin, “ex cadavere,” which translates as “from a dead body.”

Pope Benedict continued, “The principal criteria of respect for the life of the donator must always prevail so that the extraction of organs be performed only in the case of his/her true death” (cf. Compendium of the Catechism of the Catholic Church, #476). Thus, Pope Benedict is very clear, vital organs cannot be taken except from a dead body after his or her true death. A dead body does not have a beating heart, circulation and respiration.

Genuine certainty must exist prior to any declaration of death. A very simple test of the certainty that this key condition concerning “brain death” has been fulfilled is the following: Could it be wrong, and is it often wrong?

If the reply is “yes,” then the condition required for moral certainty to be genuine certainty in the sense of Pope John Paul II and Pope Benedict XVI, namely that this human body is not a living body, but is a cadaver, has not been realized.

Can there be certainty of any kind if one would say a cadaver has a beating heart, circulation and respiration? A cadaver—dead body—does not and cannot have signs of life like a beating heart, circulation and respiration. A cadaver is suitable for autopsy, embalming, cremation and burial.

Over time, it has become clear that “brain death” is not true death. Many do not accept that “brain death” is true death. These include: “Brain Death is Not Death: A Critique of the Concept, Criterion, and Tests of Brain Death,” Rix, 1990; McCullagh, 1993; Evans, 1994; Jones, 1995; Watanabe, 1997; Cranford, 1998; Potts et al., 2000; Taylor, 1997; Reuter, 2001; Lock, 2002; Byrne and Weaver, 2004; Zamperetti et al., 2004; de Mattei, 2006; Joffe, 2007; Truog, 2007; Karakatsanis, 2008; and Verheijde et al., 2009. Even the President’s Council on Bioethics in its white paper in 2008 rejected “brain death” as true death.

There are many news accounts of people recovering after a declaration of “brain dead.” Zack Dunlap from Oklahoma was declared “brain dead.” There was no blood flow to his brain as evidenced by a PET scan. A helicopter with medical personnel on board was landing to extract Zack’s organs. A cousin who was a nurse in the intensive care unit did another test. A response was observed. The transplant was stopped. This and others were recorded for the national and international community.

Even one such patient should be enough to wake people up to the fact that “brain death” is not true death. And there are many!

(Dr. Paul Byrne is clinical professor of pediatrics at the University of Toledo College of Medicine in Toledo, Ohio, and director of pediatrics and neonatology at St. Charles Mercy Hospital in Oregon, Ohio. He is a member of the Fellowship of Catholic Scholars, and is a past president of the Catholic Medical Association. Franciscan of the Immaculate Father Peter Damian M. Fehlner is rector of the Shrine of Our Lady of Guadalupe in La Crosse, Wis. He earned a doctorate in sacred theology at Seraphicum in Rome, and is a former professor of theology in the U.S. and Rome.)

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