In Gilbert Meilaender’s Bioethics, he writes on various topics of bioethical concern, such as procreative science, abortion, prenatal screening, embryonic stem cell research, suicide and euthanasia, human experimentation, and others. Meilaender’s typical approach to these topics is one of caution, especially in ways methods can be abused. In this chapter entitled, “Gifts of the Body: Organ Donation,” Meilaender also cautions his readers about the practice of organ donation, splitting the chapter into two parts, “Living Donors” and “Donation after Death.”[1]
After giving some current (as of 2011) statistics on organ donation in the United States, Meilaender then gives anecdotal information, sharing stories and examples of organ donation and asking cautious questions along the way. Meilaender is keen to lead with the big-picture moral question of organ donation, as his readers may already assume that there is not a concern here. Meilaender reports a 1995 study that indicates only forty percent of possible donors end up donating organs, largely because in most cases, the deceased donor’s family refuses the request for the donors organs to be collected for transplant.[2] Reflecting on this, Meilaender states:
If such refusal is a thoughtless act, one might argue that we should look for new ways to persuade families to consent to organ donation after death of a loved one… If such refusal is not just thoughtless but morally wrong, one might argue that we should override it — perhaps by authorizing medical professionals routinely to salvage, without prior request for approval, cadaver organs for transplant. And an increasing number of voices seem prepared to argue for that. If such refusal is motivated by concerns that are selfish or, at least, self-regarding, one might argue that we should fight fire with fire by offering to compensate the family of the deceased for donated organs — appealing to their self-regarding impulses in order to achieve desirable social aims. And such arguments have also found adherents within our society. On the other hand, if weighty — albeit often unarticulated — reasons may underlie such refusals, we ought to look with a critical eye upon the increasing social pressure to encourage organ donation and transplantation. These are not just questions of public policy. They are also questions that pit our deep-seated hunger to live longer and our fear of death against equally deep-seated notions of the sacredness of human life in the body.[3]
While Meilaender notes that the public has almost always praised organ donation—emphasizing the good that comes from these gifts of the body that can save lives—however, caution and reflection are needed for an act that raises questions on the very meaning of humanity.
In exploring “Living Donors,” Meilaender raises a series of ethical insights and questions to light when organ donation is taking place by a donor who is still living. He notes that in the United States, two series of laws have allowed organs to be donated (when authorized by the donor or family), but not to be taken without permission or sold as commodities. However, Meilaender then notes that there are limits to this, giving a case study of a living father wishing to give his heart to his dying son.[4] Meilaender brings this case to the forefront to intentionally complicate the muddied notions of Christianity’s focus on love and freedom with culture’s praise for the “gift of life.” Ultimately, Meilaender believes us to be mere stewards of our bodily lives, not owners, and calls upon Catholic and Jewish traditions who forbade self-mutilation or self-harm. He also treats organ donation that results in self-death as suicidal, and thus obviously unacceptable and not a work of creaturely love, concluding that individuals cannot intentionally harm themselves in order to help their neighbors. Meilaender does then note a difference between a transplant that will surely cause great harm (and death) to the donor, such as of the heart or lungs, and a lesser transplant of bone marrow or a kidney—although he does not view these as inconsequential in the least. Meilaender finishes the section speaking of the nature of the “body,” challenging an assertion that it is simply a collection of parts and somehow disconnected from spiritual and personal presence. He then speaks to ethical problems surrounding organ donation involving cadavers, as well as the sale of organs and payment to living donors as incentive.
Meilaender’s next section, “Donation after Death,” explores the moral questions related to organ donation after an individual has deceased. The initial chief question here is, of course, when exactly has an individual deceased? While traditionally, one was “declared dead” upon the cessation of heart and lung activity, in 1968, a committee at Harvard University proposed a shift towards the neurological criterion as indicative of death. Because technology had made it possible to sustain heart and lung activity on a respirator for several weeks, the new declaration of death called for a cessation of brain activity as the mark of one’s end of life. Beginning in 1981, laws were written that gave criteria for when all brain activity had ceased, noting that a “whole-brain” death had occurred—which is different than a case when only some brain activity ceased (most often the “higher” brain functions). Meilaender challenges this innovation in health science, arguing that most would be unable to bury an individual who had been “declared dead,” though their heart was still beating. He also questions whether a respirator is merely “oxygenating a corpse,” or instead sustaining a living being. He then explores that ethical problems that result from a neurological understanding of death, noting in 1994, it was deemed ethically permissible to secure needed organs from infants born with anencephaly (missing brain hemispheres) even though they did not have whole-brain death—casting light on what many in recent times have stated is a policy formed simply from a desire for increased organ donation. Because of the controversial nature of this policy, the American Medical Association has officially gone back-and-forth on it several times. Meilaender then concludes the section noting two ethical consequences: (1) because of the immediacy needed for organ transplantation, often patients are declared “brain dead” while their bodies are still functioning as they are wheeled into the operating room to remove their organs on the table, and (2) the reality that children have actually been conceived for the purpose of being marrow donors for siblings, parents, or even wealthy individuals who would be a match.
So what is Meilaender’s point on an issue that, by his own documentation, saves so many lives? Summarizing in two points, Meilaender is Christians to caution against: (1) the cultural trend that is teaching us to think of ourselves and others not as living beings whose bodies have their own unity and integrity knit together by God with a spirit and divine consciousness, but simply as materialistic ensembles of parts; and (2) our gradually increasing perception of our “duty” as bringing good and “meaning” out of every human tragedy that errs more on a godlike complex than one of creaturely submission. While Meilaender never firmly states whether he would accept organ donation in any circumstance, his language on the matter never had a positive side, viewing the ethical cautions and consequences as outweighing any good.
As someone who grew up as a Southern Baptist who would not begin to question the “gift” of organ donation, I found Meilaender’s analysis of the history of organ donation, statistics regarding its use, and the various case studies of actual examples, to all serve as compelling and persuasive arguments in understanding his concerns. This is not surprising, as most Christian denominations in the United States seem to be officially in support of organ donation.[5] Years into my Anglican formation, I find myself gripped by Meilaender’s emphasis on the connection between body and soul—an argument against some of the gnostic tendencies of American evangelicalism. While Meilaender did not mention the phenomena explicitly, a number of leading American medical journals have published on the myriad of accounts of strange situations of organ donations. With heavy documentation by governmental and medical sources, there are numerous stories of organ receivers having visions of the lives of their donors. In one case, an eight-year-old girl had nightmares of a murder in fine detail; the murder was of the ten-year-old girl whose heart had been donated, and the detail allowed police to solve the murder and arrest the culprit. Other cases show organ receivers calling their spouse and family by names of the spouse and family members of the donor, or noting an appetite for a food that they previously could not hold down—the favorite food of the donor. Researchers have called this sensation “cellular memory transference,” and are now speculating the possibility that consciousness and memory do not reside solely in the brain.[6]
In researching views on organ donation throughout history, it was unsurprising to discover that Roman Catholics, Orthodox, and Jews all have had similar concerns of body-soul relationship.[7] What was a surprise, however, was to discover that the Church of England passed a resolution on blood and organ donation asserting that,
“giving one’s self and one’s possessions voluntarily for the wellbeing of others and without compulsion is a Christian duty of which organ donation is a striking example. Christians have a mandate to heal, motivated by compassion, mercy, knowledge and ability. The Christian tradition both affirms the God-given value of human bodily life, and the principle of putting the needs of others before one’s own needs.”[8]
While this view does have a sense of the god-like responsibility that Meilaender attributes has been blurred with cultural duties, its main hermeneutic is the love of neighbor. Ultimately, the ethic of organ donation is one that needs more individual contemplation. However, there are several arguments I am willing to make: (1) organ donation is not always right or wrong in all situations, (2) the good can outweigh the cautions in situations of lesser mutilative harm, such as kidney tissue and marrow donation, in which our love of neighbor does not include altering self-harm, (3) for the Christian, the knowledge of body-spirit relationship should beg the question of what spirit we invite into our bodies when we receive an organ donation, as well as the effect of a non-Christian body and spirit within our own, (4) we should possibly narrow donor options to those who have been certifiably baptized, and (5) if these parameters cannot be followed, then we must move from a desire redeem a tragedy to an act of submission to our earthly lives and focused confidence on our heavenly ones.
Questions:
- Do the cautions and concerns that Meilaender brings up outweigh the good of loving ones neighbor and promoting life?
- Do you have similar concerns about inviting others’ bodies and spirits into your own and the reports of “cellular memory transference”?
- What do you think about my proposition of organ donation limited to the baptized for Christians, and would it practically be possible for denominational agencies to aid in?
[1] Gilbert C. Meilaender, Bioethics, Third Edition (Grand Rapids, MI: Wm. B. Eerdmans Publishing Co., 2013), 89.
[2] Gina Kolata, “Families Are Barriers to Many Organ Donations, Study Finds,” The New York Times, July 7, 1995, p. A9. Quoted in Meilander, Bioethics, 90.
[3] Ibid., 90-91.
[4] Paul Ramsey, The Patient as Person (New Haven and London: Yale University Press, 1970), 18-90. Quoted in Meilaender, Bioethics, 92-94.
[5] National Kidney Foundation, “Religion and Organ Donation,” February 3, 2017, https://www.kidney.org/atoz/content/religion-organ-donation.
[6] Sandeep Joshi, “Memory transference in organ transplant recipients,” Journal of New Approaches to Medicine and Health Vol. 19, Issue 1 (April 24, 2011): https://www.namahjournal.com/doc/Actual/Memory-transference-in-organ-transplant-recipients-vol-19-iss-1.html.
[7] This concept is related to their views on cremation, as well. While a more dark occurrence, in the Roman Catholic tradition this concept led to the medieval act of severing the heads of individuals who had committed suicide—holding an innate connection between their bodies and spirits after death.
[8] Philip Fletcher, “General Synod of the Church of England,” page 1 in Blood and Organ Donation, GS 2022B, Canterbury, UK: The Archbishops’ Council, 2016. https://www.churchofengland.org/sites/default/files/2017-12/gs_2022b_-_blood_and_organ_donation.pdf. The Episcopal Church passed such a measure in 1982.
Ex Vitæ Verborum 