Chapter Three: Organ Donation: Questions We Should Ask
Author: Greg Kenyon, Mitchell, Ontario, Canada
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Before reading -Please note
–This is a chapter from an online version of a book I am writing with the purpose of providing true information about organ donation and invitro fertilization (IVF) as well as raising some of the questions that should be asked.
–This book is written from a Biblical-Christian perspective. To learn more about what this means feel free to read some of the other material on my blog at https://greg.kenyonspage.ca/. You may also read my attempt to describe my beliefs at http://greg.kenyonspage/i- Believe/.
–This is a work in progress. If you are reading from a printed version or coped material, rather than directly from my website, https://greg.kenyonspage.ca/, then you may not have the most up-to-date draft of this book. Please do not copy it or pass it on to others. Instead, go to the book on my website at , https://greg.kenyonspage.ca/greg-kenyons-book-questioning-medical technologies/. Feel free to direct others to my book on line.
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The following chapter was last updated in Jan 2014 – this means that the foot notes of websites refer to how the websites were at that time.
April 17, 2016 – Section – Laying Down One’s Life For A Friend – added.
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I believe it is a good idea to read Chapter 1 – Questioning Medical Technologies: Compassion and Asking Important Questions along with this chapter. Use the links above to find it.
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Chapter Three:
Organ Donation: Questions We Should Ask
Author: Greg Kenyon, Mitchell, Ontario, Canada
Organ donation/transplantation has quite an appeal in society, with its promise to bring life from death and to renewed life to those who are dying. In the beginning we were created to live and to be fruitful and multiply and fill the earth.[1] Death, as we experience it, was not part of creation. Death came about as a consequence of the mankind’s rebellion against God, the creator.[2] They were still able to procreate, but they passed on to all of their offspring brokenness and rebellion. This rebellion against God, which is passed from all parents to their children calls for their death. As a result, all people now have to face death. Some try to look at death as a natural part of the life cycle, but deep down we all fight against death because we sense that it is not natural. In the bible, death is described as pain, as a snare, as a sting, as bitterness, as darkness, as the enemy[3]. Given opportunity, we try to live as long as possible. Modern medicine has apparently made great strides forward. A good life, lasting 40 to 50 years a few generations back, now has an expectation of 70 to 80 years. We want to live a long time. We expect to live a long time. We act like we have a right to live a long time. We lament premature deaths of children, young adults, and even of 70 year olds. Should this be? Are people who live 80 years really any better off, from a biblical perspective, than people who live 40 years or even only 20 years? Each of these lives compared to eternity, are they not but a drop in a bucket? Let these thoughts set the stage for the next in our series — Questioning Medical Technology – Organ Donation: Questions We Should Ask. Remember, from the introductory essay, that I do not mean to imply that all medical technology is wrong, but that we need to consider all medical technology developed in our broken sinful world in the light of what our Creator, the Lord God, teaches us through His Word. We need to ask how the technologies hold up under the light of Scripture. Now, as we consider organ donation, what are the questions to ask? I hope to begin to develop these questions as well to share enough information for adequate answers to be developed.
Organ donation can seem like a positive thing. The life of a young child, a teenager, a mother, a father, a business man, or a loved one can be spared. Many deaths seem to come about because of failure of one organ or another. If we can replace the failing organ, we can continue to live. Is not the Christian ethic to promote life? Of course, vital organs, that is, those organs that are necessary for the body to live, cannot be taken out of a person and that person continues to live. If a person dies, his soul leaves the body and the body is returned to the earth.[4] Ultimately, given a long enough period of time, the body becomes earth or dust. If someone dies, does not the body become part of the earth and become earth that can be used to sustain life? This being true, does using the organs of someone who has died not seem to be a good thing? Is there not comfort knowing that through death others can be saved? Consider a loved one severely injured in a car accident with no chance of recovery. If their organs can be used after they die, does it not make some sense out of their life and death? Giving of ourselves and giving our lives is part of what it means to be Christian. Is it not a good thing when the last thing we do is give a gift of life to a number of other people? Does this not, somehow, bear the image of Christ? Christ gave up His life that others may be saved from eternal death to newness of life? Looking at organ donation from this perspective it has a Christian appeal to it. Why, then, are there some Bible believing Christians who express concern about organ donation?
Remember that we live in a broken world. Good often has a not-good counterpart. The Devil attempts to draw us into sin by perverting what is good and presenting this perversion to us as good. The world, blind to the deceptions of the devil, tends to accept, as good, what is not good. We, with our deceitful hearts and our desires to be in control of life, tend to overlook these perversions and accept, as good, what is not good. We need to be careful to evaluate the things of this world in the light of Scripture. Since organ donation is among the things of this world, we need to carefully evaluate the various aspects of organ donation in the light of scripture in order to decide what is right and wrong. To do this, we need more than a superficial explanation of what happens with organ donation, for one significant deceptive technique is to tell only part of what happens.
There are, at least, three areas to consider that leave us with questions.
Created in the image of God:
The first has to do with the fact that we are created in the image of God. God created man and breathed into his nostrils the breath of life and man became a living soul.[5] It is this living being, who is created in the image of God,[6] who has the created capacity to be fruitful and multiply and fill the earth and subdue it.[7] The image of God is more than the soul. It is more than the body. It is the created living being, encompassing both body and soul. Each of us, by the fact that we are a marvellous work of God, fearfully and wonderfully made in our mother’s womb,[8] are made in the image of God. As God’s image, we reflect something of God. None of us bear His entire image. Each of us, as seen in the fact that each of us is different, with differing physical strengths, and differing spiritual gifts, in some way bear different aspects of the image of God. As we bear God’s image, do we do it with our whole body? How does taking a part of one body, and putting it into another, impact the image bearing of each? Each of our bodies has a God given DNA finger print. Is the mixing of two God given DNA fingerprints in one person intended in God’s design of His image? The fact that we cannot mix part of one person with another without giving powerful drugs to control rejection of the received part, may point to the validity of asking such questions. In biblical times it would seem that this question was not important. But consider the many crippled and paralysed people whom Jesus healed. Does Jesus not acknowledge the goodness of a whole body, thus the wholeness of the image bearer, when he makes these people whole? Jesus healed the sadness of broken hearts, some broken by physical infirmities. He gave liberty to the captives. (Luke 4:18) Would Jesus have left anyone captive to the fear of the rejection of organs, and the problems associated with anti-rejection drugs?
The second issue has to do with questions about the definition of death in the donors. We will spend a significant portion of time trying to inform you of what actually happens. Before we do that we will briefly look at a third area of concern.
Avoiding Death:
A third consideration is expressed in the question, how far should Christians go to avoid death? Considering our whole image of God, body-soul beings, we need to do all we can to avoid the combined death of both body and soul. If our body-soul being dies, we will be faced with eternal separation from God in hell. While our bodies have not yet died and returned to the dust, we say that we are still in the day of grace, where it remains possible for our dead souls to be born again. While our bodies are still alive there remains time to bow before the Lord our maker, time to repent of our sin and to receive His mercy and grace that we need to have our souls born again. The scriptures promise that those whose souls are born again, when their old bodies die, will receive new living resurrected bodies and be received into the presence of the Lord and live with Him forever. If our souls are alive in Christ then we do not need to fear death of our bodies.[9] In Christ the sting is taken out of death. We should not seek death, but to what length should we go to avoid death when it can only be avoided at great cost, especially if we already have assurance of eternal life with the Lord? Should a Christian be more concerned about trying to prevent the death of someone who has not yet been born again than preventing the death of someone already born again? If taking organs will promote the donor’s death, should we be more concerned about taking organs from the unconverted than from the converted?
The Details of Organ Transplantation: Living Donors and Clearly Dead Donors
Now let us consider some of the issues around organ donation. We will classify organ donations in terms of donor type including, living donors, clearly dead donors, and questionably dead donors.
Living donors are now possible for skin, blood, bone marrow, a kidney, a lobe of lung and a lobe of liver. To take a kidney, part of lung or part of liver from a living donor is a fairly large operation with significant risk. Is it right for a person to take this kind of risk by giving away a kidney or part of a major organ? One might build a case for giving of one’s life, or taking risk for a brother in the kingdom of God. One benefit of taking organs from living donors is that the organs can be healthy and functioning properly right up to the time of organ removal. This increases the likelihood of the organ functioning properly in the recipient. The recipient will still have to take anti-rejection drugs. If the donor is a close relative the need for anti-rejection drugs may be able to be reduced. Anti-rejection drugs affect the immune system and increase risks of infection and the risk of developing cancers. Some of the drugs can also be toxic to kidneys and the liver. Once a person has a transplant they usually need to have ongoing medical follow up for the rest of their lives in order to manage these drugs. Considering the significant risk to the donor and the ongoing problems for the recipient after organ donation, should Christians enter into such an arrangement with another true Christian? Consider this in the light of our question, how far should a Christian go to avoid death? Would the potential benefit of taking such risk be greater if the recipient was one who had not yet come to love the Lord?
Next, consider clearly dead donors. They are those donors whose hearts have stopped beating and lungs have stopped breathing irreversibly prior to beginning the organ harvesting process. If harvesting is begun too soon after the heart and/or lungs have stopped, there is a possibility that they could begin to function again. If heart or lungs can begin to function again, then unless it is a life giving miracle, the person was not yet clearly dead. Transplantation of vital organs from clearly dead donors has been tried in the 1950s with no significant success. It is tissues, rather than organs that can be used form clearly dead donors. These include, skin, bone, bone marrow, and corneas. Since corneas do not have a blood supply, they can be harvested up to 12 hours after the life blood has stopped flowing and death is diagnosed. Also, since there is no blood supply, they do not usually suffer rejection and the anti-rejection drugs are not needed. The questions with clearly dead donors seem small. Have the bodies of these clearly dead donors biblically, returned to the dust? If so, then, can we consider the utilization of such tissues the same as using various “earth products” to the benefit of our lives? I believe that we can. Yet, there may be some concern. Dead bodies in the bible are still treated as though they belong to the person. This is even true of the body of Jesus. Joseph of Arimethia took the body of Jesus, that belonging to Jesus, and prepared it for burial.[10] Should we tamper with a part of a body that belongs to the image of another when God, in His wisdom, has not yet separated the body of that person into dust?
Questionable Dead Donors: Vital Organs and Warm Ischemia:
With organ donation the greatest controversy comes with what I will call questionably dead donors. These donors are the only source of what I will call vital organs including, the heart, liver, bowels and pancreas.[11] By vital organs I mean those organs that cannot be removed from a living body without killing the body. For these organs to be useful for transplantation, they must be kept alive. Once the flow of oxygenated blood is cut off, the cells quickly use up their oxygen reserves and begin to die. This process can be slowed down by cooling the organ and by replacing the blood in the organ’s blood vessels with specially prepared solutions. The amount of time an organ can remain without proper blood supply is so critical that transplant surgery is careful to keep track of this time. There are two components. The first is the period of warm ischemia. This begins when the donors blood flow stops (or the blood pressure drops below a critical level) and ends once the organ is cooled and its blood is replaced with cooled preserving solution, after which the measurement of cold ischemic time begins. For our purposes, we will focus on the warm ischemic time. For liver transplants, the warm ischemic time needs to be less than 30 minutes and for kidneys, less than 60 minutes.[12] The acceptable ischemic times for other organs, except lungs, are likely in between 30 and 60 minutes, although I have not found the numbers yet. Lungs may be able to handle ischemic times up to 60 minutes. Removal of an organ takes time. If you wait until the heart has clearly stopped and declare death before making a cut, or giving any drugs to protect the organs, then there is only 20 to 25 minutes left to get to the point in surgery that you can infuse the cooled preservative solutions into the organs. In reality, for vital organ donation to be successful, practically speaking, the donor must be in the operating room, with their heart still pumping blood through the body, before the operation for organ retrieval is started.
Declaring Death While the Body is Alive:
I call these donors questionably dead because their bodies must be alive with the blood flowing and oxygen supplied at the time that the surgery, to retrieve organs, is started, or at least until just minutes before it is started. To achieve this, the organ retrieval operation on the donor needs to be set up and begun while the life blood still flowing in the donor. (In some cases, the operation can be started just after the life blood has quit flowing, before the organs in the body have had a chance to begin to die.) In those declared brain dead, the operation is started with the donor on life support[13] and the life support is continued until the organ removal is almost complete.
In recent years, due to a lack of donors who meet brain death criteria, another method of declaring death has been adopted. This is where death is declared in, or in very close proximity to, a fully prepared operating room where everyone is ready to begin the organ retrieval operation. Life support is then withdrawn and the operation is started as soon as the heart has stopped beating for somewhere between two and ten minutes, depending on the protocol followed.[14] In these donors, the operation must be started immediately after the declaration of death to meet the needed short warm ischemic times. I will consider both donors, those declared brain dead and those with a non-beating heart declaration of death.
Non-beating heart donors have been subdivided into a number of groups based on the duration of warm ischemia that the organs are subjected to.[15] Categories I and II have the longest warm ischemic times and are considered uncontrolled. Category I refers to people who are conventionally dead, without any attempt a resuscitation. Category II is when resuscitation is attempted without success. Category III and IV are considered controlled, and refer to a cardiac arrest that is expected and anticipated and controlled, so that it occurs in the operating room where surgery can begin immediately after death is declared. A Category V has been added, which is uncontrolled, but is, in a sense, semi-controlled. This is when the heart stops in a hospital that can be ready to begin transplantation fairly quickly. After about a 10 minute attempt to resuscitate a person they are declare death and preparation for organ donation proceeds while CPR is continued. For all major organs except kidneys, only controlled (Category III and IV) non-beating heart donors are suitable. Issues related to kidney and lungs will be considered later. For now, as we consider questionably dead donors, we will focus on those declared brain dead, and controlled, Category III and IV, non-beating heart donors.
Legal Brain Death:
In Canada and the United States a person must be declared dead before organs can be legally harvested,[16] yet the organs must be alive. To achieve both of these requirements, that the organs be alive and the person be declared dead, there needs to be a way for a person with a living body to be declared dead. To achieve this, the idea of brain death was developed. There is really little need for a diagnosis of brain death except to provide a way for living organs to be legally available in a society that says you cannot kill people to take their organs (the dead donor rule).[17] In 1968 criteria for brain death were developed that became the foundation for the definition of brain death. Since then, the idea of brain death has become established and variations in brain death criteria can be found from a number of different sources. There are also many questions about the validity of a diagnosis of death using such criteria.[18] Are people with living bodies really dead from a biblical perspective?
Seeing the desire to take organs from living people on the horizon, the United States approved a draft law called the Uniform Definition of Death Act (UDDA) in 1981. This provided the following legal definition of brain death,
An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.[19]
Most States have adopted laws that incorporate this definition. In Canada there is no statutory definition of death. In Canada, health care is considered to be in Provincial jurisdiction. Therefore, the laws pertaining to the definition of death in organ donation vary from Province to Province.[20] Like Canada, health law in the United States is not under federal Jurisdiction but unlike Canada the federal government attempted to provide guidance to encourage all of the States to adopt uniform laws about the declaration of death and they developed the UDDA. This act defines when death can legally be declared and requires that a person be legally declared dead before organs can be harvested. It allows for death to be declared when a person’s body is still alive, on life support. From a secular legal point of view, the possibility exists for a person to be declared dead while his/her body is still alive. Important questions remain. Does this possibility exist in reality? Does the Bible give any support for a person being dead when there body is still alive?[21]
According to the UDDA and by general consensus in Canada, brain death criteria are supposed to include the complete absence of any evidence of brain activity, from a functional point of view. This includes a complete absence of brain stem reflexes, such as pupil activities, gag reflex, pain response, and spontaneous respiratory movements. Such a diagnosis of brain death is a functional diagnosis. It refers to absence of brain function not absolute death of the cells that make up the brain. The UDDA also calls for the absence of brain function to be irreversible. A common reversible cause of the absence of all brain function is the general anaesthetic used in many surgical procedures, where drugs can suppress consciousness and brain stem reflexes and where brain function returns when the drugs are withdrawn. Death by these criteria, strictly applied, is likely relatively rare. Unconscious patients with some evidence of functional brain activity are much more common. Also, there is a growing list of examples of people diagnosed as being brain dead who have subsequently regained consciousness,[22] suggesting that it may not be possible to know for sure if a loss of brain function is truly irreversible.
At this point, let us assume that a donor is found who meets the legal definition of brain death, that there is no evidence of any brain activity using available tests and the brain damage is considered irreversible. This person will be on a ventilator, as breathing is a brain function. In many ways he will appear alive. He will be pink, rather than grey. The skin will be warm. Pulses will be present. Is the person alive or dead? Biblically when a Christian dies the body goes to the dust and the soul to be with the Lord, where it waits to be reunited, as united body and soul again, at the resurrection. Remember that before the face of God the person is a united body and soul. When does the soul separate from the body?[23] If it has not separated, should we then start to cut up the body, as though it has become the property of the earth rather than still belonging with the soul? Biblically we cannot be certain that the soul has left the body until the body can be returned to the dust. Such a body has no signs of life, the heart beat is absent and breathing has ceased. When there are any signs of life, do we begin the burial process of returning the body to the dust? Is there anyone willing to commit their loved one for burial when their body is still warm and, especially, when blood is still flowing through their body?
Death of the Body vs Death of the Person:
Since the body of the person must be alive before organ retrieval is begun and the body has it life blood cut off during the surgery, vital organ donation, necessarily, results in the death of the body of the donor. To make vital organ donation acceptable we have separated the death of the person from the death of his/her body. We first declare the person dead, while the body is alive and then the body dies during the organ retrieval surgery. Should we be separating the death of a person from the death of his/her body? Some may say that, while this concern may exist for a brain death declaration of death, it is not the same for a non-beating heart declaration of death, for it is the loss of heart beat that results in the death, rather than the surgery? As will be discussed later, the point the heart stops is not necessarily when the person dies. Many people, who we wish to remain alive, have been successfully resuscitated after the heart has stopped. We, also, have medical procedures where we stop the heart to have it restarted again. So, as with brain death, vital organ donation, even with a non-beating heart declaration of death, demands the separation of the death of the person from the death of his/her body. Again, should we be making this separation?
Moving beyond Brain Death to Brain Injury:
Although the brain death determination of death allows vital organ transplantation to be legal, it also presents a significant problem for the proponents of organ donation. In reality, there are few people unconscious, on life support, that fully meet brain death criteria. Since generally accepting full brain death criteria, society has moved toward becoming more accepting of taking vital organ donations from people with severe brain injury that do not have a complete absent brain activity. These brains still have blood flowing through them and the cells are alive and receiving oxygen. Dr. Robert Troug, et al. points out in an essay in a respected medical journal, the New England Journal of Medicine, in Aug 2008 that
many of these patients retain essential neurologic function, such as the regulated secretions of hypothalamic hormones….Evidence shows that if these patients are supported beyond the acute phase of their illness (which is rarely done), they can survive for many years. They then suggest that it may be perfectly ethical to remove vital organs for transplantation from such patients but the reason it is ethical cannot be because we are convinced they are really dead….at best the dead donor rule has provided misleading ethical cover that cannot withstand careful scrutiny….many will object that transplant surgeons cannot legally or ethically remove vital organs from patients before death. However, if the critiques of the current methods of diagnosing death are correct, then such actions are already taking place on a routine basis.[24]
This observation comes from secular doctors. They have no reason to hide or exaggerate what is really happening. In fact, these authors, in the same article, suggest organ removal before death is ethical as long as the donor gave informed consent and they suggest that we should change our laws to reflect this reality. Today, numerous writings about this concern can be found along with logical presentations of why these donors are not dead at the time retrieval is initiated. There are also a growing number of people who have been diagnosed as having irreversible brain damage that would not support life, who have subsequently regained consciousness. One study done in 1987 showed that brain wave activity can commonly be recorded for many hours after the brain death is diagnosed. In 56 consecutive patients diagnosed to be brain dead, brain wave activity continued for two to 168 hours, the mean being 36 hours.[25] This brain wave activity suggests that many cells are still alive. Another study from 1992, showed that even 80 hours after the criteria for brain death were used that in all 32 patients in the study their brains continued to produce relatively normal amounts brain hormones that are used to control a number of functions in the body.[26] Are we to believe that a dead brain, in a dead person, continues to control a number of functions in the body? I have just begun to look for this sort of evidence. I suspect even more can be found. Given all of this evidence, should Christians sign their donor cards and then trust the medical profession with their living bodies? Should Christians place their hope to extend the length of their life, or the life of a loved one, on receiving an organ from people who have be diagnosed dead, based on brain death criteria? Should Christians be speaking up for these most vulnerable people who are unable to speak for themselves?
Legal Non-beating Heart Death:
Even with the loose definition of brain death, there are not enough people with severe brain injuries to supply the organs society wants. This had led to the development of what is called Non-beating heart donors, where death is declared after the heart has stopped for between two and ten minutes.[27] For Christians interested in a biblical definition of death, the idea of waiting until the heart stops may appear better than claiming that someone is dead when their body is very much alive, as is the case with the “brain death” definition. People who are considered for donation as Non-beating heart donors are those who are considered to be dying usually from some form of catastrophic injury and do not meet brain death criteria. They still have too many signs of brain function for people to be comfortable with diagnosing brain death. These people are usually on ventilators. Death is diagnosed after the heart has stopped beating. Does this not sound like a more acceptable way to diagnose death? Before drawing any conclusions let us consider the process involved.
As pointed out above, for organs to be useful the cells of the organs must be alive. Once the heart stops and blood stops circulating through the organs, the organ begins to suffer ischemic damage.[28] As pointed out above, the allowable warm ischemic time is only, at most, 30 to 60 minutes. In reality, even shorter warm ischemic times are attempted. Remember that the warm ischemic time is measured from the point blood stops circulating through the organ until the organ is infused with a cooled preservative solution. If these relatively short times, from the heart stopping until the organs have their blood replace with a cooled preservative solution, are not accomplished, there will be too much damage to the organs for them to be useful for transplantation. Removal of an organ takes time. If you wait until the heart stops and declare death before making a cut, or giving any drugs to protect the organ, there is, at most, only 20 to 25 minutes to get to the point in surgery that you can infuse the cooled preservative into the organ. This means, for non-beating heart donors, that their death must be declared in the operating room, on the operating table, ready for the first cut, with everyone ready to go before the death is declared.[29] This means the donor is brought to the Operating room alive on life support. The life support is cut off and the heart monitored. As soon as the heart has stopped for the decided amount time (2 to 10 minutes), surgery is begun. Some advocate pulselessness rather than absence of regular cardiac electrical activity.[30] When they can no longer feel the pulse for the required time, death is declared. It is conceivable that there is still some heart activity and even some blood flow. Once the blood pressure is below 40mmHg the pulse can no longer be felt.
Adding Oxygen to the Blood to Keep Organs Alive: Death Negated?
Another thing that is starting to be done is to use extracorporeal membrane oxygenation (ECMO).[31] This means oxygenated blood is circulated through the body by a pump. Some doctors advocate placing the needed catheters into the donors body before death is declared in order to shorten the warm ischemic time.[32] If the ECMO adequately provides circulation of oxygenated blood to the donor’s, entire body it would retroactively negate the death. For in non-beating heart declaration of death, it is the cessation of blood flow when the heart stops that was used to define death. If we then restart the circulation of blood before the brain and body dies, then irreversible death has not occurred. Because of this, when ECMO is used a clamp is placed across the aorta above the diaphragm to keep this oxygenated blood from reaching the brain and heart so as to not negate the death.[33] Since this person is not considered brain dead, if we can keep desired vital organs alive, then if we supply circulation to the brain, we can likely keep the brain alive too. The stopping of the heart can initiate death but does not cause death if blood circulation can be started again in a relatively short period of time. In other medical situations, we actually attempt to restart circulation in order to keep someone from dying. We call this cardio pulmonary resuscitation or CPR. Can we be sure these people, whose organs are being taken, are really dead, that is that their soul is separated from their body at the time their vital organs are taken? Do we, who promote or allow loved ones to become, non-beating-heart organ donators, hold responsibility in taking the life of these people prematurely? It is interesting to note that ECMO has been used to achieve better survival in premature babies with cardio-respiratory failure.[34]
I looked for similar information about the non-beating heart definition of death in 2008 but I could not find much about what was actually happening. Searching again in 2013 I found an increased willingness among medical researchers to talk/write about the “non-beating heart” situation. This is true, in spite of the fact that such information questions the death of the donor at the time the operation begins. One thing that I think has changed is that society is now more inclined to think some people’s lives are expendable, and consider killing, in these cases, as morally acceptable. We see the same thing in abortion, euthanasia, invitro-fertilization and organ donation. Each of these situations is a part of modern medicine not based on a biblical foundation. Therefore the direction the modern medicine is going is not surprising. I suspect that over the next five years we will see a further shift in the medical literature about organ donation, such that the “Dead Donor Rule” is abandoned.[35] As a Christian community, should we remain silent? Should we be actively exposing the truth about what is happening?
A Special Case for Some Kidneys:
When considering non-beating heart deaths some kidney and lung transplant deserve special consideration. Kidneys can tolerate a longer warm ischemic time then other solid organs, such as heart, liver, bowel and pancreas. This means that it is possible for kidneys to be removed from a person after they have suffered an uncontrolled, category V and sometimes category II, cardiac arrest. By uncontrolled I mean that the timing of the cardiac arrest was not planned and that it did not occur in the operating room with the preparations in place for the immediate surgical removal of the organs. Such uncontrolled non-beating heart donations can only occur in a hospital that has protocols in place to start the preparation for donor surgery soon after the resuscitation of the heart has failed. For donations to succeed basic cardiopulmonary resuscitation cannot be stopped, except for short periods to confirm that the heart is not beating on its own. Chest compressions need to be continued in order to keep some blood flowing through the blood vessels to the kidneys. Oxygen and ventilation of the lungs also needs to be continued. The cardiac resuscitation is considered failed after about a 10 minute attempt to restart the heart. A special catheter (a tube) called a double-balloon-triple-lumen catheter is inserted into a main artery at the bedside. The balloons are inflated in the aorta, the main artery in the abdomen, at a point above and below the origin of the artery to the kidney, isolating the kidney’s blood supply from the rest of the body. Then a special cooled preservative solution is infused into the kidney.[36] Remember that the warm ischemic time begins when the blood flow to the organ stops, or becomes very low, and continues until the organ is infused with cold preserving solution. Using this technique the warm ischemic time for the kidney can be reduced. Given the cardiac arrest and the prep time, the warm ischemic time is still likely to be greater than 20 to 30 minutes. I consider these uncontrolled non-beating heart patients, semi-controlled. Even with semi-controlled non-beating heart donors, many of the questions still remain, such as when does the soul leave the body? The question of whether the organ removal surgery is responsible for the death of the person becomes smaller.
If someone is considering receiving a donated kidney, they can not necessarily assume that this special case is how the kidney they get will be obtained. Success of kidney transplants is better if there are short warm ischemic times, as seem with donors declared brain dead or with controlled, category III and V non-beating heart declarations of death. When other organs are taken, kidneys will be taken too. So, many if not most kidneys used in transplantation come from those declared brain dead or from non-beating heart donors who have had controlled cardiac arrests. Also, in hospitals where they are prepared to deal in this way with uncontrolled cardiac arrests, there could be a temptation to give-up on resuscitation sooner, so that they can get on with kidney removal preparation.
Lung Transplants:
Research has occurred over the last 20 years that suggests that lungs, like kidneys, can handle longer warm ischemic times, up to 60 minutes. Unlike kidneys a technique like the double-balloon-triple-lumen catheter techniques does not seem to have been developed for the lungs. (The last time I looked into this was January 2013) It appears that the development of this technique is what has allowed for uncontrolled (semi-controlled), category IV, non-beating heart kidney donors. A Google search shows a lot of research that relates to warm ischemic times and lung transplants in the 1990s and not much in the 2000s. A lot of the recent lung transplantation research has had to do with infection that the transplanted lungs carry or are prone to get. Since lungs are not in a sterile environment, infection issues are much more important. Wikipedia, as of January 24, 2013, comments that transplant of a lobe of lung can come from a living donor. It says that a single lung transplant typically come from brain dead donors.[37] This suggests that, currently, the discussion and concerns stated above about questionably dead donors also apply to lung transplants.
Another consideration with lung transplants is that survival rates after the transplant at 5 years are only 50% and at 10 years are only 30%.[38] Considering this and the issues related to organ rejection and infection that accompany lung transplants, for Christians the question remains, how far should we go in trying to live longer?
Laying Down One’s Life For A Friend:
With what has been presented so far, it seems vital organs cannot be completely removed without resulting in the death of the donor. Yet, the outcomes of organ transplantation for the recipient seem great. Very sick people, who are even near unto death, can have their health significantly restored. Is such restoration not in keeping with the way of the Lord? We can agree killing to get organs is wrong, but isn’t there a Christian way to proceed? What about Jesus words in John 15:13, “greater love has no one than this, than to lay down one’s life for his friends.” Can a person allow his life to be taken to help someone else? Do we not accept this in other circumstances, like a person taking a bullet, or diving in front of a train to save someone else? These are likely the nearest thing to a selfless act possible. One is not thinking about death, or reflecting on the worth of their life, when they take a bullet. With organ donation, there is time to think. A healthy person, whose life is good is unlikely to choose death and give away vital organs. Some of us might accept an elderly person, who is near death, choosing to shorten his life to give away vital organs, but what about a 25 year old healthy man? Can he do the same thing, as long as he is giving his life for another? We tend to think of organ donation when a person is near death anyway and “does not have much life left,” rather than from a healthy person. If by “laying down one’s life” we are referring only to those already dying, is this really like “laying down one’s life” as Christ did? It appears more like saying, “My life is not worth much anymore. I might as well give it up and allow someone worth more than me to live.” Is this an expression of the greatest love referred to in John 15:13? John Gill, in his commentary, says,
He [Jesus] laid down His life for His enemies, without any sinister selfish views, and that freely and voluntarily; whereas among men, when one man has laid down his life for others, either they have been very deserving, or he has been forced to it, or it has been done with the view of popular applause and vain glory. [Or when he feels he does not have much life left to give.] (– last sentence added)
Jesus willingly gave His life. He was not dying when He chose to give His life. He was very much alive. If when saying, “Christians may consider donating vital organs to others in need, even when this may bring about their death,” we refer to a man like the 25 year old mentioned above, then I think I can agree that it may fit the passage, that is, as long as it does not require another person to sin. Unfortunately, a person cannot take out his own organs. The man’s life must be taken by others. (The surgical team, the anesthetists, etc) I don’t think this can be done without their breaking the 6th commandment to not kill? Jesus said of His life, “No one takes it from Me, but I lay it down of Myself.” (John 10:17-18) A person might, out of love, be willing to lay down his life to give a vital organ to his loved one, but in practice this is not likely what Jesus is calling us to do in John 15:13.
Can the teaching of John 15:13 solve the vital organ donation dilemma? It would solve the concern of donor’s lives being killed as a result of organ retrieval. Instead lives would be laid down, that is assuming we can get past the killing that is required by the medical teams. But likely, it would be rare for a person to be willing to lay down their life and rarer to do so in the selfless way John 15:13 is speaking of. The demand for organs is large. The laying down of life out of love will not solve the demand of society.
In reality, when the organs are removed, lives are not being personally willingly laid down. Instead, people are looking at their loved ones in terrible circumstances, like severe brain trauma. Believing their loved one is near death, and thinking, if they remain alive, they will not have much of a life left, hastening death by organ retrieval is seen as a better option. This only considers things from the donor’s point of view. Should someone waiting for an organ be encouraged to think that receiving an organ is OK because the donor is giving out of love? The vast majority of organs that come available are not from people who have laid down their lives to donate their organs as an act of love.
There is a form of organ donation that can realistically follow the path of John 15:13. A person can donate non vital major organs like one kidney, part of a liver, or part of a lung. This involves risking one’s life and potentially shortens one’s life. A donation like this which involves giving away such an important part of one’s self, if done out of love, is like “laying down one’s life for a friend.” Since the intent is that the donor remains alive, the problem of the doctor’s involved ending the life of the donor are not a concern.
Carefully Consider What You Read:
Having considered some details about organ donation, I hope that you are encouraged not to sit back and simply think that, because it saves lives, and is accepted by mainstream medicine and supported by conservative governments and by many church authorities, that what is happening with vital organ donation is a good thing. David Vandrunen, in his generally helpful book on Christian bioethics, asks “the narrower question of whether individual Christians may, or even should, agree to become organ donors.” His first response is, “It is possible that someday the transplantation system will condone certain sorts of practices that would cause Christians, even if they are not opposed to transplantation in principle, to avoid becoming organ donors or recipients.”[39] Implied is that society’s approach to organ donation is becoming increasingly unethical. Have we already crossed this line? Given the information I’ve presented, especially, given the historical origin and reason for developing the definitions of “brain death” and of “non-beating heart death,” has vital organ donation ever been something that Christians should whole heartedly accept? Next, David Vandrunen says, “In the American context today, however, the law prohibits most of the practices that Christian might find most problematic, such as taking whole organs from those who are still alive…”[40] He implies that we can trust the laws and legal system of America. Many may think the same of Canada. It is true that it is currently considered illegal to take vital organs from those who are still alive, but should we accept that those legally declared dead, by brain death criteria and by non-beating heart criteria, are dead by biblical standards? Are the conclusions, that some respected Biblical ethicists arrive at, based on a naivety to the facts surrounding brain death, non-beating heart death and of the process of organ harvesting? I suspect the information I have presented above is not well known among North American Christians. I hope that the Information I have presented will help the Christian community as they consider the answers these to questions.
The Value of Life:
The information presented suggests that some organ donation practices are clearly ignoring the need to wait until the donors are dead. How common is it for us to consider the life of a severely brain damaged person or a comatose person not worth living? How many of us take the position ourselves that we would rather not live if we were severely brain injured? To what extent do such sentiments lead us to accept organ donation, even if it does, at times, lead to premature deaths? The information presented also suggests that we cannot be certain that organ donors are dead, in the eyes of God, at the time we start the organ retrieval process. Should we agree with vital organ donation and not concern ourselves with being, in part, responsible for the death of the donor?
Our culture is becoming more death oriented, even in the medical frontier, as the acceptance of abortion and growing acceptance of euthanasia reveals. Have we forgotten that the Lord God, our creator, is the author and finisher of life?
Those Who Have Already Walked the Path:
Considering the significant questions that are raised about vital organ transplantation, before finishing, I think we need to consider those who have already gone down the path of organ donation. How are we to respond to those who have gone down the organ donation path, either by giving a loved one as a donor, or being on the receiving end of an organ? How should we respond to those who have illnesses that the doctors are saying will need a vital organ transplant? These are important questions. Is it not time for Biblical Christianity to come up with clear answers to these questions?
Consider those who are now living with the “gift of life,” having being given a “new lease on life” through receiving a vital organ transplantation. More details about a Christian’s response to this situation are included in the introductory essay of this essay series.[41] God is the one who gives and sustains life. This is so even for a loved one who is living with a donated vital organ. We can and should rejoice in this life, but does that mean that we should agree with, and support, the path that was travelled by the organ recipient? Consider how we rejoice in and with the child, in our midst, who is born out of wedlock, and rightly so, for they are God’s workmanship. Should we, then, condone the conception of children out of wedlock? Since lives appear to have been sustained by vital organ donation, should we be ready to walk down the same path again? If we took a life, should we take a life again? What does the apostle Paul say, in Romans? Certainly not! If we are not certain if a life was taken in the process, should we walk down the same path again? In 1 Corinthians 8, Paul speaks of situation where a person did something he believed was wrong, even though it was not, searing his conscience. Certainly, if something is wrong, we ought not to do it. If we think something may be wrong, but are not sure, then, until we know it is right, should we not, for conscience sake, keep ourselves from going down that path and direct others to do the same?
If, in the past, we have given our loved ones as donors, can we rejoice in the improved health of others, who have benefited? I think we can. Again, the adding of years to someone’s life does not happen apart from the sustaining hand of God. But, given the questions raised by organ donation, should we continue to encourage others to go down this path?
Trust in the Lord:
What if we, or our loved ones, are “dying” from some kind of vital organ failure? Can we trust the Lord with our lives? Yes, the Lord’s children can. He works all things together for good, to those who love him and are called according to his purpose.[42] Also, it is not beyond the power of God to cure even our poorly functioning organs, any more than it is for God to bring someone seriously injured and near death, back to life. Paul, in one argument points out that we live and have our being in God.[43] Job also recognized that it is God who gives and takes away life.[44] David in Psalm 55 says to cast your burden on the Lord, and He shall sustain you; He shall never let the righteous to be moved.[45] Certainly, the Lord uses the means of medical treatments to sustain the lives of His people. The Lord can even use sinful ways to sustain the lives of His people. But does this mean that we should agree with shortening the life of another in order to physically benefit ourselves or our loved ones? Do we know the mind of the Lord, whether He would have it that our loved one, with severe organ failure be restored to health or whether He would restore the life of someone so near death that some consider it not wrong to take from them what life remains?
Let us remember that, before the Lord, we are not to take the life of another person. One more comment is warranted. Some claim that many of these people who are considered for donation would not be alive if it were not for medical intervention with various life support technologies. We cannot claim, because we think we are the ones supporting life through blood circulation and breathing support, that they are already dead. This runs the risk of us in a sense thinking that we are the one who sustain life. Is it not in God that we live and move and have our being.[46] Also, there are many instances of people who have had life support removed and gone on to live. Some would suggest that there is little difference between a decision to remove life support and a decision to proceed with organ donation. When life support is removed it is still left in the hands of the Lord to sustain or to not sustain the person’s life. Based on the information above, when we continue to support the life of the body until we have remove vital organs, thus making it impossible for the person to continue to live, then we are actively involved in the death of the person. Involvement in a death that occurs simply following the removal of life support is more passive than a death that occurs by actively removing organs necessary for life. Should we not, also, be cautious about the removal of life support. If we advocate the removal of life support, whether for organ donation or not, when there is reason to expect that further time for recovery would increase the chance of survival, might we not play an active role in the death of a person?
One last thing should be considered as we wade through these issues in real life. As mentioned above our society is more inclined to accept that some people’s lives are expendable. This approach is also becoming increasingly common among government officials and among the medical profession. This means that we need to be careful not to assume that because something is said to be right in a major medical centre, that it is necessarily right before the eyes of God. Christopher Bogosh in his book, Compassionate Jesus, says, “Both the worldview of modern medicine and Christianity offer definitions of our humanity, explain why we get sick and die, hold out healing and hop, and speak of the hereafter, but because the foundations for their belief systems are completely different, they cannot help but clash. As with all things in the world, Christians need to ‘walk circumspectly (Eph 5:15) and not be led astray through “philosophy and empty deceit, according to the traditions of men, according to the basic principles of the world, and not according to Christ (Col 2:8)” [47] We need to ask ourselves, when given guidance or advice from the medical profession, whether the advice that is given is in keeping with the boundaries for living and life that God lays out in His word.
Trust in the guidance that the Lord gives us in His word with all of your heart and lead not on your own human understanding and desires and the Lord will direct your path.
____Footnotes______
[1] Genesis 1:28
[2] Genesis 2:16-17, 3:19
[3] Death described as pain, Ps 116:3, Acts 2:24; as sting 1Cor 15:55; as the enemy 1Cor 15:26; as a snare Prov 13:4; as bitterness Eccl 7:26; as darkness, Luke 1:79
[4] As we consider funerals and graves we understand that the body returns to the dust of the earth. The Bible in Ecclesiastes 12:6-7 teaches that at the same time as the body returns to the dust the soul returns to God.
[5] Genesis 2:7
[6] Genesis 1:26-27
[7] Genesis 1:28
[8] Ps 139:13-14
[9] Matt 10:28-32
[10] Matthew 27:57-60
[11] Vital organs are those organs that a body cannot live without. A kidney, part of a liver and part of a lung can be removed for transplant without necessarily killing the body. Yet, when you hear of a kidney transplant, it did not necessarily come from a living donor. Many kidneys come from questionably dead donors.
[12] The window of opportunity for successful transplantation is very short. Organs become ischemic from the moment the heart stops beating. The first phase of ischemia is called warm ischemia since the internal body temperature is warm (normally 98.6). Warm ischemia time should not exceed 30 minutes for successful liver transplantation and 60 minutes for kidney and pancreas transplantations. If organs are not transplanted within this narrow time interval, ischemic tissue will become dead tissue and thus unsuitable for transplantation. It takes time to discuss and obtain the approval of family members to perform a transplant. And it takes time to mobilize a surgical team and prepare the recipient in the operating room. Surely, this would take longer than 30 or 60 minutes.
Mark C. Aita, SJ., M.D., Donation After Cardiac Death, Internet Journal of Catholic Bioethics, 4, (1), Winter 2009
http://icbbioethics.com/archives.php?entry=93
In another study, the table that describes the donors whose livers were suitable for transplant show that the time for death to be declared, by a non-beating heart definition, after withdrawing life support, was 9 minutes to 25min and the warm ischemic time was 8.7 minutes to 19 minutes. In the same study, those livers found not suitable for transplant had warm ischemic times of 9 minutes to 22 minutes.
Paolo Muiesan, MD,* Raffaele Girlanda, MD,* Wayel Jassem, MD,* Hector Vilca Melendez, PhD,* John O’Grady, FRCP,† Matthew Bowles, FRCS,* Mohamed Rela, FRCS,* and Nigel Heaton, FRCS, “Single-Center Experience With Liver Transplantation From Controlled Non-Heartbeating Donors: A Viable Source of Grafts”, Ann Surg. 2005 November; 242(5): 732–738.
[13] Generally when a person declared brain dead is on life support it means that the person has a machine moving air in and out of the lungs. The person may have some medications being give into their veins to constrict peripheral arteries to keep the blood pressure from going to low.
[14] See footnote number 26.
[15] Gauke Koostra, History of non-breating-heart donation. p 2
[16] Legal Foundations for the Neuological Determination of Death, a paper commissioned by the Canadian Councel for Donation and Transplantation.
[17] Some will claim that a diagnosis of brain death is needed to allow for the removal of life support from those severely injured, with no hope of recovery who are maintained alive on live support. The situations like this where a clear diagnosis of brain death can be made, using brain death criteria, are not common. It will be more common to want to answer the question of withdrawing life support when there is still evidence of brain function but the person is unconscious with little hope of recovery. Someone does not have to be declared brain dead to decide to withdraw life support. There is not a requirement that we support life at all costs. The diagnosis of brain death only becomes necessary to fulfill the need for a dead person to have living organs that may be used for transplants in a society that desires to honour the dead donor rule.
[18] A brief internet search will reveal variation in the diagnosis of brain death, as well as questions and controversy that surround the diagnosis of brain death. David Greer and colleagues reviewed the guidelines from 50 US neurology hospitals in 2006 and found great variability in requirements for the diagnosis of brain death.
David Greer et al., Variability of brain death determination guidelines in leading US neurologic institutions, Neurology, 2008; 70:284-289
The Common-wealth countries support a brainstem rather than a whole brain death diagnosis of death.
Calixto Machado, Letter on response to the above article, Neurology, 2008; 71:1125
In Canada there is no uniform definition of brain death. In 2006, a forum recommended minimum clinical criteria for a neurologic definition of death. Their recommendations are all functional clinical tests and only prove that the brain at the time of the tests is not functioning. They do not prove that the cells of the brain are dead.
The report of this forum is titled, “Severe Brain Injury to Neurological Determination of Death: Canadian forum Recommendations”, Canadian Medical Association Journal, 2006; 174:6
[19] http://en.wikipedia.org/wiki/Uniform_Determination_of_Death_Act
[20] Report found at www.organsandtissues.ca/s/wp-content/uploads/2011/11/Legal-Neurological-Death.pdf. The Planning Committee for the Forum on Severe Brain Injury to Neurological Determination of Death (April 9-11, 2003) commissioned to the legal considerations related to formalizing and recording the method for the neurological determination of death. This peace is abstracted from a longer document prepared by Kathryn Burke, BA (Hon), MA, Burke & Associates Inc. It is intended as a background document to support discussion, not as a comprehensive scholarly legal commentary.
[21] I have been working on a study of what the Bible teaches about physical death. So far I have not published this study. To date I have found no support for a person being dead while their body remains alive.
[22] -OKLAHOMA, March 27, 2008 (LifeSiteNews.com) – 21-year-old Zack Dunlap, a man who was diagnosed as “brain dead” and who was mere minutes away from having his organs harvested, now says, four months after the accident that brought him to the brink of death, that he feels “pretty good.” Dunlap’s story was told in an NBC piece aired earlier this week, in which the young man himself was interviewed…
-NORTHERN TERRITORY, Australia, May 12, 2011 (LifeSiteNews.com) – An Australian woman who was declared “brain dead” regained consciousness after weeks of fighting doctor recommendations that her ventilator be shut off, according to a report in the Northern Territory News yesterday….
[23] See footnote number 20
[24] Robert Troug, M.D., et al., “The Dead Donor Rule and Organ Transplantation”, The New England Journal of Medicine, Aug 14, 2008.
[25] Madeleine M. Grigg et al., “Electroencephalographic Activity After Brain Death”, Arch Neurol., 1987;44(9):948-954
[26] Hans-Joachim Gramm et al., “Acute Endocrine Failure After Brain Death, Transplantation”, 1992; 54:5
http://journals.lww.com/transplantjournal/Abstract/1992/11000/Acute_Endocrine_Failure_After_Brain_Death_.16.aspx
[27] Perhaps the greatest ethical question with NHBDs is measuring the period of suspension between life and death. A standoff time is observed from the time of cardiac arrest to establish the demarcation between an individual’s status changing from that of a dying patient to that of a donor. Various protocols observe different times including 2 minutes (Pittsburgh protocol), 5 minutes (Institute of Medicine), and 10 minutes (Maastricht Statements and Recommendations). This period is observed to preclude any possibility of spontaneous return of the circulation and to allow death to be pronounced with confidence.
“What duration of asystole proves irreversibility?….In their investigational protocol, Boucek et. Al. Shortened the interval of required asystole to 75 seconds….the Canadian Council for Donation and Transplantation purposely chose a conservative duration of 5 minutes, which has been adopted by most donation programs, but a few protocols use as short a span as 2 minutes.”
James Bernat, M.D., “The boundaries of Organ Donation after Circulatory Death”, The New England Journal of Medicine, 359:7, Aug 14, 2008. p 671.
“Non-beating-heart organ donors can be neurologically intact and do not fulfil the brain death criterion prior to cessation of cardiac pump activity. In response to this dilemma, the University of Pittsburgh Medical Centre developed a protocol for donation of organs that permitted their procurement from patients who were pulseless and apneic for 2 minutes….Because it is uncertain if cessation of cardiorespiratory function is irreversible after only a short time, the Institute of Medicine (IOM) extended the time required for pulselessness and apnea from 2 to 5 minutes before permitting organ procurement. Waiting longer than 5 minutes for determination of death would compromise the quality of procured organs because of warm ischemia time…”
Mohamed Rady, et. al. “‘Non-Heart-Beating,’ or ‘Cardiac Death,’ Organ Donation: Why We Should Care”, Journal of Hospital Medicine. http://www.medscape.com/viewarticle/563803
[28] Ischemic damage refers to the damage that occurs due to lack of enough oxygenated blood being delivered to the organ to keep it alive.
[29] “the families have….said their goodbyes, the patient has been transferred to the operating theatre, and the surgeon and scrub team are waiting with the patient prepared with antiseptic.”
M D D Bell, “Non-heart beating organ donation: old procurement strategy–new ethical problems”, Journal of Medical Ethics, 2003 29:176-181. P179.
[30] “One of the pivotal assumptions for NHBOD acceptance is that 5 minutes of pulselessness and apnea eliminates the possibility that the procurement process could be the cause of death and fulfills the “dead donor rule.”
Mohamed Rady, et. al. “‘Non-Heart-Beating,’ or ‘Cardiac Death,’ Organ Donation: Why We Should Care”, Journal of Hospital Medicine. http://www.medscape.com/viewarticle/563803
[31] “The situation becomes complicated, however, when a protocol permits intervention in the living donor through the administration of intravenous heparin or vasodilators, not to benefit the donor patient but only to improve the function of transplantable organs. Protocols instituting extracorporeal membrane oxygenation (ECMO) in the donor after declaration of death permit much more invasive intervention, including the insertion of arterial catheters before death. Advocates assert that surrogate consent sufficiently justifies these interventions, because they are minimally harmful to the patient and they benefit the organ recipient”
James Bernat, M.D., “The boundaries of Organ Donation after Circulatory Death”, The New England Journal of Medicine, 359:7, Aug 14, 2008. p 670.
[32] “The practice of cannulation of the patient prior to withdrawal of care for the purposes of preservation perfusion is also open to varied interpretation and it is of note that this practice is not prohibited by the above recommendations.”
M D D Bell, “Non-heart beating organ donation: old procurement strategy–new ethical problems”, Journal of Medical Ethics, 2003 29:176-181. P179.
“Protocols instituting extracorporeal membrane oxygenation (ECMO) in the donor after the declaration of death
permit much more invasive intervention including the insertion of arterial catheters before death.”
James Bernat, M.D., “The boundaries of Organ ?Donation after Circulatory Death”, The New England Journal of Medicine, 359:7, Aug 14, 2008. p 670.
[33] “A University of Michigan ECMO protocol for procuring abdominal organs apparently avoids the problem. During ECMO, an intra-aortic occlusion balloon blocks all blood flow above the diaphragm so that only the abdominal organs are perfused with oxygenated blood.”
James Bernat, M.D., “The boundaries of Organ ?Donation after Circulatory Death”, The New England Journal of Medicine, 359:7, Aug 14, 2008. p 671.
[34] “ECMO is now used in several neonatal centers as the treatment of choice for full-term infants with respiratory
failure that is unresponsive to conventional management. The success of this technique establishes, prolonged extracorporeal circulation as a definitive means’ of treatment in reversible vital organ failure.”
Robert Bartlett, M.D., et. al., “Extracorporeal Membrane Oxygenation (ECMO) in Neonatal Respiratory Failure”, Annuals of Surgery, 1986, vol 204, no 3. p 236.
[35] Dead Donor Rule — The Dead Donor Rule and Organ Transplantation — published in The New England Journal of Medicine Aug 2008 — This review gives the historical perspective of society’s development of “brain death” and the newer definition of “Non-beating heart” death. The author shows that neither of these definitions, if met, can convincingly show that the organ donor is really dead. With respect to using the “brain death” definition of death, he concludes such organ donation may be ethical but the reason it is ethical cannot be that we are convinced the donors are really dead. With respect to the “non-beating heart” definition of death, he concludes that, although it may be ethical to remove vital organs from these patients, we believe that the reason it is ethical cannot convincingly be that the donors are dead. With respect to the “dead donor rule” which says that patients must be declared dead before removal of any vital organs, he shows that, at best, the rule has provided misleading ethical cover that cannot withstand careful scrutiny. The author appears to be pro-organ donation. Yet, he concludes that the removal of vital organs from patients before they are dead is taking place on a routine basis. He suggests that “whether death occurs as the result of ventilator withdrawal or organ procurement, the ethically relevant precondition is valid consent by the patient or surrogate. With such consent, there is no harm or wrong done in retrieving vital organs before death, provided anaesthesia is administered…”
Robert Troug, M.D., et. al., “The Dead Donor Rule and Organ Transplantation”, New England Journal of Medicine, 359:7, Aug 2008. P\p
[36] Gauke Kootstra, History of non-beating-heart donation, 01-Talbot-Chap01, 2/10/2009. p 4.
(Also, found in section titled, Procedure for uncontrolled donors in the Wikipedia article title, Non-heart-beating donation. http://en.wikipedia.org/wiki/non-heart-beating_donation)
[37] Wikipedia – Lung Transplantation, January 24, 2013. http://en.wikipedia.org/wiki/Lung_transplantation
[38] Wikipedia – Lung Transplantation, January 24, 2013. http://en.wikipedia.org/wiki/Lung_transplantation
[39] David Vandrunen, “Bioethics and the Christian Live: A guide to Making Difficult Decisions”, Crossway Books (A publishing ministry of Good News Books), Wheaton, Illinois, First Ed., 2009. P189.
[40] David Vandruen, “Bioethics and the Christian Live: A guide to Making Difficult Decisions”. P189.
[41] Greg Kenyon, “Questioning Medical Technologies, Organ Donation and IVF – Introduction”, May 15, 2011 – not yet published.
[42] Rom 8:28
[43] Acts 17:28
[44] Job 1:20-21
[45] Ps 55:22
[46] Acts 17:28
[47] Christopher W. Bogosh, “Compassionate Jesus: Rethinking the Christian approach to modern medicine,” Reformation Heritage Books, Grand Rapids, MI., 2013. P. 6-7.
____________________________
Return to Book page.
Author: Greg Kenyon, Mitchell, Ontario, Canada
–This is a chapter from an online version of a book I am writing with the purpose of providing true information about organ donation and invitro fertilization (IVF) as well as raising some of the questions that should be asked.
–This book is written from a Biblical-Christian perspective. To learn more about what this means feel free to read some of the other material on my blog at https://greg.kenyonspage.ca/. You may also read my attempt to describe my beliefs at http://greg.kenyonspage/i- Believe/.
–This is a work in progress. If you are reading from a printed version or coped material, rather than directly from my website, https://greg.kenyonspage.ca/, then you may not have the most up-to-date draft of this book. Please do not copy it or pass it on to others. Instead, go to the book on my website at , https://greg.kenyonspage.ca/greg-kenyons-book-questioning-medical technologies/