The Romanian Orthodox Church’s position on transplant of human organs
The transplant of tissues and organs is one of the top forms of the contemporary medical practice, which changes sufferance into hope for longer life. It is a performance of science and medical practice that the Church blesses as long as the transplant solves the crisis caused by the lack of some solutions of healing and the normal life of a person is restored, without taking another person’s life: nobody must be killed to make somebody else live.
Definition. The transplant of tissues and/or organs is the complex medical activity which replaces, for therapeutic purpose, human tissues and/or organs compromised morphologically and functionally, from the body of a human subject with other similar structures proved healthy.
General Principles
-The life typical to the human person, unique and unrepeatable, is a gift of God, understood as living of the soul in the body; the Christian will take care of both, but paying greatest importance to the soul, fighting for its salvation.
-The act of willing offering to God or to one’s neighbour reveals the true sense of love, and that is why offering is better wished than its conservation; these principles make the bases of heroism and especially of martyrdom.
-The gift of life consists in its holiness, and this is why the “quality of life” should be taken into account to increase holiness, and the prolongation of life to keep on working for its salvation and the beneficial presence of the person in middle of the fellow beings.
-The Orthodox teaching pays great heed to body, both in lifetime and after death, because the body represents a matter structured by God in the mystery of the person; the Body is “the temple of the Holy Spirit” (1 Corinthians 6:9) and, when spiritualised it is to participate in the life beyond the grave.
-Death, as separation of soul from body, does not justify thinking the body as an object to be used as third persons would like to.
Special principles
- Transplant should be based on the Christian love of the one who gives and its fulfilment in the love of the one who receives. In this sense, he will meet the following conditions:
1. – to respect the dignity of the person (donor, receiver, physician);
2 – to have therapeutic purpose;
3. – to be useful to our neighbour;
4. – to respect life even after the death of the human person;
5. – to observe human rights and the spiritual dimension of human existence, even from its conception;
- the act of donation should be based on the Christian love for one’s neighbour and sacrifice; donation cannot make the object of transaction;
- extraction and transplant of bodies and tissues is made only for therapeutic purpose; transplant should prove it is the only valid remedy for prolonging and improving the patient’s life (in case of transplant of cornea, skin, etc);
- Because the extraction of organs implies the consent of the donor, extraction of tissues from an embryo is unconceivable given the fact that although alive, this one cannot give its consent;
- it is not admitted to cause mutilation or death through the extraction of organs, even to save the life of another person;
- transplant will be well justified: the immediate purpose and long run purpose of the transplant will be taken into account, as well as creating a satisfactory quality for the receiver’s life;
- Having been done out of love and respect for the human life, the transplant will take into account the life of the human person in all its complexity, not only the life which will be consumed in the form and at exclusively biological level, but also its spiritual dimension, the eternal human life. Having been an exceptional method of treatment, transplant is justified only after all the other methods of treatment have been exhausted.
Responsibility of the physicians
- The gift of knowledge and revelation of the new aspect comes from God, so that man is responsible to use it not against his neighbour and the world, but to support the dignified presence of the person in creation and to fulfil the sense of existence;
- In this context, the physician must have the conscience that he is an instrument and a collaborator of God for removing the manifestation of evil as sufferance in the world;
- the transplant team must inform, in all aspects and details, both the donor and the receiver of organs, in regard to the risk, benefit, procedure and consequences of extraction and of the implant of organs, respectively, so that the persons concerned should take the decision in full awareness.
Consent
- Although donation is considered an expression of love, it does not involve the moral duty to donate; the act of donation is the free and indubitable manifestation of free will;
- the application and acceptance of the written, express and free consent of the donor in advance, or of the third person who is entitled to allow this fact; the written acceptance of the receiver will be also requested;
- only the aware consent of the donor can reveal his love and spirit of sacrifice, confidence and interest in his neighbour;
- the relatives could give their consent for the transplant of organs, on behalf of their dear ones (children, minors) when they cannot do it anymore (because of the state those concerned are), especially since it is more difficult to decide for another person’s body than for yours. This is why the law should stipulate clear rules concerning the consent, in order to avoid suspicion of trading the organs by the relatives;
Yet, it is better to have the previous consent of every person, for extracting the organs after the person’s death, or at least the notification of his or her desire in this regard to the relatives, no matter if the position is pro or against; that is because only in the case of the explicit consent of the person one can talk of an act of generosity and love, so of donation;
- the non-refusal of the relatives to extract organs after the patient’s death cannot be interpreted as consent.
The Donor
1. In case the donor is alive, the transplant will be done only after observing the following norms:
- he/she should be of age and in his/her right mind;
- to be guaranteed his/her life will not be in danger;
- to be presented the risks and consequences for his/her good health and for his/her capacity of work that the extraction of organs can bring about;
- to have given his/her written consent in advance, free, express, aware and informed on extraction. In case the person is under age, the consent will be given by parents or by the legal tutors, observing the freedom and dignity of the minor;
- the act of donation will be express not presumed.
2. In case the donor is deceased:
- the team who establishes the decease will not be the same one who will make the transplant;
-the physicians who establish death are responsible in case death has not occurred or was not well established.
The Receiver
-The receiver will give his written consent for making the transplant and will be objectively informed of the chances of the transplant’s success.
-When selecting the patients who are to have a transplant done, the physicians who take the decisions of transplant must apply the therapeutic criterion, namely to take into account:
1. emergency of the transplant;
2. chances of success;
3. provision that the organ could be transplanted;
4. priority of the application.
-Because the transplant has a therapeutic character, the selection of the patients should not be hindered or vitiated for racial, social economical, religious reasons, but established by the best conditions for the transplant’s success and for its finality.
On Death
From a Christian point of view, death has two acceptances:
- Man’s moving away from God through sin (death that can be temporary or eternal, according to the seriousness of the sin, repentance or its absence);
- The physical death – materialized through the separation of the soul from the body. All Christian effort is to get rid of the eternal death through the dynamic communion with God in Christ, through the Holy Spirit. This fact does not exclude the care for the conditions, moment and way of separating the soul from the body.
From a medical and legal point of view death has several aspects, namely:
- Apparent death (the vital functions are so weak that they cannot be felt but by special machinery);
- Clinic death (the vital functions ceased without irreversibly altering the structures yet; this is why these functions should be reactivated through intensive therapy and reanimation);
- Biological death (occurred when the vital organs have already entered in the process of alteration, namely the necrosis of the tissues has already begun);
Cerebral death
The establishment of the physical death is not the object of theology or philosophy, but it belongs to medical and juridical fields. Till recently the person’s whose heart ceased to beat and had no more breathing was considered dead. Due to the reanimation technique the conviction was reached that death is a process and that it is not related by all means to the cessation of the heart beats.
Death, as effective cessation of life involves:
- Stopping of the heart
- Absence of the spontaneous breathing
- Cerebral death
All these conditions must be accomplished concomitantly and totally to avoid regrettable errors.
Essential explanations concerning the concept of cerebral death:
- From a medical point of view cerebral death represents the irreversible alteration of the life of the brain cells (cortex, cerebellum, and cerebral trunk), which causes the final cessation of the entire encephalon, which means the impossibility of the human organism to be in relation with the environment and to ensure and achieve its own existence, a specific and compulsory character for defining human life;
- Cerebral death should not be confused with the biological death;
- From a juridical point of view, death is considered only one, namely the one declared from a medical point of view.
The criteria according to which the cerebral death can be declared from a legal point of view are following:
- Clinic examination consisting in establishing the deep coma, flat, non-reactive, absence of the reflexes of the cerebral trunk (especially the absence of the photo-motor and corneal reflexes);
- Absence of the spontaneous ventilation confirmed by the apnea test (to a PaCO2 of 60 mm Hg);
- Two EEG lines, every 6 hours, to attest the lack of the cortical electro genesis
Death, as separation of the soul from the body remains a mystery. Nobody can say exactly if this separation coincides with the cerebral death; it may coincide, precede or follow the cerebral death.
Having been created in the image of God, man is understood and can value himself to the extent to which he reflects his own prototype in him. As long as he accomplishes the commandment of love and remains in God, who is love, he is a member of the Church of Christ.
From this point of view, giving an organ, a tissue, or even a drop of blood out of love for one’s neighbour, means devotion and sacrificing the entire man inside the same mystic Body of Christ, which fact excludes considering the human body as one’s simple means of physical recuperation or as a depot of organs for exchange.
Final conclusions
The Church blesses any medical practice designed to reduce sufferance in the world, and so transplant too, done with respect for receiver and donor too. The human body must have all our respect.
Yet, the Church warns everybody to understand transplant as a medical practice designed to do away with the sufferance of her members and not as one to promote the idea of the autonomy of the physical life and of its perpetuation, at the expense of the faith in eternal life (true life) neglecting its preparation.
Because the Church sees the organ donor as a man able to sacrifice himself, the Church thinks he must fulfil his gesture of love for his neighbour, of good will, after correct information and free consent independent of any influence alien to his conscience.
The same requirements must be fulfilled by the relatives of the deceased one, responsible of his body and willing to offer certain organs of the deceased for transplant.
The Church respects the desire of the receiver to live longer or in better conditions, but she also expresses her respect for the acts of love, self-sacrifice and understanding of the donor.
The Church opposes any transaction of human organs and exploit of the state of crisis and of the vulnerability of the potential donors (lack of psychic or physic freedom, social penury).
As for the establishment of the real death (leaving the body by the soul) identified with the cerebral death legally declared, the Church requires the precise observation of the criteria of diagnosis of the cerebral death and legal too. According to law, the cerebral death must be stated by a medical – legal team not involved in the transplant, based on the clinic and laboratory criteria existent.
The Church cannot agree with the transplant of the embryoid tissues which involves the risk to affect the good health of the fetus and neither with using the transplant of the organs of the acephalous or hydrocephalous new born babies. Neither does the Church agree with some people’s tendency to become donors of organs, provided they are euthanatized afterwards.
The lucid informed consent to donate an organ, while in life or after death, for the welfare of the fellow being, out of love for him and disinterested, as well as the decision of the relatives to allow the extraction of tissues or organs for transplant from the deceased bodies of those to whom they have legal rights, observing the law, are in accordance with the Christian morals.
The Church blesses the persons who can make such sacrifices, and also understands those who cannot do that, observing the freedom of decision of every human being.
On the contrary, she understands those who want to rid of sufferance and prolong their physical life, fully aware that the prolongation of the physical life will give them the chance to come closer to God and to the spiritual progress.
While blessing the effort of the physicians made to reduce sufferance in the world through the transplant of organs too, as well as the sacrifice of those willing to offer them, the Church cannot encourage the unjustified negativism of some other people (negativism consisting either in refusing to donate organs, or in refusing to accept any form of transplant or even blood transfusion). If the life of the fellow being, both physical and spiritual, is guaranteed, no sacrifice is too big, provided you must not kill a human to give life to another one.
At the same time, it is necessary that devotion and generosity for the transplant of organs should not be manipulated as pretext or cover-up for unfair financial profit, which does not elevate, but degrades the human being.
The Christians, medical staff, donors, beneficiaries, or intermediaries, must not promote science without ethic conscience and responsibility for human dignity. This is why a permanent spiritual and pastoral vigil is needed, as well as an active spiritual discernment in regard to the purposes of the transplant of organs, either declared or not.