Introduction⤒🔗

A question has been received regarding organ transplants. Prob­ably every one of us will be faced with this question, either when obtaining our driver's license for the first time or when renewing it. In formulating an answer to this question I have made use of several contributions from Dr. Thomas Blok, as well as the guidance provided by Dr. Douma's book, Rondom de dood, and various other articles.

Definition←⤒🔗

What do we mean by the dona­tion of our organs? Simply defined, this term refers to the transfer of an organ or tissue from our body to another person's body. The purpose for this transplantation is to replace a non-functioning or malfunctioning organ or tissue. This can take place either during our life (kidney, skin, or bone marrow) or at the moment of our death.

It is only in the last 130 years that it has medically become possible to transplant organs. Back in 1887 the first cornea transplant took place, which restored the lost eyesight of the recipient. Around 1900 Karl Landsteiner discovered the various blood types, which opened the possibility of "blood-transplants," commonly referred to as "blood transfusions." Since the 1960s, medical technology has been developed to transplant a wide variety of organs, such as the kidney, liver, heart, lungs, bone marrow, and skin.

It is conceivable that in the future new advances will be made in the transplantation of various body parts to replace ailing organs or to fight diseases (think of bone marrow transplants to fight leukemia).

Right or Wrong?←⤒🔗

The easiest way to decide whether something is right or wrong is to search our Bibles for any explicit direction. There is, however, no direct biblical answer which deals with this question. Hence, we need to examine principles, motives, means, and purposes connected to this issue in order to determine whether we may donate or receive organs, tissue, and blood.

Thou Shalt Not Steal←⤒🔗

The eighth commandment in its positive (commanding) aspect could be read as "Thou shalt give (donate)." According to our Heidelberg Catechism, Question 111, the fulfillment of this command is partially "that I promote the advantage of my neighbor in every instance I can or may, and deal with him as I desire to be dealt with by others."

It seems quite clear that donating one's organs (either during life or after one's life has ended) to an ailing, suffering, or otherwise dying neighbor would fall within the "every instance I can"! So far we can easily agree. It is more complicated to further define the phrase "every instance I may." We hope it is obvious to all of us that not everything which can be done necessarily maybe done. What limits are set by this may?

Limits←⤒🔗

One limit is clearly set by the sixth commandment, "Thou shalt not kill." Donating which would (1) lead directly or indirectly to one's death, or (2) hurt oneself, or (3) wilfully expose oneself to danger are "off-limits" according to God's Word (see the Heidelberg Catechism, Question 105).

Let's assume I decide to give my heart so my child can survive and live comfortably for many more years. I might be called "heroic" in this world, but nonetheless I am taking "my life into my own hands." The Bible teaches us that the beginning and ending of our life are in the hands of a sovereign God: "Who knoweth not in all these that the hand of the LORD hath wrought this? In whose hand is the soul of every living thing, and the breath of all mankind" (Job 12: 9-10; see also Acts 17:25, 28).¹ But giving a kidney, for example, in the service of a neighbor (not even necessarily my child) who otherwise would have to be on dialysis several times a week for the rest of his life, does not seem to be an act of recklessness, even though some risk is involved in having the organ removed and possibly by having to live with only one kidney.

This element of indirect suicide, of hurting oneself, or of bringing oneself into unneeded danger falls away entirely when we deal with the donation of body parts after life has ended. At that point there are no risks in removing the organs; there is no hurting oneself or wilfully expos­ing oneself to dangers. The argument that one does "hurt" his body since he allows it to be mutilated is not convincing. The medical procedures to remove the organs in no wise change the outward appearance of the person involved and could hardly be called mutilation.

Another limit in donating our body organs is with regard to those organs which bear the stamp of our individuality or personality. Perhaps it will become possible to transplant reproductive organs or even (parts of) the brain. It seems intuitively clear to me that in such cases we no more must speak about the donation of certain impersonal body parts (or body members), but rather about the transfer to another person of some­thing of our personal uniqueness which our Creator has given us.

Motive←⤒🔗

Some say that donating parts of one's body after his decease is "at least making an otherwise useless death beneficial to others." That this is a purely unbiblical motive should be clear to all of us. Death is the wages of sin (Romans 6:23) and is even "useful" in the way that it declares that God is a just, holy, and a truthful God (Genesis 2:17).

If we make the decision to donate members of our body, the motive which should underlie our decision must always be the "glory of God" and "the welfare of our neighbor," whether we give during or after our life. Never must we give organs to give some sense to our death, or to have people speak well of us, but it must be to promote the quality of life of our neighbor.

God calls us to "love our neighbor as ourselves." In order to fully understand what that means, we must seek to place ourselves in their shoes, as the Holy Spirit exhorts us to "remember them that are in bonds, as bound with them; and them which suffer adversity, as being yourselves also in the body" (Hebrews 13:3). For instance, being in the position of having to go the rest of one's days in darkness, because of the deterioration of the eyes, will give one a different perspective on the donation of a cornea.

Valid concerns←⤒🔗

There are some important moral concerns regarding organ donation and transplants, both from the perspective of the donor and from that of the recipient. These concerns need careful consideration.

1. Definition of death←↰⤒🔗

Traditionally death was defined as the irreversible cessation of breathing and heartbeat. More recently the concept of brain death has been developed. This definition arose due to advances in medical technology which make it possible to sustain blood circulation and breathing artificially for any period of time. A person is declared brain dead when the upper and lower portions of the brain have totally and irreversibly ceased all activity.

The process of determining whether a person is brain dead is a series of steps which are clearly outlined to prevent abuse. This process takes approximately eight hours. Two electroencephalograms are taken, each six hours apart, to verify whether all upper and lower brain activity has really ceased.

In addition it should be noted that the teams involved in transplanting the organs are not involved in the care of the patient before death or in determining death. This strict isolation of the transplant team from the rest of the healthcare givers avoids, as much as possible, the conflict of interest arising from a desire to remove the organs for transplantation at the expense of the dying person's dignity and rights. It is clearly unacceptable to invade the dying person's body prior to death in order to ensure greatest transplant success. There is great danger in our humanistic environment where utility (or pragmatism) outweighs the authority of God and each individual's own "right to life." This is true in both the beginning (abortion) and termination of a person's life (euthanasia).

Therefore it must be clear that if we are asked to give permission for the removal of a relative's organs, we must insist that the medical staff substantiate their claim that the patient is truly totally and irreversibly brain dead. Without that claim verified, we may not proceed with the removal of body organs.

2. The time between the pronouncement of death and the removal of organs←↰⤒🔗

Once a person has been pronounced brain dead, the body will be kept on some form of mechanical ventilation (breathing) and blood pressure support drugs to allow time for testing of the various organs with regard to their suitability for transplant and to match them to recipients. The death of the person is not immediately the death of all organs.² In order to considerably slow down this dying (decaying) process and to keep the organs viable, these procedures seem acceptable. In addition it also provides the time needed to locate the recipient and to allow the transplanting team to arrive, because they often need to fly in from a different location.

For the family, this time period can be emotionally very difficult, since, in order to proceed with the removal of the organs, consent must be obtained from the patient's family. At present, the family's wishes may override the previously expressed wishes of the patient. In other words, even though the deceased person has prior to his or her death indicated the desire to donate several organs, in most legal jurisdictions the family may refuse to allow organ donation.³ The sticker on the driver's license serves at present merely as an expression of the wish of the carrier.

I personally would advise all those who have decided to donate their organs upon their death, to communicate this desire to their immediate family. If it is your conviction and desire, you must inform them out of consideration for their needs. In case your life is ended traumatically, your family will have enough to deal with at that moment, and the additional emotional decision regarding the removal of your organs ought not to be added to it without your having previously spoken to them about your wishes.

3. The possibility of the removal of organs before one is really dead←↰⤒🔗

Concern has been expressed that in today's pragmatic society, where there is less and less respect for a Sovereign God's prerogatives in life and death, the danger is great that life will be terminated when some men conclude there is no hope for recovery. This is especially a concern in light of the fact that the "fresher" the organ is, the greater also is the hope for a successful transplant.

There are two things which may alleviate this concern somewhat. The first is the isolation of the transplant team from the rest of the healthcare givers. As stated earlier, the teams involved in the care of the patient before death and in determining the occurrence of brain death are kept separate from the teams involved in the transplanting of the organs.

Secondly, the fact that physicians will not proceed with the removal of any organ until they have received the express consent of the immediate family adds a needed safeguard against potential abuse. To prevent the early termination of a person's life, we must always insist on the family's consent. If in the future this protocol of seeking the family's consent is eliminated, it would be very crucial for those who desire to donate their organs (upon being brain dead) to carry with them some sort of documentation to indicate that they would allow the removal of their organs only after their family has given the final permission.

4. The process of deciding who will be the recipient←↰⤒🔗

At the other end of this issue is the receiving individual. At present, the various organ procurement agencies have lists of potential recipients. One's placement on this list (toward the top or bottom) is based on a variety of factors, including one's general health, particular combina­tions of other illnesses, and the seriousness of the particular organ failure for which transplantation is being considered. One's social status or wealth is not supposed to have an impact, but there remain some con­cerns that this is not always adhered to fully. Though we must acknowl­edge that there may be the possibility of undue bias or injustice in these decisions, there seems to be no right avenue for donors to exert their influence. Besides, without medical insight, who are we to judge this decision?

There is no control over the decision to whom your organs would go after your death. That decision is entirely up to the medical profession­als. There is also no disclosure about the identity of the person who does receive the organ(s) of a deceased family member. The only informa­tion that the family receives is a letter of acknowledgment from the hospital which finalized the transplant. This letter provides minimal information, such as the condition and age of the person who received the organ, but in no way reveals the identity of the recipient.

In my opinion it is important to maintain this "secrecy." It avoids all the emotional and psychological impact it may have on the remaining family to know that such and such a person has become the recipient of their family member's organ(s). For the recipient, such knowledge would also add an undue sense of obligation towards the donor. Besides, if the organ transplant is not successful (in case the body rejects the transplanted organ), this may be an additional burden to the family members. Here also the Lord's instruction applies, "But when thou doest alms, let not thy left hand know what thy right hand doeth: that thine alms maybe in secret" (Matthew 6:3-4a).

Obligation?←⤒🔗

We must, however, maintain that everyone retains his own liberty to donate or not. Even though there is a great need, never does Scripture support the use of compelling force to get what is needed. In this case, as in all giving, God loveth a cheerful giver. This also means that we must vigilantly guard against the taking of one's organs against his stated wishes.

Conclusion←⤒🔗

Having explored the various aspects of this issue, and viewing it also in the light of the Heidelberg Catechism's explanation of the eighth commandment (Question and Answer 111), we conclude that the donation of organs is an acceptable practice, as long as the motive, method, and procedures fall within the boundaries outlined above.