In general, the Catholic Church approves organ transplantation, as reiterated by Pope John Paul II in an Address to the International Congress of Transplants on August 29, 2000. Quoting from his encyclical The Gospel of Life, the Holy Father said, “…One way of nurturing a genuine culture of life ‘is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope” (#86). This teaching echoes the Catechism: “Organ transplants conform with the moral law and can be meritorious if the physical and psychological dangers and risks incurred by the donor are proportionate to the good sought for the recipient” (#2296). To better understand this teaching, let’s take it one step at a time. Keep in mind that the issue was first clearly addressed by Pope Pius XII in the 1950s, and then has been refined with the advances in this field of medicine.
First a distinction is made between transplanting organs (including tissue) from a dead person to a living person, versus transplanting organs (including tissue) from a living person to another living person. In the first instance, when the organ donor is a dead person, no moral concern arises. Pope Pius XII taught, “A person may will to dispose of his body and to destine it to ends that are useful, morally irreproachable and even noble, among them the desire to aid the sick and suffering. One may make a decision of this nature with respect to his own body with full realization of the reverence which is due it…. This decision should not be condemned but positively justified” (Allocution to a Group of Eye Specialists, May 14, 1956). Basically, if the organs of a deceased person, such as a kidney, a heart, or a cornea, can help save or improve the life of a living person, then such a transplant is morally good and even praiseworthy. Note that the donor must give his free and informed consent prior to his death, or his next of kin must do so at the time of their relative’s death: “Organ transplants are not morally acceptable if the donor or those who legitimately speak for him have not given their informed consent” (Catechism, 2296).
One caution needs to be made: The success of an organ transplant significantly depends upon the freshness of the organ, meaning that the transplant procedure must take place as soon as possible after the donor has died. However, the donor must not be declared dead prematurely or his death hastened just to utilize his organs. The moral criterion demands that the donor must be dead before his organs are used for transplantation. To avoid a conflict of interest, the Uniform Anatomical Gift Act requires that “the time of death be determined by the physician who attends the donor at his death, or, if none, the physician who certifies the death. This physician shall not participate in the procedures for removal or transplanting a part” (Section 7(b)). While this caution does not impact upon the morality of organ transplantation per se, the dignity of the dying person must be preserved, and to hasten his death or to terminate his life to acquire organs for transplant is immoral. Here again the Catechsim teaches, “It is morally inadmissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons” (#2296), a point underscored by the Holy Father in his recent address (cf. #4).
The transplantation of organs from a living donor to another person is more complicated. The ability to perform the first kidney transplant in 1954 caused a great debate among theologians. The debate focused on the principle of totality– whereby certain circumstances permit a person to sacrifice one part or function of the body for the interest of the whole body. For instance, a person may remove a diseased organ to preserve the health of his whole body, such as removing a cancerous uterus. These theologians, however, argued that a person cannot justify the removal of a healthy organ and incur the risk of future health problems when his own life is not in danger, as in the case of a person sacrificing a healthy kidney to donate to a person in need. Such surgery, they held, entails an unnecessary mutilation of the body and is thereby immoral.
Other theologians argued from the point of fraternal charity, namely that a healthy person who donates a kidney to a person in need is making a genuine act of sacrifice to save that person’s life. Such generosity is modeled after our Lord’s sacrifice of Himself on the cross, and reflects His teaching at the Last Supper: “This is my commandment: Love one another as I have loved you. There is no greater love than this: to lay down one’s life for one’s friends” (John 15:12-13). Such a sacrifice, these theologians held, is morally acceptable if the risk of harm to the donor, both from the surgery itself and the loss of the organ, is proportionate to the good for the recipient.
Moving from this reasoning, these “pro-transplant” theologians re-examined the principle of totality. They argued that while organ transplants from living donors may not preserve anatomical or physical integrity (i.e. there is a loss of a healthy organ), they do comply with a functional totality (i.e. there is the preservation of the bodily functions and system as a whole). For instance, a person can sacrifice one healthy kidney (a loss of anatomical integrity) and still be able to maintain health and proper bodily functions with the remaining kidney; such a donation would be morally permissible. Using the same reasoning, however, a person cannot sacrifice an eye to give to a blind person, because such an act impairs the bodily functions of the individual.
Pope Pius XII agreed with this understanding of charity and the broader interpretation of the principle of totality, and thereby declared organ transplants from living donors morally acceptable. He underscored the point that the donor is making a sacrifice of himself for the good of another person. Our Holy Father, Pope John Paul II, has also emphasized this point: “…Every organ transplant has its source in a decision of great ethical value: ‘the decision to offer without reward a part of one’s own body for the health and well-being of another person’” (Address to the Participants in a Congress on Organ Transplants, June 20 1991, #3). Here precisely lies the nobility of the gesture, a gesture which is a genuine act of love. It is not just a matter of giving away something that belongs to us but of giving something of ourselves…” (#3).
Nevertheless, the transplantation of organs from a living donor to another person must fulfill four criteria: (1) the risk involved to the donor in such a transplant must be proportionate to the good obtained for the recipient; (2) the removal of the organ must not seriously impair the donor’s health or bodily function; (3) the prognosis of acceptance is good for the recipient, and (4) the donor must make an informed and free decision recognizing the potential risks involved.
Having established the basic moral teaching governing organ transplants, we need to address several issues which impact upon their morality. While the advances of medical science have enabled the transplantation of organs with increasing success, certain procedures that have been introduced may be possible but not morally acceptable. What is technologically possible is not always morally good. In judging the morality of a procedure, one must maintain the dignity of the human person, who is both body and soul. As Pope John Paul II taught, “In this area of medical science too the fundamental criterion must be the defense and promotion of the integral good of the human person, in keeping with that unique dignity which is ours by virtue of our humanity. Consequently, it is evident that every medical procedure performed on the human person is subject to limits: not just the limits of what is technically possible, but also limits determined by respect for human nature itself, understood in its fullness: ‘what is technically possible is not for that reason alone morally admissible’ (Congregation for the Doctrine of the Faith, Donum Vitae, #4)” (Address to the International Congress on Transplants, #2).
One issue concerns the use of animal organs for transplantation to human beings, such as using the heart valve of a pig to replace a human heart valve. This kind of transplantation is called a xenotransplant. First addressed by Pope Pius XII in 1956, the Church maintains that such transplants are morally acceptable on three conditions: (1) the transplanted organ does not impair the integrity of the genetic or psychological identity of the recipient, (2) the transplant has a proven biological record of possible success, and (3) the transplant does not involve inordinate risk for the recipient. (Cf. Pius XII, Address to the Italian Association of Cornea Donors and to Clinical Oculists and Legal Medical Practitioners, May 14, 1956.)
A second issue concerns the use of organs or tissues from aborted children (such as those murdered through partial birth abortion procedures). Actually a lucrative organ “harvesting” industry is developing which utilizes the organs and tissues of aborted fetuses. A critical point here is that these abortions are performed with the intention of utilizing the organs or tissues of the infant, and in direct conjunction with a particular recipient in mind.
Another facet of this issue is when a child is conceived naturally or through in vitro fertilization to obtain the best genetic match, and then born or even aborted simply for organs or tissues. For example, recently a couple conceived a child for the sole purpose of being a bone marrow donor for another sibling suffering from leukemia; while the conceived child determined to be a good match while still in the womb and was born, one must wonder if the child would have been aborted if he had not been a good match. To participate in an abortion to obtain organs, to conceive a child for organs, or to knowingly use organs from aborted fetuses is morally wrong.
This issue has even become more complicated with the technological research in cloning. Some researchers hope to grow tissue and even organs from stem cells retrieved from human embryos; however, to do so necessitates the destruction of the embryo. Since human life begins at conception and is sacred from that very moment, such destruction is immoral. Pope John Paul II, affirming consistent Catholic principles, asserted, “…These techniques, insofar as they involve the manipulation and destruction of human embryos, are not morally acceptable, even when their proposed goal is good in itself” (Address to International Congress on Transplants, #8). Basically, the end does not justify the means. However, the Holy Father encouraged scientists to pursue paths of research which involve using adult stem cells, and which avoid cloning and the use of embryonic cells. In sum, any research must respect the dignity of the human person from the moment of conception.
Another moral question involves the distribution and assignment of organs to waiting recipients. Essentially, the number of recipients exceeds the number of available organs for transplant. While no perfect system will ever exist, the plan of assignment should not be discriminatory (based on age, sex, race, social status, and the like) or utilitarian (based on work capacity, social usefulness, and the like) but should strive to recognize the intrinsic value of each person. Instead, the assignment of organs to donors should proceed on immunological and clinical factors.
Finally, whether someone can sell one of his own organs for transplantation is another issue. The answer is a definitive “no.” The selling of an organ violates the dignity of the human being, eliminates the criterion of true charity for making such a donation, and promotes a market system which benefits only those who can pay, again violating genuine charity. Pope John Paul II has repeatedly underscored this teaching: “A transplant, even a simple blood transfusion, is not like other operations. It must not be separated from the donor’s act of self-giving, from the love that gives life” (Address to the First International Congress of the Society for Organ Sharing, June 24, 1991) and “Accordingly, any procedure which tends to commercialize human organs or to consider them as items for exchange or trade must be considered morally unacceptable, because to use the body as an ‘object’ is to violate the dignity of the human person” (Address to the International Congress on Transplants, #3).
Therefore, organ donation is morally permissible under certain conditions. The Ethical and Religious Directives for Catholic Health Care Services provides the following guidance: “The transplantation of organs from living donors is morally permissible when such a donation will not sacrifice or seriously impair any essential bodily function and the anticipated benefit to the recipient is proportionate to the harm done to the donor. Furthermore, the freedom of the donor must be respected, and economic advantages should not accrue to the donor” (#30). Generally, in the case of donating organs after death, the gifts that God has given to us to use in this life– our eyes, hearts, liver, and so on– can be passed on to someone in need. In the case of donating organs while alive, such as giving a healthy kidney to a relative in need, the donor needs to weigh all of the implications; in charity, a potential donor may decide he cannot offer an organ, such as if he were a parent and would not want to increase the risk of not being able to care for his own dependent children. Although organ donation is not mandatory, it is commendable as an act of charity.