Important Position Paper on Criteria for Brain Death and Organ Donation: A Call to Action

I am a signatory on this statement and it deserves to be read and shared. Although the statement touches on Catholic teaching, it is primarily is about science and ethics. Please read the statement and press release.

The statement, “Catholics United on Brain Death and Organ Donation: A Call to Action”, was published on February 27, 2024. It was prepared by Joseph Eble, a physician and President of the Tulsa Guild of the Catholic Medical Association; John Di Camillo, an ethicist of The National Catholic Bioethics Center; and Peter Colosi, a philosophy professor at Salve Regina University.

As a nurse, I have been writing about this topic for years, most recently in my May, 2021 blog “Rethinking Brain Death and Organ Donation” and my experience serving on an ethics committee at a hospital where a patient “failed” one of the hospital’s brain death tests and thus could not have her organs removed.

Although I already knew that the medical criteria used to determine brain death vary — often widely — from one hospital to another, one young doctor checked our area hospitals and came back elated after he found a hospital that did not include the test the elderly woman “failed”. He suggested that our hospital adopt the other hospital’s criteria to allow more organ donations.

When I pointed out that the public could lose trust in the ethics of organ donations if they knew we would change our rules just to get more organ transplants, I was told that I being hard-hearted to people who desperately needed such organs.

I was also alarmed when a 2011 Illinois almost passed a “presumed consent for organ donation” law in 2011 that would allow presumed consent unless a person ” opt(s) of the presumed donation by executing an anatomical gift as otherwise provided in the Act or by filing with the Secretary of State an organ donor opt out document. ” (Emphasis added) Thankfully, it was defeated especially with the help of the disability group Not Dead Yet.

FINDINGS OF THE POSITION PAPER

“At least half of donors declared brain-dead are actually alive when their organs are removed, according to the position paper endorsed by 151 Catholic health care professionals, theologians, philosophers, ethicists, lawyers, apologists, pro-life advocates, and others, including a brain death survivor and a professional organization.” (There is now a webpage of some of the people diagnosed as brain dead who “lived to tell the tale”.)

Catholic United explains that the criteria for brain death establish only partial loss of brain function. This is now abundantly clear based on scientific studies, a recent effort to lower the legal standard for death, and updated brain death guidelines issued in October 2023.” (All emphasis added)

The statement calls for an effort “to unite against the utilization of the current brain death criteria” because they do not ensure that patients are dead. They recommend concrete action steps to protect vulnerable patients, enable informed decisions, identify better criteria for determining actual death, and protect the conscience rights of healthcare professionals and organizations”.

Also “Catholics United bridges a divide among faithful Catholics about whether the concept of brain death aligns with Church teaching. Some Catholics hold that brain death represents true death when there is complete and irreversible cessation of all brain activity, often called whole brain death. Others hold that brain death does not represent true death. Since the existing criteria establish only partial loss of brain function, all the endorsers—whether they accept or reject whole brain death as true death—agree that “the current brain death criteria in widespread use do not provide moral (prudential) certainty of death.” (Emphasis added)

RECOMMENDATIONS

The statement “calls on health care professionals and institutions to cease organ harvesting that relies on the inadequate criteria, noting that 70% of all donors are declared dead using brain death criteria. “ (Emphasis added)

Given the lack of moral certainty of death whenever the current brain death criteria are used, the statement affirms that “a clear majority of vital organ donors can be presumed alive at the time of organ harvesting.” Since the Catholic Church forbids removing vital organs when this would kill the patient, “it is therefore wrong to remove organs from patients declared dead using these inadequate criteria.”

Catholics United makes a number of other strong recommendations, including:

  • Declining to be an organ donor at the Department of Motor Vehicles.
  • Refusing to be an organ donor after death in advance directives.
  • Improving education on end-of-life care and organ donation at the pastoral level.
  • Identifying criteria that will establish certainty of death.
  • Advocating for conscience protection rights for health care professionals and institutions.

The statement also cites:

“Current president and co-founder of the pro-life advocacy group American Life League, Judie Brown, has decided to update its Loving Will Comfort and Care Directive in accord with the new recommendations. “I think that any organization that has a pro-life document addressing wishes at the end of life needs to be updated in view of this article,” said Ms. Brown.”

CONCLUSION

Unfortunately, now some countries’ healthcare ethics have even degenerated to the point where eight countries including Canada, the Netherlands, Spain, and Belgium allow organ donation after euthanasia by “combining medical assistance in dying (MAiD) with donations after circulatory determination of death (DCDD) is known as organ donation after euthanasia (ODE)”. (Emphasis added)

Personally, I am all for the ethical donation of tissues like bone, skin, corneas, etc. after natural death. And I am also a strong supporter of living donation. For example, I volunteered to donate one of my kidneys to a friend years ago and one of our grandsons was saved in 2013 by an adult stem cell transplant donated by a living person.

Hopefully, this statement can help all of us to better protect ourselves and vulnerable patients at the end of life- especially when it comes to organ donation-as well as promoting a dignified, humane and peaceful end of life.