The Donation of Organs

Rapid advances in modern medicine have opened up vast new vistas in an effort to prolong human life and erad­icate disease. Most dramatic of these breakthroughs is the transplantation of vital organs from one person to another. Organ transplants are such a new phenomenom that they raise unique and never before encountered theological and ethical questions for our Orthodox faithful: Can we violate the bodily integrity of one person, in order to help another? Can we allow the deliberate “dismemberment” of a lifeless body or the “mutilation” of one living person for the sake of another? Or shall we permit an otherwise healthy person to die when an organ transplant can restore him to a fairly normal and reasonably extended life? In seeking answers to these very complex questions, we turn, as the Church has always done in every dilemma, to that rich and timeless store of Orthodox tradition which continues to serve as a guide in our fast-changing world. 

Sanctity of the Body

Before delving further into the question of organ trans­plants, it is important to stress that special sanctity accorded our limited bodily existence in the Orthodox Christian faith. The Church affirms that every man and woman is a psychosomatic unity, a union of body and soul, and cannot exist as a human person in permanent separa­tion from his or her physical manifestation in the flesh. As Christians, we recognize as well that our bodies have been sanctified by God’s own assumption of human flesh in the incarnation of our Lord and Savior Jesus Christ. And in the glorious light of His Resurrection, we await the resurrection of our own transfigured bodies α new, eternal life. Further­more, we are reminded that our bodies have become “tem­ples of the Holy Spirit” through our baptism.

From all this, it is apparent that we ought to treat our bodies with reverence as an inseparable part of our very be­ing. We manifest ourselves through our bodies, and there­fore ought not to abuse them or violate their integrity and wholeness without good cause. 

A Moral Conflict?

 At the same time, we proclaim the free and unselfish love of God Himself called agape to be the highest good of the Christian life. We accept the call to follow our Lord’s exam­ple of free self-giving to the fullest-even to the point of giving up our own life for the life of another.

Now the fundamental moral conflict involved in the question of organ transplantation is that between the rev­erence we hold for our own bodies as “temples of the living God” and our Lord’s commandment to love one another even as He loved us-between the duty to preserve the wholeness and integrity of our bodies and the call to sacri­fice a part of ourselves for the good of another. There are no absolute answers, but we can offer the following guidelines for Orthodox Christians faced with the decision to donate or not to donate their bodily organs after death. 

Suggested Guidelines

We should probably regard the donation of a duplicated organ, such as a kidney, by a living person to save the life of another person as a loving act of mercy. The donor is to be commended if he perceives his sacrifice not as a violation of his bodily integrity, but as a gracious and loving unselfish gift of himself.

The Church does, however, place a limit on the generos­ity of its members. Orthodox are not enjoined and even prohibited from giving to the point of suicide. The donation of such vital, unduplicated organs as the heart or liver by living persons is out of the question, nor is the donation of duplicated organs condoned when there is reasonable doubt that the health of the donor can be maintained by the sole remaining organ of the pair.

In addition, the Church recognizes the highly personal nature of the decision to donate. For this reason, it does not condemn the potential donor who shies away because of a particularly strong aversion to the mutilation of his own flesh; that decision too is a natural and healthy one and may be guided by Divine Providence to some future need. Furthermore, we are aware that every individual possesses his own unique calling and gifts and will respond to the gospel message accordingly. In making any decision, the potential donor must be careful to weigh all the factors en­tering into his decision, and examine both his motives and the resulting consequences. Does he choose not to donate out of selfishness or dislike for the dying person, or out of a genuine and healthy regard for self? Or does he give not out of love and compassion for his brother, but out of an exter­nally-imposed shame and guilt? No one should feel com­pelled to donate, and no person should donate if there is no reasonable chance that such a sacrifice will restore the pa­tient to health.

Organ Donation After Death

The donation of cadaver organs present additional and overlapping questions. The Orthodox Church maintains that such a donation must remain a free and unconstrained gift of self. It would in all likelihood oppose any legislation which would make the routine salvaging of usable organs standard procedure in hospitals, unless prior objection has been registered. Even in death, the human body retains its sanctity. It is horrifying to think that our bodies might be­come part of a giant “rummage sale”, a collection of “ex­changeable parts”, that one goes to the hopsital to obtain, just as one goes to an automobile “graveyard” to find spare parts for his car. And it is essential that the wishes of a per­son who explicitly expresses the desire that his body be buried fully intact be respected. Neither should vital or­gans be taken from the corpse of any person who has ex­pressed no opinion on the matter if his surviving relatives find the trauma of partial dismemberment too much to bear in their grief.

 On the other hand, if a person believes his organs ought to be donated for the benefit of others and expresses his de­sire either in his will or through provision of the Uniform Anatomical Gift Act, or lacking explicit direction, his surviving loved ones find such a donation consonant with the major thrust of his life, then the Orthodox Church in all likelihood would offer no objection to the act.

Other Issues

But it is never considered moral to hasten the death of a potential donor for the sake of salvaging vital organs. Here we encounter such technical medical questions as to what constitutes death: whether death occurs with the disap­pearance of a heart beat or the halting of brain wave pat­terns.

It is also imperative to enquire whether the candidate for an organ transplant is obligated to accept the donation. His/her decision should be based on a consideration of other alternatives, the existence of a reasonable chance of success, and the threat to health of a living donor. In some cases, the recipient may sense a threat to his own bodily integrity by the intrusion of another’s organ; we ought not condemn any person who refuses a transplant for this rea­son.

Special caution must be exercised in regard to heart transplants. As yet, a high degree of success has not been demonstrated in this area, and the risks most often out­weigh the benefits of this procedure. Here the Church also wishes to guard the special place given the heart in Ortho­dox tradition as the seat of the emotions or the soul. Yet, it is not relevant for these ethical questions to locate the soul in any specific place, such as the heart.

In conclusion, the donation or reception of organs is a personal decision which must be made on an individual ba­sis in light of the teachings of the Church. Such decisions should be made in an attitude of prayerful faith and in con­sultation with physician and spiritual advisor.

From the book Stanley S. Harakas, Contemporary moral issues: facing the Orthodox Christain.