Denise J. Hunnell, MD

The erosion of ethics in organ transplantation: what’s a Catholic to do?

Denise J. Hunnell, MD
By Denise Hunnell MD

November 19, 2012 (Zenit.org) – Caleb Beaver died at age 16 on Christmas Day in 2011 due to a previously undiagnosed congenital malformation of his blood vessels. His devastated parents agreed to the donation of his heart, kidneys, lungs, liver, and pancreas. Several months later, his mother and father were able to meet with the grateful recipient of Caleb’s heart and hear their son’s beating heart in this new body.  While the meeting could not erase their grief, the meeting offered Caleb’s parents a small bit of consolation that his death had brought life to someone else.

Organ donation can certainly be a supreme act of generosity. Pope John Paul II endorsed organ transplantation in both his encyclical Evangelium Vitae as well as his 2000 address to the 18th International Congress of the Transplantation Society as a way to build up an “authentic culture of life”. However, Pope John Paul II was also careful to insist that this lifesaving technology must be governed by critical ethical principles in order to fulfill its life affirming potential.

The first principle is the donation must be voluntary and free of all coercion. That is why there can be no sale of human organs: the prospect of financial profit would put pressure on the poor to sell their organs for subsistence. A marketplace approach would also unfairly favor those who have the means to pay as organ recipients. Second, the human dignity of both the donor and the recipient must be respected. A potential organ donor must always be seen first as a human being and a patient deserving of optimal medical care. He should never be viewed as merely a cluster of organs waiting to be harvested. With this in mind, respect for human life from conception to natural death prohibits the removal of vital organs for transplant until after a patient has died.

The explosion in organ transplant technology has resulted in a tremendous shortage of available organs. Over 6,500 patients died in 2011 while they were waiting for an organ transplant. With so many patients facing death without a transplant, it is not surprising that a black market for human organs has emerged. Organ trafficking has become a major enterprise of organized crime in Latin America, Asia and the Middle East. Western nations in Europe as well as the United States are not immune from this exploitive trade. According to the European Society of Organ Transplantation, those most likely to sell their organs include the poor, the hungry, the socially marginalized, and illegal immigrants and refugees. Dr. Francis Delmonico, a Harvard transplant surgeon, estimates that 10% of all kidney transplants worldwide are performed with illegally trafficked organs. While many governments have enacted penalties for organ trafficking, few are aggressively seeking to eliminate the black market trade of human body parts.

Perhaps even more worrisome than the deplorable practice of buying and selling human organs are the trends emerging in mainstream medicine. Two of the principles outlined by Pope John Paul II, the expectation that a potential donor is viewed as a fully human patient first, and the requirement that a donor of vital organs be dead before the organs are harvested, have long been cornerstones of transplant programs. The shortages of available organs for transplant have motivated some to question the need for such standards.

Normally, patients are not evaluated as possible organ donors until after a decision to remove life sustaining medical care is made. This ensures that the decision to withdraw extraordinary means of support is made without coercion from the transplant team waiting for the patient’s organs. The United Network for Organ Sharing (UNOS), a nonprofit organization contracted by the United States Department of Health and Human Services (HHS) to administer the nation’s organ transplant program, is revising the requirements for organ donation programs in order to allow patients to be evaluated as potential organ donors before any decisions are made about the withdrawal of life sustaining measures. The first attempt by UNOS to revise the guidelines actually designated specific neurological diseases such as high level spinal cord injuries, muscular dystrophy, and Lou Gehrig’s disease as conditions to be flagged as potential organ donors on any admission to the hospital. This brought such an outcry from disability advocates that the current revision no longer recommends singling out specific diagnoses for organ donation. Instead, all patients will be evaluated as potential donors, and no consultation with families is required. In fact, UNOS states that it is unnecessary to obtain consent for organ donation from the next of kin or other health care surrogate if a patient has indicated they want to be an organ donor through something like a living will or a check in the organ donor box on their drivers license. This rush to label a patient as an organ donor effectively removes the protective barrier between patient care and preparation for organ donation, thus diminishing the trust between patients and their doctors.

Equally disturbing is the push to remove vital organs from living patients. Since the first transplants were done, there has been a lively debate over what constitutes death, and such discussions are still active today. Some advocate for criteria that rely on the presence or absence of cardiovascular circulation and define death as the absence of a beating heart. Others push for the absence of electrical brain activity to be the gold standard of death. Until recently, the issue was always centered on reaching maximum certainty that death has occurred before harvesting organs for transplant. Now the emphasis is shifting to making sure the patient is “close enough” to dead for transplant.

In their book Death, Dying, and Organ Transplantation, Drs. Franklin Miller and Robert Truog argue that it is not necessary to wait for death in patients who are voluntary organ donors and in whom death is imminent. In Canada, the Canadian Council for Donation and Transplantation markedly loosened the neurological criteria required for organ harvesting, leading critics to question whether the patients declared dead under the new liberalized criterion are really dead.

Standard protocols for donation after circulatory death typically require a two to five minute delay from the time heart function ceases to the time organs are removed. The new UNOS requirements discussed above remove any required waiting period before removing organs after the heart stops. Each transplant center is free to define circulatory death as it sees fit. As a utilitarian ethic becomes mainstream and donor death becomes optional, the need for certainty of death becomes superfluous.

Clearly, these developments are at odds with Catholic ethical principles. The Ethical Religious Directives for Catholic Health Care Services clearly state:

63. Catholic health care institutions should encourage and provide the means whereby those who wish to do so may arrange for the donation of their organs and bodily tissue, for ethically legitimate purposes, so that they may be used for donation and research after death.

64. Such organs should not be removed until it has been medically determined that the patient has died. In order to prevent any conflict of interest, the physician who determines death should not be a member of the transplant team.

So what is a Catholic to do? As with other end of life decisions, it is important to designate a health care surrogate who will make sure your health care conforms to Catholic principles when you are unable to speak for yourself. In light of the increasing speed with which organs are removed from patients who have previously designated themselves as organ donors, it is wise to consider carefully the possible consequences of making your intentions to be an organ donor public through an advanced directive or a checked box on your drivers license. When possible, know your health care facility. Ideally, your hospital should be able to provide some assurance that any organ procurement protocol will assure quality care to the donor until the time of natural death and no vital organs will be removed before a patient is dead.

Organ transplantation, when done ethically, remains a heroic act of generosity.  This legitimate and life-saving practice must not be degraded by turning human organs into commodities, and turning seriously wounded or disabled persons into mere suppliers of organs.

Denise Hunnell, MD, is a Fellow of Human Life International, the world’s largest international pro-life organization. This article originally appeared on Zenit.org and is reprinted with permission.


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Michelle Kaufman, New Zealand Correspondent

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Abortion group targets pro-life doctors, nurses with new website: New Zealand

Michelle Kaufman, New Zealand Correspondent
By Michelle Kaufman

Pro-life health practitioners and crisis pregnancy centres in New Zealand are the target of a new website designed to intimidate those who choose not to refer for abortion or prescribe contraception.

The website, My Decision, is created by the Abortion Law Reform Association of New Zealand (ALRANZ). 

The site lists health practitioners and crisis pregnancy centres which they believe women should avoid.  The incomplete list includes the names of individuals or organisations, the region and town, and whether they are a doctor, nurse or other provider. 

Women are asked to submit their stories of “hostile or unhelpful health professionals.”  The stories are non-identifying and can be edited for length or clarity.  At the time of writing only two stories had been posted.

In an earlier blog post, ALRANZ mentioned that the new website, which was still under construction at the time, is “aimed at shining the light on ‘conscientious objectors’… who deny people the reproductive healthcare they want or need.”

Right to Life NZ says they believe the site is “denigrating the good name and reputations of health professionals who believe that abortion is a harmful choice.”

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Under New Zealand law, health practitioners can object to providing reproductive health services according to their conscience.  However, there is one caveat – they “must inform the person who requests the service that he or she can obtain the service from another health practitioner or from a family planning clinic.”

 “Sonscientious objection is a fundamental right and one that must be preserved if we are to continue to live in a free and civil society,” said Chris O’Brien, Vice President of Right to Life NZ. “We risk tyranny if this right is taken away.”

“There are very good doctors that appear on that website” said Dame Colleen Bayer, whose Dunedin Family Life Crisis Pregnancy Centre is also named.  “These doctors speak truthfully and have real care and concern for their patients.  Women do themselves a disservice to discount them based on this information.”

The resource section on the My Decision website links to ALRANZ, Family Planning (an affiliate of International Planned Parenthood Federation and an abortion provider), and the website Abortion Services in New Zealand. 

The Abortion Services website is sponsored by ISTAR Ltd, a registered Charitable Trust which is the sole importer of mifepristone into New Zealand.  ISTAR also provides Manual Vacuum Aspiration equipment for early surgical abortions.

ALRANZ, was instrumental in the writing of the Greens abortion policy, which was unveiled earlier this year.  That policy aims to take abortion out of the Crimes Act making it more accessible.  The policy also targets health professionals who may conscientiously object to ensure they refer patients on to a “neutral practitioner”.

More information about freedom of conscience in healthcare 


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The government is proposing allowing the killing of pre-born babies suspected of being disabled and those conceived through rape or incest.
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Northern Ireland considers allowing killing disabled unborn babies: pro-lifers condemn

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By Thaddeus Baklinski

Northern Ireland’s leading pro-life group, Precious Life, has condemned this week's announcement by Justice Minister David Ford that a consultation on changing the abortion law will be "ready by autumn." The government is considering allowing the killing of pre-born babies suspected of being disabled and those conceived through rape or incest.

“Abortion is a serious criminal offence in Northern Ireland,” said the director of Precious Life, Bernadette Smyth. “The law here protects unborn babies, and David Ford as Minister for Justice must ensure that all children are legally protected."

Last December, Ford revealed he would be undertaking a consultation to consider changes to the law after he heard the stories of two women, who complained that they had not been allowed to abort their babies who had been diagnosed with anencephaly. Instead, they said, they had traveled to Britain for abortions.

Abortion was refused under Northern Ireland’s laws because the diagnosis of anencephaly for the child poses no medical threat to the mother.

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On Monday Ford told the BBC that the Department of Justice would bring forward its consultation paper on changing Northern Ireland's abortion laws by the fall.

However, Smyth warned that “the core ethical principle which must underpin this discussion is that every child deserves the right to life regardless of how short their life may be, and regardless of the circumstances of their conception."

She vowed that Precious Life will launch a public campaign in support of the life of all unborn babies.

“We all feel enormous sympathy for parents in these traumatic and distressing cases," Precious Life stressed in a statement. "But parents in these difficult situations deserve much more than our sympathy – they need a professional support system in place, which will provide them with help, support and resources.

"Precious Life are resolved to work towards a solution that loves and protects both mother and baby. Once again we call on the Health Minister to immediately establish perinatal hospice services for parents who have received a poor or difficult prenatal diagnosis for their baby,” said Smyth.

 

Contact:

Justice Minister David Ford
Department of Justice
Stormont Estate
Belfast, Northern Ireland
BT4 3SG
Phone:(028) 9076 3000
Email: via website (http://www.dojni.gov.uk/contact-us.htm)


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80% of parents who have an unborn child with spina bifida choose abortion. But Chad Judice (pictured with Eli) knows that life is worth it.
Dustin Siggins Dustin Siggins Follow Dustin

Abortion? No way. Dad says son with spina bifida is a ‘gift’ to the family.

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By Dustin Siggins

What is the most pro-life, pro-God influence in your life? According to Catholic author and speaker Chad Judice, his five-year old, disabled son has been a tremendous source of happiness and faith for even the hardest of hearts.

In an op-ed published in The New York Post, Judice writes that when he and his wife found out their unborn son Elijah had spina bifida, they were offered the option of abortion. While they chose life, it didn't stop them from fearing the worst for their careers, eldest child, and Eli.

"That evening...Ashley cried as she read to me from the literature we’d been given," writes Judice. "It said 80 percent of parents who receive a spina bifida diagnosis choose abortion."

"And it told us that our son might have learning disabilities and be paralyzed from the waist down, unable to ever walk."

According to WemMD.com, the two most common forms of spina bifida have few, if any effects, on those who have them. However, the most rare and most aggressive form of the disability can result in significant problems for life:

  • Little or no feeling in their legs, feet, or arms, so they may not be able to move those parts of the body.
  • Bladder or bowel problems, such as leaking urine or having a hard time passing stools.
  • Fluid buildup in the brain (hydrocephalus). Even when it is treated, this may cause seizures, learning problems, or vision problems.
  • A curve in their spine, such as scoliosis.

Eli's form of spina bifida was severe, but -- as it turned out -- manageable, writes Judice. Despite surgeries and "medical challenges," he was out of the hospital within thirty days, though seizures and surgeries would continue to challenge the family. At five-and-a-half, he is entering kindergarten, learning to walk with modern technology, and "his intelligence is at or above average, and he's very talkative."

But perhaps the greatest miracle of all, Judice says, is the effect Eli has had on those who are outside of the family. His story has helped "some pregnant mothers...to reject abortion," and "rekindle the dormant faith of some...drawing them into a life with more room for God and family."

One of those rekindled Christians was a man who, after years in prison, prayed for Eli "as he recited The Lord's Prayer." According to Judice, "it was the first time he’d prayed in 30 years."

Since Eli's birth, Judice has written two books about his son and their family. "Waiting for Eli: A Father's Journey from Fear to Faith" was the first, and has received praise from Father Frank Pavone of Priests for Life. According to Pavone, it is "an inspiring story of faith, hope, love, and the power of prayer."

"The world judges the value of human life by physical perfection, but God sees things differently. To Him, we are perfectly lovable in our imperfection. Uplifting in its reverence for human life in its most fragile stages, WAITING FOR ELI will encourage pro-life activists everywhere, from the most seasoned to the newly initiated."

Also unstinting in praise was the Chair of the Committee for Pro-Life Activities, Archbishop Daniel Cardinal Dinardo, who writes for Judice's website that the book "chronicles [Judice's] spiritual journey from fear of one’s personal limitations to self-abandonment to the divine mercy of God’s providence."

The second book, "Eli's Reach: On the Value of Human Life and the Power of Prayer," received the "Best Book by Small Publisher" award in 2013 by the Catholic Press Association.

"I think of Eli as God’s special gift to my family," Judice wrote in the Post. "And as I share about him, Eli’s story softens hearts and brings people to a greater appreciation of the beauty and sacredness of life."


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