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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Cardinal Dolan: Debate on denying Communion to pro-abortion pols ‘in the past’

Lisa Bourne
By Lisa Bourne

As America heads into its 2014 midterm elections, a leading U.S. prelate says the nation’s bishops believe debate over whether to deny Communion to pro-abortion Catholic politicians is “in the past.”

The Church’s Code of Canon Law states in Canon 915 that those “obstinately persevering in manifest grave sin are not to be admitted to Holy Communion.” Leading Vatican officials, including Pope Benedict XVI himself, have said this canon ought to be applied in the case of pro-abortion Catholic politicians. However, prelates in the West have widely ignored it, and some have openly disagreed.

John Allen, Jr. of the new website Crux, launched as a Catholic initiative under the auspices of the Boston Globe, asked New York Cardinal Timothy Dolan about the issue earlier this month.

“In a way, I like to think it’s an issue that served us well in forcing us to do a serious examination of conscience about how we can best teach our people about their political responsibilities,” the cardinal responded, “but by now that inflammatory issue is in the past.”

“I don’t hear too many bishops saying it’s something that we need to debate nationally, or that we have to decide collegially,” he continued. “I think most bishops have said, ‘We trust individual bishops in individual cases.’ Most don’t think it’s something for which we have to go to the mat.”

Cardinal Dolan expressed personal disinterest in upholding Canon 915 publicly in 2010 when he told an Albany TV station he was not in favor of denying Communion to pro-abortion politicians. He said at the time that he preferred “to follow the lead of Popes John Paul II and Benedict XVI, who said it was better to try to persuade them than to impose sanctions.”

However, in 2004 Cardinal Joseph Ratzinger, who became Pope Benedict XVI the following year, wrote the U.S. Bishops a letter stating that a Catholic politician who would vote for "permissive abortion and euthanasia laws" after being duly instructed and warned, "must" be denied Communion. 

Cardinal Ratzinger sent the document to the U.S. Bishops in 2004 to help inform their debate on the issue. However, Cardinal Theodore McCarrick, then-chair of the USCCB Task Force on Catholic Bishops and Catholic Politicians, who received the letter, withheld the full text from the bishops, and used it instead to suggest ambiguity on the issue from the Vatican.

A couple of weeks after Cardinal McCarrick’s June 2004 address to the USCCB, the letter from Cardinal Ratzinger was leaked to well-known Vatican reporter Sandro Magister, who published the full document. Cardinal Ratzinger’s office later confirmed the leaked document as authentic.

Since the debate in 2004, numerous U.S. prelates have openly opposed denying Communion to pro-abortion Catholic politicians.

In 2008, Boston Cardinal Sean O’Malley suggested the Church had yet to formally pronounce on the issue, and that until it does, “I don’t think we’re going to be denying Communion to the people.”

In 2009, Cardinal Donald Wuerl of Washington D.C. in 2009 said that upholding of Canon 915 would turn the Eucharist into a political “weapon,” refusing to employ the law in the case of abortion supporter Rep. Nancy Pelosi.

Cardinal Roger Mahoney, archbishop emeritus of Los Angeles, said in a 2009 newspaper interview that pro-abortion politicians should be granted communion because Jesus Christ gave Holy Communion to Judas Iscariot.

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However, one of the Church’s leading proponents of the practice, U.S. Cardinal Raymond Burke, who is prefect of the Vatican’s Apostolic Signatura, insists that denying Communion is not a punishment.

“The Church’s discipline from the time of Saint Paul has admonished those who obstinately persevere in manifest grave sin not to present themselves for Holy Communion,” he said at LifeSiteNews’ first annual Rome Life Forum in Vatican City in early May. "The discipline is not a punishment but the recognition of the objective condition of the soul of the person involved in such sin."  

Only days earlier, Cardinal Francis Arinze, former prefect of the Congregation for Divine Worship and the Discipline of the Sacraments, told LifeSiteNews that he has no patience for politicians who say that they are “personally” opposed to abortion, but are unwilling to “impose” their views on others.

On the question of Communion, he said, “Do you really need a cardinal from the Vatican to answer that?”

Cardinal Christian Tumi, archbishop emeritus of Douala, told LifeSiteNews around the same time that ministers of Holy Communion are “bound not to” give the Eucharist to Catholic politicians who support abortion.

Pro-life organizations across the world have said they share the pastoral concern for pro-abortion politicians. Fifty-two pro-life leaders from 16 nations at the recent Rome Life Forum called on the bishops of the Catholic Church to honor Canon 915 and withhold Communion from pro-abortion politicians as an act of love and mercy.

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‘His bones are basically like paper’: Parents refuse to abort baby with rare condition

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By Kirsten Anderson

At just 11 weeks old, little Layton Diven is not like other babies. Every time his parents pick him up or cuddle him, there is a chance they will break his bones. In fact, Layton has already suffered more than 20 fractures in his short life – beginning at the moment of his birth.

Layton has Osteogenesis Imperfecta (OI), a rare disease that makes his bones brittle and prone to breakage. There are several types of OI, and Layton’s type, OI Type III, is the most severe type found among infants. Most babies born with the disease, like Layton, are born with multiple fractures, especially along the rib cage. Many struggle to breathe or swallow. The incurable disease is progressive, so it will get worse as he gets older.

Layton was diagnosed with OI in the womb, but abortion wasn’t an option for his parents, Chad and Angela Diven, who considered their baby a gift from God, no matter his condition.

“We weren't going to have an abortion, so he was born with the disease,” Angela Diven told KSLA. “God chose me for him, to be his mom, so I have to take that huge responsibility and do what's best for him.”

That responsibility comes with a heavy price. Layton requires 24-hour care, but both Angela and Chad have full-time jobs. He can’t go to regular daycare, because it’s not safe for him.

“You can't just pick him up like a normal baby,” Diven said. “You can't dress him like a normal child; his bones are basically like paper. He can't go to daycare because of his condition. He's medically fragile, and a daycare can't handle him."

Childcare costs are just the beginning, though – the treatments Layton will need throughout his life are expensive and may not be covered by insurance.

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Layton is currently receiving pamidronate IV therapy, which will help to strengthen his bones. But in order to be able to stand or walk, he will need metal rods implanted in his legs – an operation that will cost the Divens $80,000. The OI specialist coordinating Layton’s care is in Omaha, Nebraska, while the Divens live in Louisiana. As he grows, Layton will also require special equipment, such as a wheelchair, along with extensive physical therapy.

Despite the hardships they knew would come, the Divens stepped out in faith to bring Layton into the world. Now, they are reaching out to the internet for help to shoulder the financial burdens that came with their baby blessing. The family has set up both a GoFundMe and a Facebook page called “Lifting Up Layton Diven,” where people can receive updates on Layton’s condition and contribute to the cost of his care.

To donate to baby Layton’s medical trust fund, click here.

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Sources confirm Cardinal Burke will be removed. But will he attend the Synod?

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By John-Henry Westen

Sources in Rome have confirmed to LifeSiteNews that Cardinal Raymond Burke, the head of the Vatican’s highest court, known as the Apostolic Signatura, is to be removed from his post as head of the Vatican dicastery and given a non-curial assignment as patron of the Order of Malta.

The timing of the move is key since Cardinal Burke is currently on the list to attend October’s Extraordinary Synod on the Family. He is attending in his capacity as head of one of the dicasteries of the Roman Curia, so if he is removed prior to the Synod it could mean he would not be able to attend.

Burke has been one of the key defenders in the lead-up to the Synod of the Church's traditional practice of withholding Communion from Catholics who are divorced and civilly remarried.

Most of the Catholic world first learned of the shocking development through Vatican reporter Sandro Magister, whose post ‘Exile to Malta for Cardinal Burke’ went out late last night.

If Burke’s removal from the Signatura is confirmed, said Magister, the cardinal “would not be promoted - as some are fantasizing in the blogosphere - to the difficult but prestigious see of Chicago, but rather demoted to the pompous - but ecclesiastically very modest - title of ‘cardinal patron’ of the Sovereign Military Order of Malta, replacing the current head, Paolo Sardi, who recently turned 80.”

At 66, Cardinal Burke is still in his Episcopal prime.

The prominent traditional Catholic blog Rorate Caeli goes as far as to say, “It would be the greatest humiliation of a Curial Cardinal in living memory, truly unprecedented in modern times: considering the reasonably young age of the Cardinal, such a move would be, in terms of the modern Church, nothing short than a complete degradation and a clear punishment.”

On Tuesday, American traditionalist priest-blogger Fr. John Zuhlsdorf also hinted he had heard the move was underway. “I’ve been biting the inside of my mouth for a while now,” he wrote. “The optimist in me was saying that the official announcement would not be made until after the Synod of Bishops, or at least the beginning of the Synod. Or at all.”

“It’s not good news,” he added.

Both Magister and Zuhlsdorf predicted that the controversial move would unleash a wave of simultaneous jubilation from dissident Catholics and criticism from faithful Catholics. The decision to remove Cardinal Burke from his position on the Congregation for Bishops last December caused a public outpouring of concern and dismay from Catholic and pro-life leaders across the globe.

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Both men speculated on the reasons for the ouster. 

Magister pointed out that Burke is the latest in a line of ‘Ratzingerian’ prelates to undergo the axe.

“In his first months as bishop of Rome, pope Bergoglio immediately provided for the transfer to lower-ranking positions of three prominent curial figures: Cardinal Mauro Piacenza, Archbishop Guido Pozzo, and Bishop Giuseppe Sciacca, considered for their theological and liturgical sensibilities among the most ‘Ratzingerian’ of the Roman curia,” said Magister.

He added: “Another whose fate appears to be sealed is the Spanish archbishop of Opus Dei Celso Morga Iruzubieta.”

Fr. Zuhlsdorf observed that Pope Francis may also be shrinking the Curial offices and thus reducing the number of Cardinals needed to fill those posts. He adds however, “It would be naïve in the extreme to think that there are lacking near Francis’s elbows those who have been sharpening their knives for Card. Burke and for anyone else associated closely with Pope Benedict.” 

“This is millennial, clerical blood sport.”

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