Denise J. Hunnell, MD

Opinion

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

Denise J. 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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‘Little miracles’: Mom gives birth to naturally-conceived quintuplets after refusing ‘selective reduction’

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An ultrasound of the five different compartments, each with its own baby, inside Kim's womb.

AUSTRALIA, February 5, 2016 (LifeSiteNews) -- A 26-year-old Australian mom has given birth to five healthy babies, all conceived naturally, after refusing the doctor’s advice that she must abort three of them in order to give the remaining two a better chance at life. 

“After my initial ultrasound I was told I could consider the selection method to give 2 babies the best chance in life,” wrote mom Kim Tucci in a Facebook post last September. 

“I watched a YouTube video on the procedure and I cried. I could never do that! Was I selfish for not giving two the chance of 100% survival? All I knew is that I already love them and that every heart beat I heard I connect with them more. For me life starts when a heart starts beating and all I know for sure is that I will do whatever it takes to bring them into this world healthy,” she wrote. 

Last Thursday Kim and her husband Vaughn welcomed the five new members into their family — one boy and four girls —increasing the number of their children from 3 to 8. The babies were born at 30 weeks, 10 weeks early, due to insufficient space in Kim’s womb. They weighed on average about 2.5 pounds. 

The quintuplets’ story began last March, after Kim and Vaughn had been trying for six months to conceive just one more child for their family. Due to health complications, Kim wondered if she would ever become a mother again. 

After what she thought was an extra long cycle, she decided to take a pregnancy test. 

“I was feeling tired and a little nauseated and thought I would take a pregnancy test just to get the ‘what if’ out of my head. To my shock and utter excitement it was positive,” she wrote on a Facebook post.

The parents got the shock of their lives when doctors confirmed in an ultrasound examination that there was not one baby, but five. 

“After a long wait for the ultrasound we finally went in. The sonographer told me there were multiple gestational sacks, but she could only see a heart beat in two. I was so excited! Twins!”

“I was moved to another machine for a clearer view and had the head doctor come in and double check the findings. She started to count, one, two, three, four, five. Did i hear that correctly? Five? My legs start to shake uncontrollably and all i can do is laugh. The sonographer then told me the term for five is ‘quintuplets,’” Kim wrote.

Even though Kim began to feel stretched to the limit with all those human lives growing inside her, she chose to focus on her babies, and not herself, referring to them as “my five little miracles.” 

“It's getting harder as each day passes to push through the pain, every part of my body aches and sleeping is becoming very painful. No amount of pillows are helping support my back and belly. Sometimes I get so upset that I just want to throw my hands up and give in.”

“Sometimes my pelvis becomes so stiff I can barely walk and my hips feel like they are grinding away constantly. I'm finding it hard to eat as I basically have no room left in my stomach, and the way it is positioned it's pushed all the way back with the babies leaning against it.” 

“My skin on my belly is so stretched its painful and hot to touch. It literally feels like I have hives! No amount of cream helps relieve the discomfort. I have a lot of stretch marks now. Dealing with such a huge change in my body is hard.” 

“Is it all worth it? Yes!!!! I will keep pushing through,” she wrote in one Facebook post days before the babies were born. 

The newborns' names are Keith, Ali, Penelope, Tiffany, and Beatrix. They were born at King Edward Memorial Hospital in Subiaco, Western Australia. Mother and babies are reported to be doing well. 



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UN rights chief tells Catholic countries to legalize abortion over Zika virus: bishops and cardinal react

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GENEVA, February 5, 2016 (LifeSiteNews) -- The United Nations, following the lead of international abortion activists, is now urging Latin American countries hit by the mosquito-borne Zika virus to lift restrictions on abortion for pregnant women who have contacted the virus and whose pre-born children may be at risk for birth defects, including having smaller than normal heads. 

The UN human rights office said today that it is not enough for South American countries to urge women to postpone pregnancy without also offering them abortion as a final solution. 

“How can they ask these women not to become pregnant, but not offer… the possibility to stop their pregnancies?” UN spokeswoman Cecile Pouilly told reporters. 

UN human rights chief Zeid Ra’ad al-Hussein said that governments should make available contraception and abortion services.

“Laws and policies that restrict (women’s) access to these services must be urgently reviewed in line with human rights obligations in order to ensure the right to health for all in practice,” he said.

But Brazil’s bishops strongly asserted yesterday that efforts should be made to eradicate the virus, not the people who may be infected by it. 

The disease is “no justification whatsoever to promote abortion,” they said in a statement, adding that it is not morally acceptable to promote abortion “in the cases of microcephaly, as, unfortunately, some groups are proposing to the Supreme Federal Court, in a total lack of respect for the gift of life.”

Honduras Cardinal Oscar Rodriguez Maradiaga has also come out strongly against the notion of “therapeutic abortions” as a response to the problem. Unlike Brazil where abortion is legal in the case of rape or health of the mother, abortion remains entirely illegal in Honduras.

“We should never talk about ‘therapeutic’ abortion,” the cardinal said in a homily at a February 3 Mass in Suyap. “Therapeutic abortion doesn’t exist. Therapeutic means curing, and abortion cures nothing. It takes innocent lives,” he said. 

While the World Health Organization (WHO) declared an international public health emergency February 1 on account of concerns over the virus, critics have pointed out, however, that not one death as resulted from the virus. Even on WHO’s own website the virus is described in mild terms. 

“It causes mild fever and rash. Other symptoms include muscle pain, joint pain, headache, pain behind the eyes and conjunctivitis. Zika virus disease is usually mild, with symptoms lasting only a few days,” the website states. “To date, there have been no reported deaths associated with Zika virus,” it added. 

Critics suspect that the crisis is being manipulated to advance an anti-human agenda on the pre-born. 

“Is Zika, actually, a hideous virus that threatens to spread uncontrollably across the world creating an army of disabled children with tiny heads and low IQ’s? Or might this be a willful misinterpretation of the scarce data to manipulate public opinion and legislatures?” wrote pro-life critic Mei-Li Garcia earlier this week.

“It becomes very clear that the publicity surrounding this story has a very little to do with medicine and a lot to do with a convenient crisis that is being used by those pushing for the legalization of abortion around the world,” she wrote.



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Hillary’s litmus test for Supreme Court picks: They must ‘preserve Roe v. Wade’

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DERRY, NH, February 5, 2016 (LifeSiteNews) - Hillary Clinton has a litmus test for Supreme Court nominees - several, in fact. At a Democratic event on Wednesday, Clinton unveiled her criteria in selecting a judge for the nation's highest court.

“I do have a litmus test, I have a bunch of litmus tests," she said.

"We’ve got to make sure to preserve Roe v. Wade, not let it be nibbled away or repealed,” she said.

There have been over 58,000,000 abortions since the 1973 court ruling legalizing abortion in all 50 states, according to National Right to Life.

That echoes her recent call to arms speech before Planned Parenthood last month, when she stated that taxpayers must fund abortion-on-demand in order to uphold the "right" of choice.

“We have to preserve marriage equality,” Clinton said, referring to last summer's Obergefell v. Hodges case, a 5-4 ruling that redefined marriage nationwide. “We have to go further to end discrimination against the LGBT community."

Her views differentiate her from the Republican front runners. Ted Cruz has called the court's marriage ruling "fundamentally illegitimate," and Donald Trump told Fox News Sunday this week that he would "be very strong on putting certain judges on the bench that I think maybe could change things." Marco Rubio has said he won't "concede" the issue to the one-vote majority.

All Republican presidential hopefuls say they are pro-life and will defund Planned Parenthood.

Her husband, Bill Clinton, raised the makeup of the Supreme Court early last month in New Hampshire, saying it receives "almost no attention" as a campaign issue.

On Wednesday, Hillary said "the next president could get as many as three appointments. It’s one of the many reasons why we can’t turn the White House over to the Republicans again.”

Clinton said her judicial appointees must also reverse the Citizens United ruling on campaign finance and oppose a recent decision striking down a portion of the 1965 Voting Rights Act. In 2013's Shelby County v. Holder, justices struck down Section 4(b) of the act, which said that certain states and jurisdictions had to obtain permission from the federal government before changing their voting laws.

At one time, most politicians frowned upon any "litmus test" for judicial nominees, emphasizing the independence of the third branch of government. "I don't believe in litmus tests," Jeb Bush told Chuck Todd last November.

But with the rise of an activist judiciary in the middle of the 20th century, constitutionalists have sought to rein in the power of the bench.



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