Organ Donation After Cardiac Death

Ioannis Pauli PP. II Summi Pontificis “Evangelium Vitae” Litterae Encyclicae Episcopis, Presbyteris et Diaconis Religiosis Viris et Mulieribus Christifidelibus Laicis Universisque Bonae Voluntatis Hominibus de Vitae Humanae Inviolabili Bono

86. As part of the spiritual worship acceptable to God (cf. Rom 12:1), the Gospel of life is to be celebrated above all in daily living, which should be filled with self-giving love for others. In this way, our lives will become a genuine and responsible acceptance of the gift of life and a heartfelt song of praise and gratitude to God who has given us this gift. This is already happening in the many different acts of selfless generosity, often humble and hidden, carried out by men and women, children and adults, the young and the old, the healthy and the sick.	86. In ratione spiritalis cultus Deo grati (Cfr. Rom. 12, 1), Evangelii vitae celebratio suam postulat effectionem praesertim in cotidiana exsistentia, quae in caritate erga alios agitur atque sui ipsius oblatione. Hac ratione tota nostra exsistentia fiet vera et officii conscia acceptio doni vitae atque sincera grataque laus in Deum qui nobis talem tribuit donationem. Quod iam accidit plurimis in signis donationis, modestae saepe et absconditae, quae primos exhibent actores viros et mulieres, parvulos et adultos, iuvenes et seniores, sanos et aegrotos.
It is in this context, so humanly rich and filled with love, that heroic actions too are born. These are the most solemn celebration of the Gospel of life, for they proclaim it by the total gift of self. They are the radiant manifestation of the highest degree of love, which is to give one’s life for the person loved (cf. Jn 15:13). They are a sharing in the mystery of the Cross, in which Jesus reveals the value of every person, and how life attains its fullness in the sincere gift of self. Over and above such outstanding moments, there is an everyday heroism, made up of gestures of sharing, big or small, which build up an authentic culture of life.	Hoc in rerum contextu, humanitatis caritatisque pleno, heroicae oriuntur res gestae. Quae sunt sollemnissima Evangelii vitae celebratio, utpote quae illud tota sui ipsius donatione proclament; sunt clara supremae caritatis significatio, actio scilicet ponendi vitam pro amico dilecto (Cfr. Io. 15, 13); sunt mysterii Crucis participatio, qua Iesus patefacit quantum pretium habeat sibi vita cuiusque hominis atque quo modo ea in sincerae sui ipsius donationis plenitudine efficiatur. Praeter facta celebria rerum cotidianarum exstat heroica virtus, quae parvis magnisve constat beneficentiae actibus unde verus alitur vitae cultus.
A particularly praiseworthy example of such gestures is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope.	Quos inter plurimi ducenda est organorum donatio rationibus ethica disciplina probabilibus effecta, ut salutis vel etiam vitae ipsius opportunitas aegris praebeatur omni nonnumquam spe destitutis.

2296 Organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as a expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons.

2296 Organorum transplantatio legi morali est conformis, si pericula et discrimina physica atque psychica quae donans subit, bono sunt proportionata quod pro eo quaeritur cui illa destinatur. Donatio organorum post mortem est actus nobilis et meritorius atque alliciendus tamquam generosae solidarietatis manifestatio. Moraliter acceptabilis non est, si donans vel eius propinqui ius ad id habentes suum explicitum non dederint consensum. Praeterea nequit moraliter admitti, mutilationem, quae invalidum reddit, vel mortem directe provocare, etiamsi id fiat pro aliarum personarum retardanda morte.

Organ donation is a peculiar form of witness to charity. In a period like ours, often marked by various forms of selfishness, it is ever more urgent to understand how the logic of free giving is vital to a correct conception of life. Indeed, a responsibility of love and charity exist that commits one to make of their own life a gift to others, if one truly wishes to fulfil oneself. As the Lord Jesus has taught us, only whoever gives his own life can save it (cf. Lk 9: 24). In greeting all those present, with a particular thought for Senator Maurizio Sacconi, Minister of Labour, Health and Social Policies, I thanks Archbishop Rino Fisichella, President of the Pontifical Academy for Life, for the words he has addressed to me illustrating the profound meaning of this meeting and presenting the synthesis of the Congress’ works. Together with him I also thank the President of the International Federation of Catholic Medical Associations and the Director of the Centro Nazionale Trapianti, underlining my appreciation of the value of the collaboration of these Organizations in an area like that of organ transplants which, distinguished Ladies and Gentlemen, has been the object of your days of study and debate.

Medical history clearly shows the great progress that it has been possible to accomplish to ensure to each person who suffers an ever more worthy life. Tissue and organ transplants represent a great victory for medical science and are certainly a sign of hope for many patients who are experiencing grave and sometimes extreme clinical situations. If we broaden our gaze to the entire world it is easy to identify the many and complex cases in which, thanks to the technique of the transplantation of organs, many people have survived very critical phases and have been restored to the joy of life. This could never have happened if the committed doctors and qualified researchers had not been able to count on the generosity and altruism of those who have donated their organs. The problem of the availability of vital organs to transplant, unfortunately, is not theoretic, but dramatically practical; it is shown by the long waiting lists of many sick people whose sole possibility for survival is linked to the meagre offers that do not correspond to the objective need.

It is helpful, above all in today’s context, to return to reflect on this scientific breakthrough, to prevent the multiple requests for transplants from subverting the ethical principles that are at its base. As I said in my first Encyclical, the body can never be considered a mere object (cf. Deus Caritas Est, n. 5); otherwise the logic of the market would gain the upper hand. The body of each person, together with the spirit that has been given to each one singly constitutes an inseparable unity in which the image of God himself is imprinted. Prescinding from this dimension leads to a perspective incapable of grasping the totality of the mystery present in each one. Therefore, it is necessary to put respect for the dignity of the person and the protection of his/her personal identity in the first place. As regards the practice of organ transplants, it means that someone can give only if he/she is not placing his/her own health and identity in serious danger, and only for a morally valid and proportional reason. The possibility of organ sales, as well as the adoption of discriminatory and utilitarian criteria, would greatly clash with the underlying meaning of the gift that would place it out of consideration, qualifying it as a morally illicit act. Transplant abuses and their trafficking, which often involve innocent people like babies, must find the scientific and medical community ready to unite in rejecting such unacceptable practices. Therefore they are to be decisively condemned as abominable. The same ethical principle is to be repeated when one wishes to touch upon creation and destroy the human embryo destined for a therapeutic purpose. The simple idea of considering the embryo as “therapeutic material” contradicts the cultural, civil and ethical foundations upon which the dignity of the person rests.

It often happens that organ transplantation techniques take place with a totally free act on the part of the parents of patients in which death has been certified. In these cases, informed consent is the condition subject to freedom, for the transplant to have the characteristic of a gift and is not to be interpreted as an act of coercion or exploitation. It is helpful to remember, however, that the individual vital organs cannot be extracted except ex cadavere, which, moreover, possesses its own dignity that must be respected. In these years science has accomplished further progress in certifying the death of the patient. It is good, therefore, that the results attained receive the consent of the entire scientific community in order to further research for solutions that give certainty to all. In an area such as this, in fact, there cannot be the slightest suspicion of arbitration and where certainty has not been attained the principle of precaution must prevail. This is why it is useful to promote research and interdisciplinary reflection to place public opinion before the most transparent truth on the anthropological, social, ethical and juridical implications of the practice of transplantation.
However, in these cases the principal criteria of respect for the life of the donator must always prevail so that the extraction of organs be performed only in the case of his/her true death (cf. Compendium of the Catechism of the Catholic Church, n. 476). The act of love which is expressed with the gift on one’s vital organs remains a genuine testimony of charity that is able to look beyond death so that life always wins. The recipient of this gesture must be well aware of its value. He is the receiver of a gift that goes far beyond the therapeutic benefit. In fact, what he/she receives, before being an organ, is a witness of love that must raise an equally generous response, so as to increase the culture of gift and free giving.

The right road to follow, until science is able to discover other new forms and more advanced therapies, must be the formation and the spreading of a culture of solidarity that is open to all and does not exclude anyone. A medical transplantation corresponds to an ethic of donation that demands on the part of all the commitment to invest every possible effort in formation and information, to make the conscience ever more sensitive to an issue that directly touches the life of many people. Therefore it will be necessary to reject prejudices and misunderstandings, widespread indifference and fear to substitute them with certainty and guarantees in order to permit an ever more heightened and diffuse awareness of the great gift of life in everyone. With these sentiments, while I wish each one to continue in his/her own commitment with the due competence and professionalism, I invoke the help of God on the Congress’ works and I impart to all my warm Blessing.

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.

POPE BENEDICT XVI has long championed organ transplants, but don’t expect an organ donation from him. The Vatican says his body belongs to the whole church. While the former Cardinal Joseph Ratzinger has possessed an organ donor card since the 1970s when he lived in Germany, it was rendered void when he became pope in 2005, his secretary said.

Monsignor Georg Gaenswein addressed the issue in a letter to a German doctor who has been using the fact that Benedict possessed a donor card to recruit other donors. Vatican Radio reported on the letter in a German language broadcast this week. Gaenswein sought to put the matter to rest, saying any references to the now invalid document are mistaken.

Polish Archbishop Zygmunt Zimowski, head of the Vatican’s health office, told La Repubblica newspaper that it was understandable that a pope’s body remains intact because it belongs to the entire church.

“It is also understandable in view of possible future veneration,” he said, referring to future sainthood. “This doesn’t take anything away from the validity and the beauty of the gift of organ donation.”

In a 2008 speech, Benedict lamented the shortage of organs for transplants, but denounced any selling of organs as immoral.

Until the last century papal organs were removed - not for transplants but to make embalming more durable. The organs of 22 popes are preserved as relics in the church of Saints Anastasio and Vincent near the Trevi Fountain in Rome. The custom of removing the organs was abolished by Pope Pius X in the early 1900s. The collection includes the liver, spleen and pancreas of the popes.

When Pope John Paul II died in 2005, the Vatican denied that some of his organs would be sent to his native Poland as relics. He is buried at the Vatican. [N.B a medical vial of his blood, drawn by a phlebotomist shortly before his death, was venerated as part of the process of beatification in May, 2011; a second vial was subsequently sent to Poland]

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Reliquary of the blood	of Pope Saint John Paul II,	Beatification Liturgy