Last Updated: Friday - 09/24/2010
Week of October 30, 2000
'A genuine act of love'
Church shows greater openness to organ donation
By ANH HOANG
WCR Staff Writer
A royal blue sticker in Karen Elgert's office reads "Don't take your organs/tissues to heaven. Heaven knows we need them here."
In Alberta, the waiting list for organ transplants is about 350 and growing everyday. This number is significant enough for Elgert to declare the need for organ donors as critical.
"It's a very important need," said Elgert, a coordinator with the HOPE (Human Organ Procurement and Exchange) Program. "You're dealing with people's lives, that's very important."
But the problem with organ donation is the small population who are eligible. Only about three per cent of deaths meet the program's criteria.
Organ donors must be declared brain dead before their organs can be transplanted. Organs on the transplant list include heart, lung, liver and kidney.
A person is dead when "in effect he is ready for the morgue. Theologically, we say his soul has left," said Sister Mary Lou Cranston, director of St. Joseph's Ethics Centre.
Medically, death is defined in the Canadian Medical Association Home Medical Encyclopedia as the irreversible cessation of all functions of the entire brain, including the brain stem.
Your body is like a computer, explained Elgert. The screen might still be on, but when the computer is shut off none of the programs will work.
"Your heart might be beating, but if your brain shuts down, there are no responses in your body," Elgert said. "(Brain death) knocks your computer dead, but your body might keep going. Your heart is beating, but you won't be responding to a touch."
But few incidents lend itself to brain death, said Elgert. These include massive head injuries, brain strokes, gunshot wounds and complications from brain surgery.
"It's not so much who can donate," Elgert said. "But not many (patients) progress to a point where they can donate."
Organ donation has not always been widely accepted in Christian churches. Many who see the body as the temple of the Holy Spirit find it sacrilegious to donate an organ or tissue. Organ donation was seen as a sign of body mutilation and as something that would reflect poorly on one's religious belief.
But Cranston said there has been a switch in Christian theology about organ transplants.
"Like everything in theology, new understandings, new possibilities in technology are changing the way we think about things."
Kidney transplants are far less risky than they were 20 years ago. As are transplants of hearts and other vital organs.
What was considered sheer mutilation is now considered treatment, said Cranston.
At an international organ transplant conference in August, Pope John Paul praised organ donation as "a genuine act of love" and one way of furthering "a genuine culture of life." He also endorsed brain death as an indicator of a potential donor's death.
Cranston said the term brain dead is sometimes a "slippery slope."
"How do I define dead? How dead is dead? What's death, what's alive?"
Cranston said these are among the questions medical professionals have to answer before determining the status of a potential organ donor.
The answer, said Cranston, lies in the time frame when a person is no longer a person, but is simply a body.
"To his family that person lying there looks like the person they know," Cranston said. "But he's hooked up to all these machines. What happens when you take all those machines away?"
Once the machines are taken away, what is left is a body, said Cranston, not a person with feelings, impulses, emotions or the skills to do what they normally did.
Although brain death determines the readiness of a body for organ transplant, Cranston said there is also the ethical issue that you also don't want "that person to be too dead, where their body starts deteriorating." There is a small window of opportunity when an organ is viable.
The issues of suicide and euthanasia also come to mind when people consider disconnecting life support, she said.
Forgoing additional treatments and dying slowly cannot be defined as suicide, said Cranston. Nor is it euthanasia when a brain dead patient is taken off life support.
At the August conference, the pope also supported the use of the "brain death" test, saying it did not appear to threaten respect for life.
He added such tests could not determine the exact moment of a patient's death, but were instead "a scientifically secure means of identifying the biological signs that a person has indeed died."
But the slippery slope of euthanasia comes into play when families start thinking about the patient's quality of life.
"You have to look at what's dead, what's alive. It's not a quality of life question. Quality of life means you're alive. If you're alive then it becomes a euthanasia issue.
"If that body on its own is not functioning in any shape or form, it is brain dead."
Elgert and Cranston said technology and the growing number of successful transplants have encouraged people to see the positive side of organ donation.
Elgert said a lot of families approach her with the idea of organ donation.
"It's certainly come to the forefront in the last four to five years. Politically it's become more upfront. More dollars are going into transplant research. In the '90s it became a standard treatment."
As a bioethicist, Cranston is often called upon to comfort families. She never brings up the subject of organ donation unless the family raises it first. Then she provides the information and options.
"People are in a very vulnerable position," she said. "If they hear that a Roman Catholic ethicist is coming to talk to them, it's already very traumatic for them.
"I could probably very easily manipulate you."
But there are still fears and misunderstandings. People often believe that signing the donor card on the back of their Alberta Health Care is sufficient. But Elgert encourages people to discuss such matters with their family. After a person's death, a family has the right to override the donor card.
Elgert said there is also the misunderstanding that doctors may be too eager to declare brain death because of the long waiting list for organ transplant patients.
"People ask if the doctor will do all they can to revive me before taking my organs. We assure them that everything possible will be done. (Doctors) don't start considering organ transplant when a patient comes in."
For more information contact the HOPE Program at 407-8411.