by Mark Moran
Mr. Moran is associate editor for International Medical News Group, with offices in Rockville, Maryland.
This article appeared in the Christian Century, June 18, 1986, p. 572. Copyright by the Christian Century Foundation and used by permission. Current articles and subscription information can be found at www.christiancentury.org. This material was prepared for Religion Online by Ted & Winnie Brock.
The need for human organs is acute, and pastors should be able to broach the sensitive subject of organ donation during bereavement counseling. However, organ donation is best facilitated by confronting the question before a tragedy occurs.
Rarely in recent history has there been a scientific advancement that has not shaken the foundations of Judeo-Christian faith. And hardly ever has scientific virtuosity actually invited a reaffirmation of basic Christian themes or opened up new possibilities for their application.
However, the transplantation of human organs and the possibility of organ donation may be a watershed in the relationship between science and Christian ethics. The option of organ donation gives Christians a concrete opportunity to act as "people of the resurrection" by passing on the gift of life.
With this need in mind, pastors and ethicists organized a day-long conference in mid-April on "Organ and Tissue Donation: Role of the Ministry" to inform pastors about the current need for donor organs and to help them approach the topic of organ donation during bereavement counseling.
The need for organs is acute. An estimated 7,000 people are waiting for kidney transplants, 40 for hearts, 175 for livers and 30 for pancreata. More than 3,000 people need corneal transplants, and, if there were no shortage of tissue, an additional 100,000 skin grafts could be performed each year to help burn victims.
Arthur R. Lillicrop III, of the pastoral counseling center at the Washington Hospital Center (which hosted the conference) , told participants that the gap between the number of organ donors and the number of potential recipients is ripe for redress by Christians. "I feel the community that can narrow this gap is the religious community," he said. "A pastoral mode of education is greatly needed on the local church level where people can think through, pray through and make preparations well in advance of their own deaths for organ donation."
Most transplantable organs come from individuals who have been killed in accidents (automobile collision, shooting or drowning) that result in "brain death" but leave vital organs such as the heart, liver, kidney and pancreas intact. Physicians are understandably reluctant to approach family members at the worst moment of their lives to ask them to donate a loved one’s organs. Consequently, many hospitals are turning to ministers, priests, rabbis and social workers to request organ donations from grieving families.
Asking a grieving family to donate a loved one’s organs -- with its intimations of "body snatching" -- is not a simple matter. "The task requires a pastoral alliance that is based on trust, faith and risking," Lillicrop said. "One must be person-centered, empathic and able to respond to the feelings of the client or family."
Daniel G. Smith, Washington Hospital Center’s transplant coordinator, said that when he began asking for donations, he couldn’t help wondering if he was doing more harm than good. "Here’s a man who has just lost his only daughter. How much more can you lose?" he said. "Then I come along and ask him to donate the child’s organs. It took me a while to realize that we aren’t really taking something away, but that we are giving something back."
Smith admitted that it can be frustrating when a family refuses to donate. However, he is careful not to influence decisions one way or the other. "My intent is not to get them to agree to donate, but to have an educated choice," he explained. John Fletcher of the Bioethics Program at the Clinical Center of the National Institutes of Health added that a grieving family overwhelmed with anger and frustration is apt to blame not only a transplant coordinator, but also the physician who failed to keep the loved one alive. Ultimately, the family may blame God. Hence, a pastor involved in bereavement counseling must confront the difficulty of explaining the ways of God to humans. The option of organ donation may actually help resolve a family’s anger over the death, allowing them the chance to forgive, Fletcher said.
Several political options are being considered to increase the number of donor organs. Yet physicians and ethicists agree that donating must always be a choice, not a requirement. The notion that the human body and its parts are automatically interchangeable, or that a physician has a presumptive right to remove an organ, raises serious religious, moral and philosophical questions.
Nevertheless, some physicians have advocated a policy of "presumed consent," which they say will still respect the rights of those who don’t want to donate. At a conference on transplantation last year sponsored by the American College of Legal Medicine, Thomas Starzl endorsed a policy of presumed consent, which allows physicians to retrieve organs unless the deceased opted out by specifically stating an opposition to organ donation prior to death. Dr. Starzl, a prominent transplant surgeon from the University of Pittsburgh School of Medicine, suggested that drivers’ licenses could be used for this purpose.
At that same conference, however, Arthur Caplan of the Hastings Center countered that presumed consent is fraught with legal and ethical traps. "It will only take one case in which someone’s decision not to donate is overlooked or ignored," he admonished, "to put an end to presumed consent for good."
More popular with both physicians and ethicists is the policy of "required request," mandating that hospitals ask families about organ donation in every case of brain death. Many hospitals across the country have voluntarily adopted such a policy, and several states have enacted or have pending required-request legislation.
"The beauty of required request is that it takes the question of organ transplantation out of the realm of the extraordinary," Smith said. "The public still thinks of transplantation as something highly unusual, but the possibility of organ donation needs to be thought of as a natural part of the process of dying."
It is roundly agreed that a family’s decision about organ donation is best facilitated by confronting the question before a tragedy occurs. Lillicrop described how his former Episcopal parish sponsored an annual organ and tissue donor Sunday, with an adult forum focusing on the issue. Parishioners were asked to sign an organ donor card and present it as a symbolic offering during the worship service.
Lillicrop -- who is himself a three-time corneal transplant patient -- testified that the transplant that allowed him to regain his sight was nothing less than a miracle. "Words like incarnation and resurrection started taking on new meaning for me when I thought of someone’s death giving me a new life," he said. "Surely this is what we are all supporting and working for in our journey as a risen community. It was a spiritual healing that reflects the dreams shared by a Nazarene who said there is ‘no greater love than that a man lay down his life for his friends."’