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A theological and ethical reflection on the practice of organ donation and transplantationcomment (0)

April 19, 2012

By Jeffrey B. Riley

A theological and ethical reflection on the practice of organ donation and transplantation


The familiar Dr. Pepper tune is stuck in my head — a sign of good advertising — but the words have changed. No longer, “I’m a Pepper, you’re a Pepper,” but, “I’m a donor, he’s a donor, she’s a donor, we’re a donor, wouldn’t you like to be a donor too?” The video, produced by the Oschner Health System and filmed in the streets and carnival atmosphere of New Orleans, uses donors and recipients of organs through transplantation to encourage you to become a donor. All that you need to do to join the “organ donor craze” is to check the donor box on your driver’s license or go online and sign up on a donor registry. Simple. Easy. Free. 

I must admit that seeing donors and recipients alike is a powerful incentive to consider organ donation. Approximately 110,000 people are waiting for an organ and on average 144 are added every day to the list. But something seems to be missing from this video and most other means used to persuade us to become organ donors: explicit moral justification. Public and private invitations to become an organ donor often say simply that it is the right thing to do. But to say that something is right begs the following ethical question: on what basis do you justify the act? Moreover, is organ donation merely permissible or is it obligatory, or perhaps supererogatory (beyond the requirements of duty)? In other words, checking a box and being listed on a registry should not be confused with ethical and theological reflection on what it means to be an organ donor.

Granted, one important point is often raised — people are dying while waiting for organs to become available. Nevertheless, not one of the 18 or so who die every day awaiting an organ can be saved by you becoming a donor, unless you are willing to be a living, matching donor. In most cases, to save a life as a donor means that you must first die, which not only brings to mind another common New Orleans tradition — the jazz funeral — but also drives the Christian to a more profound level of moral and theological reflection on the issue of organ donation.

What does it mean to have a body in life and in death? All the consequences related to organ transplantation, the profound needs, success stories, and so forth — ought to take a back seat ethically to reflection on what it means to a person’s identity to be embodied. To consider giving away body parts for someone else to use strikes at the core of our personal identity. We don’t know life and living apart from having a body. With bodies, we are born, mature, marry, live, suffer and die. With bodies, we love our Lord, spouses and families; we enjoy life, work, play and worship. With bodies, we laugh and cry, sing and suffer, hope and despair. God creates us embodied. Eventually, however, we will die. But what happens to our identity when we die?

In short, we continue to live, disembodied for a time in what theologians call “the intermediate state of the soul,” best captured by Paul’s words, “to be absent from the body is to be present with the Lord” (2 Cor. 5:8). A dead person no longer needs body parts, right? Even so, the Bible indicates that the disembodied state, what Paul calls being unclothed, is neither desired nor final, though to be in the presence of the Lord is preferred over current sufferings. Most preferred is to be in the presence of God clothed with our resurrected bodies (2 Cor. 5:1–10), a body that has a direct connection to our earthly, soulless, dead body.

The church has acknowledged historically that what happens to the body before and after death has no immediate bearing on the hope of the gospel or the promise of the resurrection of the dead. The martyrs eaten by lions or burned at the stake, the saints lost at sea or in the desert and the faithful citizen decimated in an act of war are all promised full, bodily resurrections. Southern Baptists, in a resolution (see story, page 8), defend the practice of human organ donation, stating the “complete resurrection of the body does not depend on bodily wholeness at death.”

The resurrection occurs by the power of God, not the condition of the body. Even so, the Bible indicates and Christian theology affirms that in the resurrection God does not create a new body ex nihilo (out of nothing). The resurrection is of the dead, out of the grave, sea, or dust, such that some form of continuity is maintained with our earthly bodies even though a real, resurrected body is transformed into what Paul calls a spiritual body. A spiritual body is not a ghostly, ethereal existence but is a corporeal or physical body that is completely under the power and authority of the Spirit of God and thus limited only by God Himself.

Although the resurrected body is an existence we cannot yet fully comprehend, we do an example for the kind of bodies we will have at the resurrection — Jesus Christ (1 Cor. 15). The same body placed dead in the tomb was raised from the dead on the third day and now resides in the presence of God the Father. This continuity and discontinuity between our earthly and resurrected bodies creates ethical tension in the issue of organ donation. Does donating organs jeopardize the integrity of our bodily identity?

In this life, your identity is not divided. Certainly you can lose parts of your body, but your identity is captured in the whole of who you are and will be restored in the resurrection consistently with the whole of who you ought to be. Let me try to clarify this point with two illustrations.

First our bodies are always changing physically, though our physical identities remain the same. We see this obviously in the normal maturation of the body. I mature. I change, but I’m still me. What might not be obvious, however, is that within a seven-year span, the cells in your body are replaced. All of this physical change, however, is orchestrated internally and consistently, influenced by our environment and circumstances, and located in the plans and purposes of God. Very real changes to your body are harmonized by and consistent with your identity. Physical identity will be sustained in the resurrected body such that what is lost or, for some, never had, such as experienced by those with birth defects, will be graciously restored by the power of God at the resurrection. 

A second illustration comes from my mother. When my mother had her gallbladder removed, she was told that she no longer needed it. Mom’s gallbladder was removed; her identity is still secure. The same could be said of living donors who give a kidney to someone. Their physical identity as a whole is secure even when part of their body is alive in someone else. We should insist that the identity of the deceased be maintained in the act of donation. Why? Because the hope of the bodily resurrection prevents us from saying that a dead body has no identity and therefore can be used indiscriminately as a source of body parts.

Motive also matters for the morality of organ donation. An improper motive would be: I’ll donate my organs because I’ll be dead anyway and will no longer need them. This motive alone has the same moral capital as giving your trash away and then claiming that you are a generous person. 

St. Augustine serves us well on this point. In the book, “City of God,” he writes that proper funerals are not necessary for the sake of the resurrection, for bodies and limbs “will be restored and renewed, in an instant, not only from the earth, but also from the remotest hiding-places in the other elements into which their dead bodies passed in disintegration.” Nevertheless our treatment of the dead is an opportunity to esteem the lives of those we love and to show that God is “concerned with the bodies of the dead, so as to promote faith in the resurrection.” Augustine continues, “If such things as a father’s clothes, and his ring, are dear to their children in proportion to their affection for their parents, then the actual bodies are certainly not to be treated with contempt, since we wear them in a much closer and more intimate way than any clothing.”

The practice of organ donation and transplantation must preserve the dignity of the human body, even in death. Proper motives that sustain human dignity are characterized by love, compassion and the desire to bear witness to the life giving power of Christ Jesus and to the hope of the resurrection. Jesus Christ is the great example of right motive. In giving His whole body for our eternal life, He opens the door for us to give parts of our bodies so that others might continue to live and have opportunity to know and serve God. We can be sacrificial with our bodies because we trust that the Creator and Redeemer of heaven and earth will resurrect us in full. 

What ethical conclusions can we make in light of the above tensions? 

First we should make room for the freedom of conscience. No one should be coerced into donating organs. Nevertheless tensions related to personal identity and to the prospect that the very practice of organ donation might contribute to a culture that wrongly views the human body might move Christians to reject organ donation and transplantation. 

Second given that an appropriate motivation for organ donation is love, persons should not be coerced to do something they believe might be unfaithful toward God or that would offend the weak consciences of others. As Paul said regarding things permissible, the one who doubts is condemned, and whatever is not of faith is sin (Rom. 14:23). Those who are considering organ donations must, therefore, examine their own hearts and minds and choose what they deem is right before God, demonstrating love for strangers and neighbors who are in need of organs.

The short, easy answer is that organ donation and transplantation is permissible but is not obligatory, but the starting point for the one considering donation ought to be a deep reflection on what it means to be a person with a body, who lives and dies in relationship with God, family and others. If Christians properly and faithfully consider and decide on the issue of organ donation and transplantation, then even death becomes an opportunity to show the love of God and bear witness to the hope of the gospel and of the resurrection.

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