In light of our recent Journal Club discussion on organ donation after circulatory death and normothermic regional perfusion (original post and follow-up), we wanted to make mention of two things.

First, the Catechism provides guidance regarding organ donation:

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 that is sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as an 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 directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons.

There is a lot here to be unpacked here. For our purposes, the important phrase is “after death.” One concern that has been raised in the literature, and was discussed during Journal Club, is whether or not we can have moral certainty of a person is (truly) dead under the conditions that allow for legal organ retrieval. There is reason to be concerned that many/most state laws do NOT allow for that moral certainty of death for either donation after circulatory death (DCD) or after death by neurologic criteria (commonly called “brain death”). This is, to say the least, troubling.

Add to this is extremely disturbing details of normothermic regional perfusion (NRP), especially the clamping of the carotid and vertebral arteries before the heart is restarted to avoid “accidentally” brining the (so-called) dead person back to life(?) by reprofusing the brain…and the situation becomes only more troubling.

Second, the FAQ on the NYS Donate Life Registry website is very clear that the little heart on NYS driver licenses (including very likely on yours) carries quite a bit of legal weight:

What if I am a registered donor, but my family is opposed?
If you are 18 or older enrolled in the Registry, your decision to donate must be honored if medically possible.

• State and federal laws support your rights to be an organ, eye and tissue donor.
• If you are in the Registry, your family will be told of your decision, and given information about the process, but their permission is not needed for the donation to proceed.
• Most families of registered donors are happy to know their loved one made this decision. They follow their wishes.
• If you are 16 or 17 at the time of your death, your parents or legal guardians can revoke your decision to be a donor. The consent to donate for people enrolled in the Registry that are 18 years of age or older can only be revoked by the enrollee themselves.

So we have a very unfortunate combination of: 1) organ donation is, in principle “a noble and meritorious act,” 2) there is legitimate worry that living humans are (at least possibly in some cases and not intentionally) being killed by having their organs removed, 3) having checked the “organ donor” consent box when we first received our license (likely at age 16 or 17) can legally override a family’s opposition to having their loved one under organ donation of circulatory or brain (so-called) death.

Navigating this is truly a challenge. There are people alive today because of organ donation…and…we have to look a very difficult question in the face and answer it honestly: “Are we (even inadvertently) killing people for their organs.”