Paul A. Byrne, M.D.
Vital organ transplantation- -not truly dead
By Paul A. Byrne, M.D. and Peter Damian Fehlner, F.I., S.T.D.
Blessed John Paul II wrote in Evangelium Vitae: "Nothing and no one can in any way permit the killing of an innocent human being, whether a fetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. Furthermore, no one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly " (Ev. Vitae 52). On Feb 11, 2003, World Day of the Sick, His Holiness stated, "Every therapeutic procedure, all experimentation and every transplant must take into account this fundamental truth. Thus it is never licit to kill one human being in order to save another."
Pope John Paul II's Address to the Pontifical Academy of Sciences February 3-4, 2005 included, "It is well known that the moment of death for each person consists in the definitive loss of the constitutive unity of body and spirit. Each human being, in fact, is alive precisely insofar as he or she is 'corpore et anima unus' (Gaudium et Spes, 14), and he or she remains so for as long as this substantial unity-in-totality subsists."
Many in support of vital organ transplantation base their position on the August 29, 2000, Address by Pope John Paul II: "This consists in establishing, according to clearly determined parameters commonly held by the international scientific community, the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity."
A survey of the leading neurological institutions showed that there is no consensus of the many (more than 30, probably 100, or even more) disparate sets of criteria (Neurology, Jan 2010). Then, in Neurology, July 2010, it was published that "brain death" is not evidence based. Thus, for "brain death" can there be "clearly defined parameters commonly held by the international scientific community"? ["Evidence based is the modern standard that doctors are encouraged to follow; but it doesn't exist for "brain death"!]
Many misconceptions about criteria for determining "brain death" revolve around "irreversibility." Irreversibility cannot be observed by a doctor like a change in function or even destruction of tissue or an organ. Thus, "irreversibility cannot serve as evidence, nor can it rightly be made part of an observable criterion of death." [1]
A presumption of irreversibility of a lack of brain functioning, even if "cerebrum, cerebellum and brain-stem" are included, is insufficient grounds for removing a patient's vital organs or for immediate autopsy, cremation, or burial. Even though cerebellum is included, none of the many sets of criteria include evaluation of the cerebellum.
ABSOLUTE irreversibility of brain functioning, among other characteristics of a cadaver, reflects the fact of death. But such irreversibility can be known by us only if we already know the fact of death. Death is the criterion of absolute irreversibility, not vice-versa. RELATIVE irreversibility, viz., relative to our capacity to reverse the non-functional character of this brain, is not a criterion of death. If we are not sure of absolute irreversibility, then we are not sure that real death, as distinct from a clinical declaration of "brain death," "heart death," "as good as dead," "soon to be dead," etc., has occurred. Without such certainty organ extraction cannot begin without violating the fifth commandment.
The declaration of Pope John Paul II is a conditional one that has not been met because there are no "clearly determined parameters commonly held by the international scientific community."
Pope Benedict XVI on November 7, 2008 specified: "Individual vital organs cannot be extracted except ex cadavere." Pope Benedict XVI made his teaching clear and specific by using Latin, "ex cadavere," which translates as "from a dead body." Pope Benedict continued, "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)." Thus, Pope Benedict is very clear, vital organs cannot be taken except from a dead body after his/her true death. A dead body does not have a beating heart, circulation and respiration.
Genuine certainty must exist prior to any declaration of death. A very simple test of the certainty that this key condition concerning "brain death" has been fulfilled is the following: could it be wrong and is it often wrong? If the reply is yes, then the condition required for moral certainty to be genuine certainty in the sense of Pope John Paul II and Pope Benedict XVI, namely that this human body is not a living body, but is a cadaver, has not been realized. Can there be certainty of any kind if one would say a cadaver has a beating heart, circulation, and respiration? A cadaver (dead body) does not and cannot have signs of life like a beating heart, circulation and respiration; a cadaver is suitable for autopsy, embalming, cremation and burial.
Over time it has become clear that "brain death" is not true death. Many do not accept that "brain death" is true death. These include: "Brain Death is Not Death: A Critique of the Concept, Criterion, and Tests of Brain Death" [2] Rix, 1990; McCullagh, 1993; Evans, 1994; Jones, 1995; Watanabe, 1997; Cranford, 1998; Potts et al., 2000; Taylor, 1997; Reuter, 2001; Lock, 2002; Byrne and Weaver, 2004; Zamperetti et al., 2004; de Mattei, 2006; Joffe, 2007; Truog, 2007; Karakatsanis, 2008; and Verheijde et al., 2009. Even the President's Council on Bioethics (2008) in its white paper, has rejected "brain death" as true death.
There are many news accounts of people recovering after a declaration of "brain dead." [3] Zack Dunlap from Oklahoma was declared "brain dead." There was no blood flow to his brain as evidenced by a PET scan. The helicopter was landing to extract Zack's organs. A cousin who is a nurse in the ICU did another test. A response was observed. The transplant was stopped. This and others were recorded for the national and international community. Even one such patient should be enough to wake people up to the fact "brain death" is not true death. And there are many!
NOTES:
Answer (A): To make this vital decision, you must be well informed about what is required to be an organ donor.
Q: Which organs can be transplanted?
A: Heart, lungs, liver, kidneys, pancreas, and intestine can be transplanted — all are vital organs. To be suitable for transplantation these organs must be healthy.
Q: Who has healthy organs?
A: Only living persons have healthy organs. Organs are taken from persons of all ages, but especially desirable are those who are 16 to 30 years of age. When there is brain injury, persons 16-30 years are prime candidates to have their organs taken. This is because these younger people have the healthiest organs. Their life is in jeopardy!
Q: After true death (Latin: cadaver, mors vera, mors realis, distinguished from apparent death mors apparens) can vital organs be healthy and suitable for transplantation?
A: No. After true death (mors vera) vital organs are so damaged that organs cannot be transplanted. After circulation and respiration has stopped, within 4-5 minutes the heart and liver are corrupted to such a degree that they are not suitable for transplantation. For kidneys this time is about 30 minutes. After true death skin, bones, cornea, veins, heart valves and connective tissues can be transplanted. Note that these are tissues, not organs.
Q: Then why are we asked to be an organ donor if they won't wait until we are truly dead?
A: After true death, no organs can be transplanted. Those applicants for a learner's or driver's permit are not informed about the risks of being declared "brain dead" or "heart dead" rather than being truly dead. Thus, when organs are taken all donors are living and not truly dead. Donors are paralyzed or given an anesthetic to keep them from moving and squirming when cut to take their organs.
Q: What is "brain death"?
A: "Brain death" revolves around cessation of neurological functioning while heart beat, circulation and respiration continue, although supported by a ventilator. "Brain death" was concocted to get beating hearts for transplantation. In 1968 the Harvard Criteria was the first set of "brain death" criteria to get beating hearts for transplantation. These donors are called heart beating donors or DBD (donation by "brain death"). 30 disparate sets of criteria were published by 1978 and many more since then. Each new set of criteria tends to be less strict than previous sets. A person can be declared 'brain dead" by one set but be alive by the other sets. The declaration of "brain death" legally is "in accordance with accepted medical standards" (Uniform Determination of Death Act). "Major differences exist in brain death guidelines among the leading neurologic hospitals in the United States" (Neurology January 2008). There is no consensus as to which set of criteria is used. Criteria to declare "brain death" are not evidenced-based (Neurology July, 2010). Thus, there are no "clearly determined parameters commonly held by the international scientific community, [for] the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem)" (Within quotations is from Address by Pope John Paul II, August 29, 2000).
Q: What is donation by cardiac death (DCD)?
A: Such donors have a functioning brain and do not fulfill any "brain death" criteria but the desire is to get their organs. First, a Do Not Resuscitate (DNR) is obtained. The patient is taken off the ventilator for 10 minutes; the patient's respiratory rate, inspiratory effort, age and other parameters are scored. This is known as the Wisconsin Score, which is used to predict (60 or 120 minutes after the ventilator is taken away for the second time) when the patient will be without a pulse. Note that the donor-patient's heart continues to beat, but the heart beat is not strong enough for a pulse to be recorded. When there is no pulse for 5, 2 or 1.25 minutes (depending on the locale), this is the signal to take the organs. The 1.25 minutes (75 seconds) was the time without pulse for 2 babies in Colorado when their beating heart was cut out and transplanted (NEJM 8-14-10). Their hearts never stopped beating; the beating heart was cut out and continues to beat in the recipient!
Q: What happens to the donor after vital organs are taken?
A: After the organ(s) is (are) excised the donor is then either truly dead, e.g., after the heart is excised, or weakened after one of two kidneys or part of whole liver is excised.
Q: What happens to the recipient?
A: The recipient must take anti-rejection drugs for the rest of his/her life. These are anti-immune, anti-nature drugs. The recipient exchanges one set of problems for another set of problems.
Q: What is the moral teaching of Pope Benedict XVI on this topic?
A: "Individual vital organs cannot be extracted except ex cadavere. . . "
"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).
Q: What does the Catechism of the Catholic Church teach about this?
A: Article 5 The Fifth Commandment, Section 2296 states: "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 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 to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons." (Bold and underline added by author.)
Q: Now, do you WISH to be an organ donor?
A: After full and explicit information is obtained, it seems one cannot be an organ donor.
© Paul A. Byrne, M.D. and Peter Damian Fehlner, F.I., S.T.D.
August 18, 2011
Blessed John Paul II wrote in Evangelium Vitae: "Nothing and no one can in any way permit the killing of an innocent human being, whether a fetus or an embryo, an infant or an adult, an old person, or one suffering from an incurable disease, or a person who is dying. Furthermore, no one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly " (Ev. Vitae 52). On Feb 11, 2003, World Day of the Sick, His Holiness stated, "Every therapeutic procedure, all experimentation and every transplant must take into account this fundamental truth. Thus it is never licit to kill one human being in order to save another."
Pope John Paul II's Address to the Pontifical Academy of Sciences February 3-4, 2005 included, "It is well known that the moment of death for each person consists in the definitive loss of the constitutive unity of body and spirit. Each human being, in fact, is alive precisely insofar as he or she is 'corpore et anima unus' (Gaudium et Spes, 14), and he or she remains so for as long as this substantial unity-in-totality subsists."
Many in support of vital organ transplantation base their position on the August 29, 2000, Address by Pope John Paul II: "This consists in establishing, according to clearly determined parameters commonly held by the international scientific community, the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity."
A survey of the leading neurological institutions showed that there is no consensus of the many (more than 30, probably 100, or even more) disparate sets of criteria (Neurology, Jan 2010). Then, in Neurology, July 2010, it was published that "brain death" is not evidence based. Thus, for "brain death" can there be "clearly defined parameters commonly held by the international scientific community"? ["Evidence based is the modern standard that doctors are encouraged to follow; but it doesn't exist for "brain death"!]
Many misconceptions about criteria for determining "brain death" revolve around "irreversibility." Irreversibility cannot be observed by a doctor like a change in function or even destruction of tissue or an organ. Thus, "irreversibility cannot serve as evidence, nor can it rightly be made part of an observable criterion of death." [1]
A presumption of irreversibility of a lack of brain functioning, even if "cerebrum, cerebellum and brain-stem" are included, is insufficient grounds for removing a patient's vital organs or for immediate autopsy, cremation, or burial. Even though cerebellum is included, none of the many sets of criteria include evaluation of the cerebellum.
ABSOLUTE irreversibility of brain functioning, among other characteristics of a cadaver, reflects the fact of death. But such irreversibility can be known by us only if we already know the fact of death. Death is the criterion of absolute irreversibility, not vice-versa. RELATIVE irreversibility, viz., relative to our capacity to reverse the non-functional character of this brain, is not a criterion of death. If we are not sure of absolute irreversibility, then we are not sure that real death, as distinct from a clinical declaration of "brain death," "heart death," "as good as dead," "soon to be dead," etc., has occurred. Without such certainty organ extraction cannot begin without violating the fifth commandment.
The declaration of Pope John Paul II is a conditional one that has not been met because there are no "clearly determined parameters commonly held by the international scientific community."
Pope Benedict XVI on November 7, 2008 specified: "Individual vital organs cannot be extracted except ex cadavere." Pope Benedict XVI made his teaching clear and specific by using Latin, "ex cadavere," which translates as "from a dead body." Pope Benedict continued, "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)." Thus, Pope Benedict is very clear, vital organs cannot be taken except from a dead body after his/her true death. A dead body does not have a beating heart, circulation and respiration.
Genuine certainty must exist prior to any declaration of death. A very simple test of the certainty that this key condition concerning "brain death" has been fulfilled is the following: could it be wrong and is it often wrong? If the reply is yes, then the condition required for moral certainty to be genuine certainty in the sense of Pope John Paul II and Pope Benedict XVI, namely that this human body is not a living body, but is a cadaver, has not been realized. Can there be certainty of any kind if one would say a cadaver has a beating heart, circulation, and respiration? A cadaver (dead body) does not and cannot have signs of life like a beating heart, circulation and respiration; a cadaver is suitable for autopsy, embalming, cremation and burial.
Over time it has become clear that "brain death" is not true death. Many do not accept that "brain death" is true death. These include: "Brain Death is Not Death: A Critique of the Concept, Criterion, and Tests of Brain Death" [2] Rix, 1990; McCullagh, 1993; Evans, 1994; Jones, 1995; Watanabe, 1997; Cranford, 1998; Potts et al., 2000; Taylor, 1997; Reuter, 2001; Lock, 2002; Byrne and Weaver, 2004; Zamperetti et al., 2004; de Mattei, 2006; Joffe, 2007; Truog, 2007; Karakatsanis, 2008; and Verheijde et al., 2009. Even the President's Council on Bioethics (2008) in its white paper, has rejected "brain death" as true death.
There are many news accounts of people recovering after a declaration of "brain dead." [3] Zack Dunlap from Oklahoma was declared "brain dead." There was no blood flow to his brain as evidenced by a PET scan. The helicopter was landing to extract Zack's organs. A cousin who is a nurse in the ICU did another test. A response was observed. The transplant was stopped. This and others were recorded for the national and international community. Even one such patient should be enough to wake people up to the fact "brain death" is not true death. And there are many!
NOTES:
[1] Byrne PA,O'Reilly S, Quay PM:Brain Death — An Opposing Viewpoint. JAMA 242:1985-1990 . 1979.
[2] Joffe, A. Brain Death is Not Death: A Critique of the Concept, Criterion, and Tests of Brain Death. Reviews in the Neurosciences, 20, 187-198 (2009), and
References that "brain death" is not true death include: Rix, 1990; McCullagh, 1993; Evans, 1994; Jones, 1995; Watanabe, 1997; Cranford, 1998; Potts et al., 2000; Taylor, 1997; Reuter, 2001; Lock, 2002; Byrne and Weaver, 2004; Zamperetti et al., 2004; de Mattei, 2006; Joffe, 2007; Truog, 2007; Karakatsanis, 2008; Verheijde et al., 2009. Even the President's Council on Bioethics (2008), in its white paper, has rejected "brain death" as true death.
References that "brain death" is not true death include: Rix, 1990; McCullagh, 1993; Evans, 1994; Jones, 1995; Watanabe, 1997; Cranford, 1998; Potts et al., 2000; Taylor, 1997; Reuter, 2001; Lock, 2002; Byrne and Weaver, 2004; Zamperetti et al., 2004; de Mattei, 2006; Joffe, 2007; Truog, 2007; Karakatsanis, 2008; Verheijde et al., 2009. Even the President's Council on Bioethics (2008), in its white paper, has rejected "brain death" as true death.
[3] Zack Dunlap from Oklahoma www.msnbc.msn.com/id/23768436/
Val Thomas from West Virginia www.foxnews.com/story/0,2933,357463,0.html
Frenchman began breathing on own as docs prepared to harvest his organs www.msnbc.msn.com/id/25081786
Australian woman survives "brain death" http://www.lifesitenews.com/news/brain-dead-woman-recovers-after-husband-refuses-to-withdraw-life-support UTM source=LifeSiteNews.com+Daily+Newsletter&utm_campaign=231fd2c2c9-LifeSiteNews_com_US_Headlines05_12_2011&utm_medium=email
Val Thomas from West Virginia www.foxnews.com/story/0,2933,357463,0.html
Frenchman began breathing on own as docs prepared to harvest his organs www.msnbc.msn.com/id/25081786
Australian woman survives "brain death" http://www.lifesitenews.com/news/brain-dead-woman-recovers-after-husband-refuses-to-withdraw-life-support UTM source=LifeSiteNews.com+Daily+Newsletter&utm_campaign=231fd2c2c9-LifeSiteNews_com_US_Headlines05_12_2011&utm_medium=email
Visit Life Guardian at www.lifeguardianfoundation.org
Q & A with Dr. Paul A. Byrne about organ transplantation
Question (Q): Do you want to be an organ donor?Answer (A): To make this vital decision, you must be well informed about what is required to be an organ donor.
Q: Which organs can be transplanted?
A: Heart, lungs, liver, kidneys, pancreas, and intestine can be transplanted — all are vital organs. To be suitable for transplantation these organs must be healthy.
Q: Who has healthy organs?
A: Only living persons have healthy organs. Organs are taken from persons of all ages, but especially desirable are those who are 16 to 30 years of age. When there is brain injury, persons 16-30 years are prime candidates to have their organs taken. This is because these younger people have the healthiest organs. Their life is in jeopardy!
Q: After true death (Latin: cadaver, mors vera, mors realis, distinguished from apparent death mors apparens) can vital organs be healthy and suitable for transplantation?
A: No. After true death (mors vera) vital organs are so damaged that organs cannot be transplanted. After circulation and respiration has stopped, within 4-5 minutes the heart and liver are corrupted to such a degree that they are not suitable for transplantation. For kidneys this time is about 30 minutes. After true death skin, bones, cornea, veins, heart valves and connective tissues can be transplanted. Note that these are tissues, not organs.
Q: Then why are we asked to be an organ donor if they won't wait until we are truly dead?
A: After true death, no organs can be transplanted. Those applicants for a learner's or driver's permit are not informed about the risks of being declared "brain dead" or "heart dead" rather than being truly dead. Thus, when organs are taken all donors are living and not truly dead. Donors are paralyzed or given an anesthetic to keep them from moving and squirming when cut to take their organs.
Q: What is "brain death"?
A: "Brain death" revolves around cessation of neurological functioning while heart beat, circulation and respiration continue, although supported by a ventilator. "Brain death" was concocted to get beating hearts for transplantation. In 1968 the Harvard Criteria was the first set of "brain death" criteria to get beating hearts for transplantation. These donors are called heart beating donors or DBD (donation by "brain death"). 30 disparate sets of criteria were published by 1978 and many more since then. Each new set of criteria tends to be less strict than previous sets. A person can be declared 'brain dead" by one set but be alive by the other sets. The declaration of "brain death" legally is "in accordance with accepted medical standards" (Uniform Determination of Death Act). "Major differences exist in brain death guidelines among the leading neurologic hospitals in the United States" (Neurology January 2008). There is no consensus as to which set of criteria is used. Criteria to declare "brain death" are not evidenced-based (Neurology July, 2010). Thus, there are no "clearly determined parameters commonly held by the international scientific community, [for] the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem)" (Within quotations is from Address by Pope John Paul II, August 29, 2000).
Q: What is donation by cardiac death (DCD)?
A: Such donors have a functioning brain and do not fulfill any "brain death" criteria but the desire is to get their organs. First, a Do Not Resuscitate (DNR) is obtained. The patient is taken off the ventilator for 10 minutes; the patient's respiratory rate, inspiratory effort, age and other parameters are scored. This is known as the Wisconsin Score, which is used to predict (60 or 120 minutes after the ventilator is taken away for the second time) when the patient will be without a pulse. Note that the donor-patient's heart continues to beat, but the heart beat is not strong enough for a pulse to be recorded. When there is no pulse for 5, 2 or 1.25 minutes (depending on the locale), this is the signal to take the organs. The 1.25 minutes (75 seconds) was the time without pulse for 2 babies in Colorado when their beating heart was cut out and transplanted (NEJM 8-14-10). Their hearts never stopped beating; the beating heart was cut out and continues to beat in the recipient!
Q: What happens to the donor after vital organs are taken?
A: After the organ(s) is (are) excised the donor is then either truly dead, e.g., after the heart is excised, or weakened after one of two kidneys or part of whole liver is excised.
Q: What happens to the recipient?
A: The recipient must take anti-rejection drugs for the rest of his/her life. These are anti-immune, anti-nature drugs. The recipient exchanges one set of problems for another set of problems.
Q: What is the moral teaching of Pope Benedict XVI on this topic?
A: "Individual vital organs cannot be extracted except ex cadavere. . . "
"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).
Q: What does the Catechism of the Catholic Church teach about this?
A: Article 5 The Fifth Commandment, Section 2296 states: "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 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 to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons." (Bold and underline added by author.)
Q: Now, do you WISH to be an organ donor?
A: After full and explicit information is obtained, it seems one cannot be an organ donor.
© Paul A. Byrne, M.D. and Peter Damian Fehlner, F.I., S.T.D.
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