A recent statement with many signatories has been distributed: Catholics United on Brain Death and Organ Donation: A Call to Action See here: https://www.catholicculture.org/culture/library/view.cfm?recnum=12731

A few comments:

Much of the “Catholics United” is commendable, but it is insufficient to protect life of the unconscious patient—and the Uniform Determination of Death Act (UDDA), the determination of death law in the USA allows for legal killing. How can any Catholic, or any one, support this (UDDA)?

The National Catholic Bioethics Center (NCBC) has been supportive of “brain death” and related matters for multi-years. I have been following their misleading, beginning in 1981. They have written in a non-complimentary manner about my position on “brain death.”

“A person considering organ donation does not have good reason to expect that he or she will be truly dead at the time of vital organ procurement. Physicians who personally conduct determinations of death may wish to use more rigorous BD criteria that they are convinced, in conscience, truly establish whole BD. However, no one can know in advance which health care facility or physician will be involved in the determination of his or her death or which criteria will be used. In the United States, 70% of donors were declared dead using BD criteria in 2021. Given that we must presume life in every case until death is certain, and given the lack of moral certainty of death whenever the current BD criteria are used, a clear majority of vital organ donors can be presumed alive at the time of organ harvesting.”

Excerpt from this paragraph: “Physicians who personally conduct determinations of death may wish to use more rigorous BD criteria that they are convinced, in conscience, truly establish whole BD.”

Is someone declared to have “whole BD” dead? No. “More rigorous criteria – convinced in conscience” allows for killing. The Uniform Determination of Death Act (UDDA) allows for killing of donors. This is not acceptable.

While there are “doubts about moral certitude” that “brain death” (BD) is death and the “level of principle of when to declare death,” there are facts of life and death that are studied from disciplines of medicine, law and philosophy. If there are contradictions, further study is indicated.

While BD and vital organ donation are related because of invention of BD to get organs, they are different topics. Cessation of brain function alone to be death is contradicted by biology and the philosophical principle that soul is whole and entire in the whole and whole and entire in each part. Bd alone is not death. Life is a gift from God. Organs, contrary to donor campaigns, are not the gift of life. The legal statute for determination of death ought to reflect from a negative point of view the minimal criteria to declare death to protect still-living patients from being treated as dead.

“Brain death” is a misnomer because not even necrosis/destruction of the brain is necessarily present, only lack of observation of functions are required. Even if destruction of the whole brain were present, with vital signs of life, the person is not dead.

Action to protect life of the person is important, and more is needed. I (PAB) am a doctor that goes to see the patient at request of the family and have participated in legal battles that have precipitated the identification that “all functions of the entire brain” are not tested and have not been fulfilled. Some of my “actions” are notable: Jahi McMath, “TK,” Israel Stinson, Aden Hailu, and more are patients who were living persons when I personally participated in their treatment and care. None of them or any “bd” patients were dead when I saw them.

Now the practice of medicine includes criteria to make a declaration of “brain death.” When death is declared based on cessation of brain functions, it is the action that follows declaration of BD (excision of vital organs or taking away life supporting treatments) that causes death.

Moral certitude of death is in a cadaver suitable to embalm and bury. The UDDA defines as dead a person who has a beating heart, circulation, respiration (exchange of oxygen and carbon dioxide in lungs and tissues), functioning liver and kidneys, maintenance of body temperature, wound healing, and other signs of life. While some make a declaration of death based on cessation of brain functions alone, how can there be moral certitude of death in such patient with many signs of life?

To accept UDDA is to accept legal killing. Death based on cessation of functions of the brain alone is not sufficient for destruction of the brain, much less death of the person.

Death is a change of state from living to dead. Death is absence of life. Death is manifest as destruction, disintegration, and decay, which is the cause for the cessation of functions. The practice of medicine and statutes that distinguish life from death ought to protect the life of the person unless dead. Death ought not be declared unless the circulatory and respiratory systems and the entire brain are destroyed.”

The Gonzaga Law Review Article Model Statute is highly recommended:

“No one shall be declared dead unless the respiratory and circulatory systems and the entire brain have been destroyed. Such destruction shall be determined in accord with universally accepted medical standards.”

This is solidly based medically and unexceptionable ethically and religiously.

Further, under the current UDDA, persons can be legally killed for organs if legally declared BD. They may also be legally killed if under new Normothermic Regional Perfusion (NRP) protocols a Do Not Resuscitate (DNR) order is made, the heart stops, death is declared, but within a short window of time, circulation is restarted to vital organs. However, e.g., in thoraco-abdominal NRP (taNRP), the circulation to the brain via the carotid arteries is clamped (NB other brain perfusion may persist). If BD proponents believe that lack of brain blood flow sufficient to cause lack of functions and even necrosis of the brain, is evidence of BD and death of the person, what is purposely occluding brain blood flow, if not murder?

The Call to Action accepts the UDDA and the possibility of whole brain death. The authors are to be applauded for encouraging persons to refuse to be organ donors, get off the organ donation registries, and to note same in advance directives.

But the UDDA is a bad law and should be repealed and replaced with the model statute to protect innocent persons. The model statute incorporates the importance of destruction of 3 vital systems, not either the cardio-pulmonary or brain, but both, and sets minimum criteria. By being worded in the negative, protects the person with signs of life, from being treated as dead.

Paul A. Byrne, M.D.

Christine M. Zainer, M.D.