Don’t Bring Your Organs to Heaven,
Because Heaven Knows We Need Them Here!
Theological Issues Surrounding Cadaver Organ Donation
Recently, TV Land aired a 1975 episode of All in the Family in which Archie Bunker tries to impress his boss by being the first in line to sign up for the boss’ favorite charity (Bogart 1975). It is not until Archie is holding his donor card that he realizes that he has signed up to be an organ donor. This causes great anxiety for Archie which manifests itself as more stress than usual, worrying about his age, and problems sleeping. Archie finally goes to rescind his donation and states that it is for religious purposes. Archie states that he had a dream in which he has died and is driving his taxi toward heaven. As he is driving toward heaven, people begin taking parts from the taxi. As he continues, people begin removing parts from Archie. When he reaches heaven he is not allowed in because God does not recognize him due to so many parts missing.
Another humorous piece concerning organ donation is from Monty Python's Meaning of Life. In “Part V: Live Organ Donations” Mr. Brown answers the door and finds two men who have come to take his liver, which Mr. Brown states that he is still using. The two men wrestle Mr. Brown to the ground and find on him his Liver Donation Card. Mr. Brown states “Listen! I can't give it to you now. It says, 'in the event of death'.” One of the men respond with, “No one who has ever had their liver taken out by us has survived,” followed by a very bloody removal of Mr. Brown’s liver. Mrs. Brown enters the room and confronts the two men who respond that they are taking Mr. Brown’s liver. After she realizes what is going on she sees the entire episode as being Mr. Brown’s fault for signing the donation card in the first place (Gilliam and Jones 1983).
These two views of organ donation in the popular culture make light of reasons why people do not register to be organ donors; however, they do reflect many people’s anxieties about being an organ donor. An example of this is found in a Boston Herald front page article where the removal of organs from an eighteen month old boy, not for the purpose of transplant, was called “heartless.” The child’s mother stated, “Our son David was all heart, and now he is buried without his heart. He isn’t resting in peace. He’s resting in pieces.” Although this article is not referring to organs removed from transplant, it does point toward a prevailing public attitude in society about organ removal and burial. This public attitude is still the single most important determinant of whether someone will be given a chance at receiving a donated organ for transplant. While there are some local and national organizations who do a great deal of work in attempting to educate the public, the Partnership for Organ Donation Gallup poll shows that the majority of the public gets their information about donation and transplantation from TV and movies; a statistic that should startle no one (Partnership for Organ Donation 1993). The poll also shows that while a majority believe that organ donation is a decent idea, less than half are prepared to sign an organ donor card and discuss their wishes with family members. Preconceived notions about organ donation continue to exist, and some members of minority groups speak openly of their deep distrust of organ procurement and allocation. One of these notions which is perpetuated by televison includes the belief that there is a large organ black market (Arnason 1991).
Partnership for Organ Donation, The. 1993. American Public's Attitudes Toward Organ Donation and Transplantation.
The number of television shows using transplantation in some aspect of a plot device has exploded in the last several years. From my perspective, there have been few TV shows or movies portraying organ donation and/or organ transplant in a positive manner. It is rare that an accurate portrayal of the process of procurement and surgery is shown. If they mention the donation shortage at all, it is only to support a plot line that includes murder for the sake of obtaining organs. All kinds of drama, adventure, and soap opera shows, some of which specialize in plausible, current events story lines, are basing their plots on the worst myths and urban legends that have been spread around the world in the last two decades. What makes this fact frightening is that over eighty-eight percent (88%) of Americas get their information about health issues from television, and the majority of those get there information from either soap operas or prime time TV shows (Center for Disease Control 2000). Those that watch soap operas are more likely to express negative views on important healthcare practices that those who do not. It is not just stay at home women who are watching soap operas either - thirty percent (30%) of the audience for soap operas was made up of groups outside the core demographic group of eighteen to forty-nine year-old women, including substantial numbers of teenage boys and girls (up to fifteen percent of the total audience for some soaps) and adult men (particularly those over fifty). Since 1982 there have been over 3 million college student viewers of soap operas as well (Soap Opera Digest 2003).
Regular TV viewers report they learned something about Disease, Disease Prevention, and/or Medical Procedures from Entertainment (not news or documentries) television shows:
Source: Center for Disease Control and Prevention. 2000.
Besides society being “educated” by fictional TV shows in areas of medicine such as organ donation and transplantation, people often state that they would not donate due to religious reasons. This is in spite of the fact that only one organized religion (Shinto) and one large folk religion (Gypsies) have strict prohibitions against organ donation. There are no Christian denominations which prohibit organ donation (Including the Jehovah’s Witnesses which state that it is a matter for individuals to decide), and many of them have issued official statements supporting organ donation. The Roman Catholic Church states that organ donation is the “manifestation of the highest degree of love” (John Paul II, Evangelium Vitae 1995, section 86). Pope John Paul II, the head of the world’s largest Christian denomination, addressed International Congress on Organ Transplants in August 2000 and stated that
It must first be emphasized, as I observed on another occasion, that every organ transplant has its source in a decision of great ethical value: "the decision to offer without reward a part of one's own body for the health and well-being of another person." Here precisely lies the nobility of the gesture, a gesture which is a genuine act of love. It is not just a matter of giving away something that belongs to us but of giving something of ourselves, for "by virtue of its substantial union with a spiritual soul, the human body cannot be considered as a mere complex of tissues, organs and functions, rather it is a constitutive part of the person who manifests and expresses himself through it.” (Address of John Paul II to the International Congress on Organ Transplants, 2000)
The Roman Catholic Church is not the only Christian denomination to issue polity statements on organ donation and transplantation. Below is a sample of a few of those statements:
Presbyterian Church (U.S.A.)
With these denomination resolutions affirming organ donation, as well as numerous resources on the internet regarding religious beliefs concerning organ donation, there are still many Christians who believe that it is against their religion to donate organs. Arthur Caplan wrote that the major reason people do not donate their organs is that they have religious or spiritual concerns, this includes being able to have a normal funeral (Caplan 2002). According to a recent editorial in the Caymen News, some religious people object to organ donation for a couple different reasons. The first, pointing to the Apostles’ Creed, believe that the resurrection of the dead specifically refers to the “resurrection of the body.” For many Christians there is a belief that the same earthly body will be used again, and they therefore see the need to keep it intact, as much as possible. Another religious objection to organ donation is the concept of letting God be in control, or “playing God” through transplants. Those with this belief state that if parts of the body are failing it should be accepted as part of God’s plan (2003).
According to the Partnership for Organ Donation, Blacks and Hispanics are much more likely to report that organ donation is against their religion than whites. There were no substantial differences (only one percent) between those who profess to be “Catholic,” “Baptist,” “Christian,” or “Other Protestant.” However, “Catholics” were almost twice as likely to answer that they did not really have a reason for not wanting to be an organ donor when compared to the full sample (1993).
There is another reason that some Christians may not elect to donate the organs of family member, and that is hope for a miracle. I spoke with the members of the Adult Sunday School class I help teach about organ donation. Two members stated that they would not donate their family members’ organs because that is taking away the chance that a miracle could take place. This is also reflected in the Partnership for Organ Donation survey where twenty-one percent (21%) of all the participates appear to have some hope of a recovery from “brain death.”
While the Partnership for Organ Donation survey does not link funeral practices with religion, funerals are seen by most Christians as an important part of their faith. Recently at a Plymouth Area Interfaith Clergy Association meeting, a representative from each local funeral home attended a special dialogue meeting. During this meeting, each funeral home reported that a majority of those they perform services for are not a member of a worship community. However, the families for over three-fourths of those who are not church members (with over half of the families not belonging to a church either) requested a Christian funeral service. The funeral home directors at the meeting also indicated that this was true for most areas of the United States. According to the Partnership for Organ Donation survey, thirteen percent (13%) of the respondents believe that it is impossible to have a regular funeral service following a organ donation. Seventeen percent (17%) either agreed or strongly agreed that it is important for a person’s body to have all of its parts when it is buried. For both of these questions, the percentage of non-whites who believe these two statements were nearly twice that of white respondents.
In preparing for this project, I emailed questions to the individual who oversees either community education or community outreach at twenty-six of the fifty-one independent Organ Procurement Organizations (OPO) and four of the eight hospital-based OPO’s. I received answers from nineteen of the independent and one of the hospital OPO’s in time for this project. One of the questions I asked was, “Do you know of a time or feel that your OPO has ever been unsuccessful in obtaining organs because of donor family religious issues?” All but two of the responses I received answered that they had been unsuccessful in obtaining organs due to the family citing religions reasons. The executive director of one OPO told me that there had been a number of occasions when Roman Catholic and Protestant families have said no to organ donation due to religious issues. “Usually, the family says no to donation despite information presented by the OPO, hospital clergy, and in some cases, the presence of the family’s own clergy stating that donation is an option that does not conflict with religious beliefs.”
A CHRISTIAN RESPONSE
From the information above it can be seen that there is a need to demythologize some areas of death and dying. Our Christian beliefs do not deny the reality of dying and death, but rather view these events as part of the fullness of life which God has given us. There are preparations that can and should be made before our death, including talking to family and friends about organ donation. This is a call to stewardship of the end of life.
For many people it is the process of dying that is the most forbidding aspect of facing either our own death or that of a loved one. There are issues of control (either taking control or losing control) when we are faced with death. Because of the need to demythologize death and dying, especially in the area of organ donation, a proactive approach to discussing organ donation issues is included in this project which would begin the process of looking at the issue of organ donation objectively and with other Christians before a medical crisis or death of a family member. As we seek to be faithful to our Christian calling, we have the opportunity to discuss stewardship of end of life issues. The decisions to be made are personal, but do affect others as well. These include our family, friends and others in our support network. These decisions call also affect those outside our support network such as medical personnel and those awaiting organs to sustain life. The decision making process does not need to be done in isolation, but ought to be done in the community of faith since it is in community that we take our life’s journey. We also make this journey knowing that we are made in the image of God. As part of this journey, this pilgrimage of faith, we are faced with many responsibilities such as how to live our life in faithfulness to our calling as children of God. We seek to be faithful in our calling and in determining what it is to celebrate life with all of its nuances.
The journey is not always pleasant. There are many joys to be sure, but there are also sorrows as well. It is far easier to focus our attention on life and its living than to look at topics such as dying and organ donation. These remain issues we would like to avoid, yet are also a vital and important part of our life.
Saint Paul assures us that death is no longer victorious, it has been stripped of its sting (1 Corinthians 15:54-55). There has been an increasing emphasis by society regarding the use of technology to add length to our lives. As Christians, when we come to terms with the mortality of our earthly bodies and are able to articulate our beliefs about dying and death, we are able to look at the issues surrounding cadaver organ donation from a theological stance. With the level of medical technology today we are often unable to separate the difference between causing death and allowing it to happen. We are too often faced with the decision about when it is acceptable to accept death or when to fight it with everything possible. There is the argument that since life is a gift from God, it must be preserved and fought for until all possible alternatives have been exhausted. In following this logic, there is a sense that letting people die is an insult to God, the giver of life. Lewis Smeades continues this line of thinking:
Does God give someone this pearl of great price only to let a green-smocked medic decide to let it slip away? Must we not assume that the gift of life must always be worth keeping as long as God considers it worth giving? (Smeades 1987, 147)
There are things about the gift of life that get between our gratitude for it and a conviction that we may never let people die. Smeades continues:
For one thing some gifts are more important even than the gift of life, and we may do a good thing if we trade our gift of life for some more important things. One instance: ‘Greater love has no man than this, that he trade his (gift of) life for the life of a friend.’ Furthermore, the gift of life can turn very sour, so that by itself it does not compensate for the terrible price of prolonging it. The sheer fact that God gives life must be balanced by the fact that it may be good stewardship to turn the gift back, with respectful thanks, to the giver. (Smeades 1987, 148)
Scripture encourages a response to this gift from God, a sense of love-impelled ethics. Our response to this type of ethical decision making takes the form of acknowledging this great gift that we have been given from God. The response may be motivated by a desire to please God (Romans 14:18). The response may be motivated by a desire to honor God (Romans 15:7). Accordingly, ethical living is a matter of faith in God and faithfulness to God (Romans 3:3-4).
Ethics becomes the ground upon which to begin to lay the foundation for our discussion. If we continue to look to St. Paul as a source of our foundation, we see an approach that advocates a loving, free flowing ethics rather than following a rigid dogmatic formula. If one follows St. Paul’s writing, then Christian ethics becomes desires of the Holy Spirit, and one’s judgment should be molded by the gospel. This takes us to a different level of understanding of living the Christian journey. When St. Paul tells us that we do not have to “grieve as others do who have no hope,” when he speaks of Christians who have died, we are being told that the living and the dead will join Christ in one community. Because of this belief, the task of ethical discernment is to discover how the new vision by the gospel is to quality our questions and our problems. This we seek to do in faith as individuals and in community.
One way in which this approach can be applied to end of life issues is in using the stewardship model. There are over twenty-five reference to the steward or stewardship in the scriptures. The concept that someone is to manage the affairs of another is implicit throughout the Bible. This is both a relationship between ourselves with God and a relationship between ourselves and others. One example is the parable of the talents in the Gospel According to Matthew (25:14-30) where we are charged with the responsibility for what we have been given. As Christians, we should be familiar with stewardship concepts of our time and resources, and we should be committed to these concepts. It is because we seek to be faithful together that we begin to apply the ideals of stewardship into our lives. The church gives the added dimension of offering guidance about ways in which this can be accomplished. This image of stewardship not only provides a model of the disciples being charged with responsibility for Christ’s household, it also extends into the ecclesiological area of theology. The church is a stewardship community. This concept as it applies to life is applicable to end of life issues as well. We are accountable in our lives for our commissions as well as our omissions. When we ignore planning and stating our wishes and concerns regarding such issues as organ donation we place undue hardship on our family in making decisions for us, and in the process, are not being faithful stewards.
There lingers an idea that if we do not talk about death and its consequences then it is not a real concern. Then there is a common superstition that to talk about death is to cause it. At a small extent, these points of view are understandable since talking about death is often only done at times when death becomes a higher probability for a family member. Dealing with our earthly mortality is often quite difficult, yet it is important for a Christian to give it due consideration. This is where the stewardship model offers us another view. Martin Israel states:
The process of being separated from our earthly belongings is not pleasant when we grow into adult estate, because we readily fall victim to the misapprehension that we really own these things, instead of seeing ourselves merely as their custodians. Stewardship is an important experience for making us value the things of the world, but the good steward is always ready to hand back the material to the owner, who is God. If we have carried on our work well, more will be given to us, but nothing is ours in perpetuity. We have no possession other than the focus of identity which we know as the soul or the spiritual itself. In the enterprise of earthly life everything else drops away from us except the experiences derived from our stewardship. These add their quota to the soul’s memory and the wisdom it accumulates for what is to follow in the time of our decline and the new life ahead of us afterwards. (Israel 1993, 39-40)
If this is true, then it is in this context that end of life decisions ought to be made by each of us. These decisions ought not to be made solely on our own, but by also looking to the community of faith for guidance and direction as we seek to begin the planning process. The stewardship model provides us with images of what we as individuals can do in response to God’s trusting us with the care of the gifts we have been given. A good steward is always willing to had back that to which has been entrusted.
This approach also extends into ecclesiology. The church is truly a stewardship community. This is a very special calling that as we seek to celebrate our lives as Christians, we acknowledge together that we are also there to search together into end of life issues. As members of the Body of Christ, we are called together to continue the work of God. One area in which the church applies this model is bioethics.
This begs the question, Why should the church be involved in bioethics and healthcare concerns? Because in essence it is the church that seeks to journey with the faithful in discovering the meaning and purpose of life. In looking at the stewardship of the end of life, we are also looking at stewardship of the body as well. As such, we as the church are called to look at and to equip ourselves to decide the difficult issues of life.
The church is also called upon to discern and articulate an ethics of technology. These decisions cannot be left to the medical and legal areas to determine and for the church to act upon. The issues surrounding organ donation are not only legal or medical. They are also issues of profound importance to the Christian community and deserve the proper and full attention of the church and its clergy. The church’s response to these issues is important because lawyers and doctors are often not willing, nor equipped, to discuss the spiritual, theological and practical implications. Therefore, we should take steps to address these matters within Christ’s community. It is especially important that they be addressed in a timely manner. One should not have to face the deep emotional and spiritual issues of death and organ donation for the first time when they are in a medical facility (House 1991, 1139). In our faithfulness we are to be in the forefront of making decisions, not simply reacting to what society dictates. The church is a proactive agent in the process of empowering believers in affirming what life is, how it has its meaning, and issues surrounding its end.
One role the church should fill with regard to the ethics of organ donation is that of teaching. In making decisions on organ donation we raise questions and make choices that are spiritual and relates to theological understanding. We can communicate a theological understanding in the form of sermons and adult education classes. In seeking to be faith together, we covenant as a community of faith to support and encourage each other. The second part of this project is to provide the church with resources on how to spirituality and theologically address organ donation. Below are the links for that part of the project.
With Hyperlinks to Sources
Monty Python's Meaning of Life, Part V: Live Organ Donations
The links in the project which redirect one to another website are there for the enhancement of the project and are not maintained by the author of this project. Therefore, he is not responsible for any changes or redirects at those websites.
Project by Robert L. Lewis, Jr.
Last updated December 10, 2003