1. Organ Transplantation, (Brain) Death, and Advance Directives Saint Cecilia Motherhouse Bioethics Workshop July 10, 2010 Sister Mary Diana Dreger, O.P., M.D.

2. The risk of dying is decreased in those who exercise regularly.

3. Because of the lack of available donors in this country, 4,573 kidney patients, 1,506 liver patients, 371 heart patients and 234 lung patients died in 2008 while waiting for life-saving organ transplants. Because of the lack of available donors in this country, 4,573 kidney patients, 1,506 liver patients, 371 heart patients and 234 lung patients died in 2008 while waiting for life-saving organ transplants.

4. It is surely a reason for satisfaction that many sick people, who until recently could only expect death or at best a painful and restricted existence, can now recover more or less fully through the replacement of a diseased organ with a healthy donated one. We should rejoice that medicine, in its service to life, has found in organ transplantation a new way of serving the human family, precisely by safeguarding that fundamental good of the person. Pope John Paul II, 1991 Address to First International Congress of the Society for Organ Sharing

5. …there is an everyday heroism, made up of gestures of sharing, big or small, which build up an authentic culture of life. A particularly praiseworthy example of such gestures is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope. Pope John Paul II Evangelium Vitae

6. In this area of medical science too the fundamental criterion must be the defence and promotion of the integral good of the human person, in keeping with that unique dignity which is ours by virtue of our humanity. Consequently, it is evident that every medical procedure performed on the human person is subject to limits: not just the limits of what it is technically possible, but also limits determined by respect for human nature itself, understood in its fullness…. Pope John Paul II, 2000 Address to International Congress on Transplants

7. Good of the human person Organ donor –Informed consent –First do no harm –Not an object of exchange Organ recipient –Informed consent –Contextual understanding –Not an object of medical science

8. Tissues/organs for transplant Tissues: –Blood (living donor) –Bone, cartilage, cornea, heart valves (from cadaver/corpse) Organs: –Kidney, lobe of a liver (living donor) –Heart, lungs, liver  Donor cannot live without these

9. Dead Donor Rule (DDR) The donor must be dead before a vital, unpaired organ may be removed for transplant Criteria for death can vary

10. Death Separation of body and soul (philosophical) How do we measure this? (scientifically)

11. Measures of Death Cardiopulmonary criteria Artificial ventilation steps in Neurological criterion CONCEPT: brain as the “unifying principle” which “integrates” the human person – without the brain, the human life “disintegrates”

12. Brain Death That is, death of the body by neurologic criteria 1968 – Harvard paper “Total brain failure” Brain dead means dead

13. It is a well-known fact that for some time certain scientific approaches to ascertaining death have shifted the emphasis from the traditional cardio- respiratory signs to the so-called "neurological" criterion. Specifically, 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. Pope John Paul II, 2000 Address to International Congress on Transplants

14. With regard to the parameters used today for ascertaining death - whether the "encephalic" signs or the more traditional cardio-respiratory signs - the Church does not make technical decisions. She limits herself to the Gospel duty of comparing the data offered by medical science with the Christian understanding of the unity of the person…. Pope John Paul II, 2000 Address to International Congress on Transplants

15. Here it can be said that the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology. Pope John Paul II, 2000 Address to International Congress on Transplants Here it can be said that the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology. Pope John Paul II, 2000 Address to International Congress on Transplants

16. Current Controversies 1998: Alan Shewmon (UCLA neurologist) – case series of patients (cadavers?) – integrative functions appear to still be present Confusion with PVS (persistent vegetative state) Controlled donation after cardiac death (controlled DCD) Abandoning the dead donor rule

17. The President’s Council on Bioethics December 2008 Chairman: Edmund Pellegrino, M.D. “Controversies in the Determination of Death” Presented two positions (against and for…. but a qualified for)

18. With regard to the parameters used today for ascertaining death - whether the "encephalic" signs or the more traditional cardio-respiratory signs - the Church does not make technical decisions. She limits herself to the Gospel duty of comparing the data offered by medical science with the Christian understanding of the unity of the person…. Pope John Paul II, 2000 Address to International Congress on Transplants The Catholic Church

19. Central issues The good of one person cannot be placed over the good of another Definition of death (and believing this is important) leads to ways to make moral choices Moving toward a society that is unsure of how to define death, and not sure that this is important

20. Advance Directives Durable Power of Attorney for Health Care Living Will The Five Wishes POST or POLST forms

21. New directions From New York…. Specially equipped ambulances A proposed bill to presume donor status

22. Do not fear the one who can kill the body, but the one who can kill both body and soul.