I was asked recently whether I would receive a transplant. I have often addressed this question in my lectures and videos on the ethics of organ harvesting and transplantation.

Like most questions, the answer to this question is, “It depends!” There are many types of transplants, some of which are ethical and some which are not. And since ethical questions require a moral framework, my answers are based on the moral law found in the Ten Commandments against murder, lying, and theft.

Would I receive a tissue transplant? Absolutely! Tissues are things like skin, bone, heart valves, and corneas. Tissues are simple structures and are very tolerant of a lack of blood flow. They can be harvested from a corpse (a donor who is biologically dead and whose spirit has departed) and are completely ethical.

There is one ethical caveat to tissue donation, however. An LA Times article revealed that organ procurement organizations are harvesting tissues from the corpses of registered organ donors before the medical examiner has a chance to determine the cause of death. This article shared the devastating sorrow of families who were denied closure because their loved ones had unselfishly signed a donor card. Unfortunately, at autopsy, the bodies of these victims are so mangled by tissue harvesting that crime lab pathologists are sometimes unable to determine if injuries related to domestic violence resulted in murder. Thus, I recommend that no one be a registered organ or tissue donor. If you desire to donate your tissues, simply notify your family that they may release your corpse for tissue donation after all their questions regarding your death have been answered.

Image by stefamerpik.

This brings me to the question of organ transplants. Organs (things like livers, kidneys, hearts, and lungs) can only be harvested from a biologically living donor. This is because internal organs are complex structures that very quickly begin to break down and decompose when circulation stops, making them unsuitable for transplant. However, living organ donation, in which both donor and recipient remain alive after the procedure, is a wonderful and ethical form of transplant, one that every altruistic person should consider.

I would definitely consider donating one of my paired organs (such as a kidney) or a lobe of my liver to help another person. One of our friends donated a kidney to her young daughter, allowing her daughter to live for over twenty more years. Living donations are some of the most successful transplants and are in the best tradition of selfless service to a person in need.

I think it goes without saying that I would never condone travel to Communist China to receive an organ from a political prisoner executed by forced organ harvesting. And I deplore the exploitation of the poor by organ trafficking of kidneys on the black market. Both of these are human rights abuses and deserve to be condemned.

What about organs harvested from a “brain dead“ organ donor? Brain death is a legal fiction, a term that was coined in 1968 when a group of doctors at Harvard Medical School decided that people in an irreversible coma could be declared dead for use as organ donors. People in a coma are still biologically alive, with beating hearts, and their spirits are still incorporated within their bodies.

The fact that people have survived a diagnosis of brain death and have gone on to live normal lives bears this out. These people are alive when brought to the operating room and respond to surgery like any other patient, as I saw firsthand during my anesthesiology training. Calling these people dead is a lie, and even though removing their beating hearts is legal under the Uniform Determination of Death Act, it is morally wrong. Knowing these facts, I could not ethically receive an organ from a “brain dead” person without being complicit in their murder.

And lastly, would I receive an organ from a “circulatory death” organ donor? These donors are not brain-dead, but they are not expected to survive. Again, the devil is in the details. Because organs begin to disintegrate so quickly without circulation, doctors begin harvest surgery in these cases within 75 seconds to 5 minutes after the heart stops beating. Every medical professional knows that people are routinely resuscitated after such a short period of cardiac arrest (see “Pronounced Dead Twice: What Should an Attending Physician Do in Between?“).

Even worse is the newer technique of normothermic regional perfusion with controlled donation after circulatory death (NRP-cDCD), in which doctors clamp off the circulation to the brain to make the donor brain dead on purpose before resuscitating the remaining organs for viable harvesting. The American College of Physicians has called for a pause in the practice of NRP-cDCD, as “the burden of proof regarding the ethical and legal propriety of this practice has not been met.” So, because patients declared dead by circulatory criteria are still capable of being resuscitated, and the ethics surrounding this is questionable, I could not ethically receive an organ from someone declared dead by circulatory death standards either.

Emotional appeals about organ donation ignore what is really going on behind the operating room doors. Catchy slogans like “Give the gift of life” sound good, but gloss over critical details that everyone who signs a donor card has a right to know. The public is being misled while doctors, lawyers, and ethicists continue to debate whether people should be told the truth. Even Dr. Robert Truog, a proponent of transplant, states in his book Death, Dying, and Organ Transplantation, “…’brain dead’ donors remain alive and donors declared dead according to circulatory-respiratory criteria are not known to be dead at the time that their organs are procured.” I agree with ethicist Dr. Michael Nair-Collins, who writes, “Appealing to the good consequences of organ transplantation in an attempt to justify the lack of transparency, if not outright obfuscation on which the transplantation enterprise rests, is not a very compelling argument.”

Heidi Klessig is a retired anesthesiologist and pain management specialist who writes and speaks about organ donation. Her work can be found at respectforhumanlife.com.