Tremendous controversy surrounds the discussions surrounding brain death, which is the notion that when the brain is dead, the person is dead.
In 1997 one of the world’s foremost brain death scholars published “Recovery from ‘Brain Death’: A Neurologist’s Apologia” (republished with updated endnotes in April 2024). In it, pediatric neurologist D. Alan Shewmon, a convert to Catholicism, documents his professional conversion from believing that brain-dead patients are dead to the firm conviction that nearly all of them are alive. (He allows for the possibility that some patients who have died from widespread bodily injury incidentally meet the criteria for brain death.) “There is no question that [this] truth will eventually prevail,” Shewmon wrote. “The only questions are: after how long a time and at what human cost?”
Despite this clarion call 27 years ago to stop harvesting organs from brain-dead patients, organ donation and transplantation practices have remained essentially unchanged.
While some Catholics hold that the person is dead when there is complete and irreversible cessation of all brain activity (“whole brain death”), a growing number of Catholics agree with Shewmon that whole brain death cannot be used to diagnose the death of the person. Crucially, though, on a pragmatic level, this difference of opinion is irrelevant because the medical criteria to diagnose brain death establishes only partial loss of brain function (“partial brain death”). All Catholics agree that patients with partial brain death are alive, and the Catholic Church forbids removing vital organs when this act would kill the patient.
The April 11 statement by The National Catholic Bioethics Center (NCBC) titled, “Integrity in the Determination of Brain Death: Recent Challenges and Next Steps,” affirms that “a partial brain death standard can never be acceptable to Catholics.”
In response to a clear need for updated guidance, a statement was released in February 2024 titled “Catholics United on Brain Death and Organ Donation: A Call to Action.” The document explained that at least half, and as many as four out of five, donors declared brain-dead are alive when their organs are removed based on the persistent function of a part of the brain called the hypothalamus. “Catholics United” was endorsed by 151 Catholic health-care professionals, theologians, philosophers, ethicists, lawyers, apologists, pro-life advocates and others, including a BD survivor and a professional organization.
The recent NCBC statement acknowledges this same reality, drawing attention to a deficiency in the clinical criteria for a BD diagnosis. It states, “Yet, despite evidence that some parts of the brain — primarily the hypothalamus, a part of the neuroendocrine system — continue to function in roughly half of patients who might otherwise qualify as brain dead, clinical guidelines did not require testing for neuroendocrine function (NEF) before diagnosing brain death.” In fact, when the clinical guideline was recently updated in late 2023, it stated “more explicitly than ever that clinicians may declare patients brain dead despite evidence of neuroendocrine function” (emphasis in the original). This is significant because “patients with confirmed hypothalamic function should not be diagnosed as brain dead, nor treated as dead, for the purpose of organ procurement.”
Pope St. John Paul II stipulated that for organs to ethically be harvested from brain-dead patients, moral certainty must exist that they are truly dead. But, in his foundational articulation of moral certainty, Pope Pius XII explained that moral certainty cannot exist if a competent judge finds evidence supporting the contrary position compelling. This precise situation exists regarding BD: The NCBC and the 151 endorsers of “Catholics United” acknowledge that many (if not all) brain-dead patients are alive.
Therefore, it is impossible to claim that we have moral certainty that brain-dead patients are dead. Catholics — whether they accept or reject whole BD as true death — should unite against the current BD criteria because the use of the criteria results in patients being killed when their organs are harvested. In recognition of this reality, “Catholics United” makes several strong recommendations, including:
· Decline to be an organ donor at the Department of Motor Vehicles.
· Refuse to be an organ donor after death in advance directives.
· Improve education on end-of-life care and organ donation at the pastoral level.
· Advocate for conscience protection rights for health care professionals and institutions with regard to participation in BD determinations and organ transplantation.
· Coordinate and encourage further discussion and action on BD and organ donation.
Judie Brown, the current president and co-founder of the pro-life advocacy group American Life League, has decided to update their Loving Will Comfort and Care Directive in accordance with the recommendations made in “Catholics United.”
“I think that any organization that has a pro-life document addressing wishes at the end of life needs to be updated in view of this [statement],” said Brown.
To summarize:
1. Most, if not all, patients declared brain-dead are alive at the time of organ harvesting.
2. This reality leads to action steps that should be taken to protect yourself and your loved ones.
3. Most importantly, decline to be an organ donor on your driver’s license and in your advance directive.
Whatever position Catholics held on brain death in the past, now is the time for us to unite against declarations in clinical practice. By following simple, actionable steps, Catholics in the pew can help to ensure that the sacredness of human life is reverenced during end-of-life care for themselves and their loved ones. Let’s pray and work together for the protection of vulnerable patients at the end of life, especially when it comes to organ donation.
Joseph Eble, MD, is the president of the Tulsa Guild of the Catholic Medical Association and vice president of Fidelis Radiology. His most recent paper is “Catholics United on Brain Death and Organ Donation: A Call to Action,” co-written with John A. Di Camillo and Peter J. Colosi. He may be reached at eblej@yahoo.com.