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Wednesday, 5 September 2012

Does fifth commandment forbid heart tranplantation?


Heart transplantation is becoming more popular these days. You might have noticed one such venture which took place in Kerala also. It was well appreciated by most of the Media. There were also Malayalam movies with central theme as heart transplantation. Seeing the real beating heart being taken out from the donor, you might have had a question whether heart transplantation is actually accentuating death of the donor. This is a little quest into this constantly scrutinized subject. Hope you might notice author’s effort!                                        

Who are selected for heart donation?
Science explains death in 3 ways, termed modes of death namely coma, asphyxia and syncope, each representing the failure of a major organ to function in an optimal level to sustain life. In coma it is the brain that fails, in asphyxia it is the lung and in syncope the heart. Those selected as donors are those in coma - as in this state, their brain is badly damaged (irreversibly) due to an insult (ischemia or hemorrhage) while their heart still remains suitable for transplantation.

What constitutes death? 
A well explained theological explanation is difficult. But science comes to our aid, by describing death as cessations of bodily functions necessary for life clinically represented by bilateral fixed and dilated pupils, absent spontaneous respiration and no cardiac activity. Further supported by a plain ECG reading and many more…
Yet, in the theological point of view, the Catechism of Catholic Church states: “The unity of soul and body is so profound that one has to consider the soul to be the "form" of the body: i.e., it is because of its spiritual soul that the body made of matter becomes a living, human body; spirit and matter, in man, are not two natures united, but rather their union forms a single nature” (CCC 365).  Death represents the separation of the spirit and the body. So what still remains is the debate on the point of separation of the spirit and body.
Pope Pius XII in 1957 in an Address to International Congress of Anesthesiologists stated: "But considerations of a general nature allow us to believe that human life continues for as long as its vital functions—distinguished from the simple life of organs manifest themselves spontaneously or even with help of artificial processes." and
Pope John Paul II to the Participants of the 1989 Pontifical Academy of Sciences stated: Death can mean decomposition, disintegration, a separation. It occurs when the spiritual principle which ensures the unity of the individual can no longer exercise its functions in and upon the organism, whose elements left to themselves, disintegrate.” So again in conclusion: death means the separation of the human spirit from its earthly body. This is characterized by the absence of vital functions and as long as the vital organs are functioning it shows the persistence of spirit and the person is said to be alive.

Are brain dead actually dead?
The church relies on science (modern medicine) to help it in describing or pointing the point of death or no return to normalcy. Every now and then the church formulates pastoral guidelines on death description without violating the ecclesiastical laws through the works of The Pontifical Academy for Life, The Pontifical Council for Health Care Workers etc… so it is well said that brain death is described accordingly to present scientific knowledge of the day. The present day medical science teaches that:  A COMPLETE and IRREVERSIBLE brain death can be considered a real death. While Coma many times may be due to death of the lower centers of brain (brain stem) alone and such patients would have difficulty only in breathing. Such patients are not dead but just diseased and can be treated with the aid of a ventilator. This state is called persistent vegetative state and it is entirely different from brain death. On the contrary, if both higher and lower centers of brain are dead, patients have undergone complete brain death and are called dead as they cannot be kept on (treated with) a ventilator forever. With complete brain death, central regulatory mechanisms will no longer function, so blood pressure, electrolyte levels, temperature regulation etc. will all soon get "out of whack". Disintegration will inevitably set in. Heart contractions will typically cease in brain-dead individuals after a few days despite the presence of a ventilator.

On the third side, if the upper centers alone die, leaving behind functions of lower centers intact, of course then the patient will respire on his own and hence is not dead.

Is it possible to determine complete and irreversible cessation of brain functions?
Deterioration of brain functions can be objectively determined by a battery of tests, as stated by Harward University. But the question whether reversible or irreversible, cannot be empirically determined. So again, the cessation of both higher and lower brain functions are, in fact, directly observable and objective while those on reversibility is not. Irreversibility is the presently believed dictum in neuroscience; major neurological injuries are usually considered irreversible. Bringing to say, that now Brain death is an end state of no return to normal. Yet science has much left to discover or I better say unravel, our presently considered irreversible brain death may one day, in the future will be just another treatable neurological disorder.

What if science invents artificial brains?
Mankind is quite far from that feat at the moment, but it does not rule out the option. If man does one day succeed in making an artificial brain that could function in keeping the physiological functions intact, we would have cured brain death. And lets hope they develop a proper successful version of the artificial heart too…

Finally, should we donate our hearts?
Catholic Church is as social institution. All the laws of the Catholic Church including that of the ecclesiastical are made for the humans and not vice versa.  God created laws as a way of life where every commandment or rule is made to serve the love (that is God) and not for the sake of the law.
It’s always good to remember that: It’s always good to remember that:
“The Sabbath was made for humankind and not humankind for the Sabbath” (Mark 2:27)
So nobody is forbidden by any commandment from donating heart out of love. Amen