Can the dilemmas of kidney transplantation be resolved? For Christians?

Are your kidneys available to me? - Ninth in a series

  • Hiring dynamic leaders to manage the operations of the hospital departments,
  • Working with Congress to revise legal and financial barriers,
  • Settling the question of when death occurs— or efforts to do so,
  • Stepped up solicitations for living donors, and more,

are all being done.

An Organ Donor Bill of Rights and the Living Donor Advocate are also in the mix.

The Organ Donor Bill of Rights was penned by Nancy Scheper-Hughes, who has stated, “If you were able, as I have been, to talk to kidney sellers the world over, you would find that even years after the operation, the sellers are still suffering from its effects on their bodies, minds, social status, intimate relations, and working lives.” She hopes this Bill will be read by the body brokers.

Article 1
All humans have the right to bodily integrity. Organs are every person’s birthright, their bodily patrimony. Humans both are and have a body. (A post-Cartesian notion of the person is not ‘cogito ergo sum’ but rather ‘I am embodied, therefore I am’.)
Article 2
There are no ‘spare’ kidneys, lungs, or part-livers. To share these human parts is a sacrifice not to be normalized, routinized, or taken lightly.
Article 3
Although living donation is honorable and ethical, it is never to be presented by the recipient or his surgeons as an obligation.
Article 4
Green donation (deceased donors) should be the default system. Red donation (living donors) should be viewed as the exception, not the rule.
Article 5
Acknowledge that vulnerable populations – young people, the unemployed, prisoners, the mentally ill, the mentally deficient, guest workers, the uninsured, economic and political refugees, those in debt – are exploitable and that the ‘choice’ to sell a kidney is often coerced.
Article 6
Recognize the role of relative power/powerlessness based on gender, race, class, education, citizenship, nationality in organ selling, transplant tour, internet brokering schemes.
Article 7
Establish a principle of solidarity with the weak, the frail, the sick and the economically and existentially shaken.
Article 8
Recognize that the medical, psychological, social and political consequences of kidney selling, like the scars themselves, are often kept hidden from view.
Article 9
Revise hospital protocol to increase surveillance of living donation to include a ‘donor’s doula’, a guardian-advocate at the bedside, independent of and un-beholding to, or financially dependent on the transplant team, to represent the living donor during screening, surgery, and post-surgical follow up.
Article 10
No living organ donation from the unemployed or medically uninsured. (ref)

Dr. Scheper-Hughes suggests, “if you are able and willing to pay someone for a kidney (or a liver lobe) to save your life, please make sure that the money is paid to someone you know, even to someone you love, someone who you will be able to watch out for over the long term should their health fail and, turning the tables, they may need you to give them a helping hand.”

Article 9 is now part of the current American regimen:

In the US, all transplant hospitals are required to have either a Living Donor Advocate or a Living Donor Advocate Team. The role of this job is to screen candidates who desire to be living organ donors to ascertain if they understand the risks and benefits of donation, if they can provide informed consent, and to look after their safety and welfare. They aim to discover the motivations and expectations about donating, and if there is any coercion to donate. (ref)

Other attempts to solve the dilemmas of kidney transplantation are being carried out in biotech labs. Will lab-grown kidneys fix our transplant waiting lists? Various experiments have shown promise. Example:

Scientists removed the cells from a rat kidney, leaving only its collagen scaffolding, then re-seeded the scaffolding with neonatal kidney cells and endothelial cells, producing a functional man-made kidney that, when transplanted into rats, filters waste and produces urine. It raises hopes for a bioengineered human kidney.

The referenced article also mentions at-home and portable dialysis as new techniques, but stresses that one new kidney is what frees patients from devices.

The prospect for growing kidneys in labs using stem cells from human embryos or for developing inter-species kidneys for human transplant are real, yet these are not expected to be on the market anytime soon.

Would you want to have a kidney that came from a pig? Many people have porcine (pig) or cow heart valves in place of their own and may be considered chimeras, yet there is a significant difference between a man who has a pig valve in place of his own faulty valve, and animal embryos merged with human in a petri dish to invent a chimeric kidney or other body part.

Animals have long been incubators for human medical advancements, but where do you draw the line?

For the Christian, the line is drawn at using human embryos in research. Life begins at conception. This is a scientific truth that, like the definition of death, is now disregarded. It is rejected by those who desire to use human embryos “for the greater good.” An excellent article that explains why life begins at conception is here.

Also, for the Christian, there should be no acceptance of fusing the types or “kinds” that God created, but regenerative therapies may hold promise, and these, I believe, could meet with Christian approval.

What other lines should a Christian draw? We cannot steer the sciences but we should have our own insights and convictions to live by and to share as we may feel led.

Prev | Next

Theory and practice disparity

Are your kidneys available to me? - Eighth in a series

In theory kidney transplantation, begun in 1954, is being perfected as a medical procedure to save lives and and to improve healthcare; the future looks bright. In practice it is a boondoggle of financial wreckage for taxpayers, questionable truth in advertising to prospective donors, a cauldron brewing up a black market for human organs, a quandary of legal matters, a patchwork of medical and government coordination, and an ethical minefield.

Various approaches have developed to try to resolve these dilemmas.

Public relations efforts are ongoing to recruit living donors. Numerous medical communities hire the best people to achieve results in all program aspects. More living donors will save taxpayers money. (See previous post.)

Changing the law to permit selling ones kidneys is possible, to address the black market mess (previous post). Iran alone among the nations legalized kidney sales, but some countries are very well known for trafficking so much so that selling seems accepted; an internet search will return these perpetrators.

Churches set guidelines to try to enforce an ethic of life that nevertheless upholds transplants, to help clear the ethical minefield (previous posts). Clearing minefields is slow and dangerous work. For example, the Catholic church catechism states:

Organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as a expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons. (#2296)

The tricky word in this teaching is death. The Catholic hierarchy accepts the neurological definition, or brain death, as true death, but a sizable number of parishioners do not. (example)

They hold to the “the time proven, generally accepted criteria for death — the cessation of circulation, respiration, and reflexes.” This controversy is delineated on the Truth about Organ Donation website.

At a Vatican conference to explore the differing definitions, one doctor provided background information for the controversy:

Dr. Hill recalled that the earliest attempts at transplanting vital organs often failed because the organs, taken from cadavers, did not recover from the period of ischemia following the donor's death. The adoption of brain-death criteria solved that problem, he reported, "by allowing the removal of vital organs before life support was turned off--without the legal consequences that might otherwise have attended the practice.” 
While it is remarkable that the public has accepted these new criteria, Dr. Hill remarked, he attributed that acceptance in large part to the favorable publicity for organ transplants, and in part to public ignorance about the procedures.
“It is not generally realized,” he said, “that life support is not withdrawn before organs are taken; nor that some form of anaesthesia is needed to control the donor whilst the operation is performed. As knowledge of the procedure increases,” he observed, “it is not surprising that — as reported in a 2004 British study – ‘the refusal rate by relatives for organ removal has risen from 30 percent in 1992 to 44 percent.’” Dr. Hill also suggested that when relatives see with their own eyes the evidence that a potential organ donor is still alive, they harbor enough doubts so that they are not ready to consent to the organ removal. (ref)

Dr. Paul A. Byrne may be the best known physician in this camp. His articles have been so helpful to me. He is in agreement with Catholic classical doctrine, but not with the Vatican’s acceptance of the definition of death.

I have gotten off on a rabbit trail exploring the definition of death controversy. We will pause here and take up a few more approaches to resolving dilemmas arising from the practice of transplantation in the next post.

Prev | Next

Angel fish
Public Domain, Link

...and every living creature that moveth, which the waters brought forth abundantly, after their kind, and every winged fowl after his kind ... the living creature after his kind, cattle, and creeping thing, and beast of the earth after his kind ...the beast of the earth after his kind, and cattle after their kind, and every thing that creepeth upon the earth after his kind: and God saw that it was good. -Genesis 1

Search

A SistersSite eBook

Flesh and Bone and The Protestant Conscience is an e-book on Amazon.com. It is 99¢ and in the Amazon lending library as well. It is also available here in PDF format. The book description follows.

Would you let your conscience be your guide?

Does God care if the skin and bone of the dead are passed along to the living for medical uses? Is organ donation OK with God? Should you sign a Living Will?

Did you know that dead organ donors are often anesthetized before their organs are removed? Do you know the current definition of death? The conscience cannot function without facts.

As we ponder the ethics of in vitro fertilization, stem cell research and man-made chimeras, our thoughts trail off. How then should we live? (Ez 33:10)

How should a Christian think about euthanasia by starvation when doctors and the state attorney general all agree it is time to withhold feeding from a brain injured patient? Some things are family matters, but someday it may be our family.

Here is a small book to help you think about whether you want to sign your driver's license, donate a kidney, cremate your loved one, and many other practical questions that may arise in the course of your healthcare decisions or watch over others.

It offers a special focus on the doctrine of the Resurrection that is related to such decisions. Sunday School classes and Bible Study groups could use this book to facilitate discussion about the issues covered.