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Organ Donation and Determination of Death


FAQ on "Brain Death"


To what does the expression "brain death" refer?
"Brain death" refers to the medical judgment that a person is dead by using "neurological criteria". Properly diagnosed, "brain death" refers to the complete cessation of all organized neurological activity throughout the entire brain, including the cerebrum, cerebellum, and brain stem. At this point, the body irrevocably ceases to function as a unified whole. The appropriate Phraseology here is "the determination of death using neurological criteria."
Is it appropriate to use neurological criteria to determine death?
The customary criteria for determining death are "cardio-pulmonary," i.e., death is declared after breathing and heart-beat cease. Technological advancements in critical care, however, have made continued circulation and respiration possible through mechanical means even after brain function has ceased.
The use of neurological criteria for the determination of death is legitimate according to the Catholic Church. Pope John Paul II approved this approach in an address he gave to the 18th International Conference of Organ Transplant Specialists in August 2000. Neurological criteria consist of four key signs: coma or unresponsiveness, absence of cerebral motor responses to pain in all extremities, absence of brain stem reflexes, and apnea. Pope Pius XII and Pope John Paul II both said the Church has no competency in determining death; this properly belongs to medical science.
May I receive organs for transplant from those declared dead using neurological criteria?
Yes, a faithful Catholic may receive organs from a donor who is declared dead by neurological criteria. A faithful Catholic may also make provisions for the donation of his own organs in the event of his death whether it is determined by cardio-pulmonary or neurological criteria.
Why does the use of neurological criteria remain controversial?
As mentioned above, when a person suffers total loss of brain function, the heart may continue to beat with the assistance of mechanical ventilatory support. In such cases, this artificial support may cause the victim to appear alive visually and to the touch. Medical evidence, indicated by the four signs listed above, shows that this is not the case. In short, there is no reason for controversy. The use of neurological criteria makes certain that life has ceased.
Why does the Church accept this definition of death?
This is not a new definition of death but rather of the use of new signs to determine that death has occurred. The Christian understanding of death has always been that it is the separation of the soul from the body. The Catholic Church looks to the medical community to determine the biological signs that indicate with moral certainty that this event has already occurred. In recent years, medical research has indicated that the irreversible loss of brain function provides a firm indicator that death has already occurred.
What does Catholic theology say about this definition of death?
Neurological criteria are compatible with Catholic teaching that a human being is a substantial union of body and rational soul. When all brain function is completely and irreversibly lost, this may be taken as a reasonable indicator that the rational soul is no longer present.
Does the use of "brain death" criteria cause the death of the patient?
The use of brain death criteria does not cause the death of the patient, but only assesses whether that death has already occurred. This is analogous to the way that cessation of heartbeat and respiration have traditionally been used to make that assessment.
Why do some say that taking organs from those declared dead by neurological criteria is a form of homicide?
Such comments are irresponsible. Those who make such statements wrongly believe that a person is still alive because the corpse appears to be alive from the effect of oxygenated blood continuing to be pumped through the body which is usually accomplished with the aid of breathing machines and cardiac drugs to maintain blood pressure. Those who reject the use of neurological criteria for the determination of death claim that a patient declared dead by this method is killed for his organs. Such comments overlook the important distinctions mentioned above, and are in tension with sound Catholic teaching.
In medical practice, a physician who is not on the organ transplant team must declare death to avoid any potential conflict of interest. However, it must be emphasized, that the neurological criteria must be rigorously and consistently applied and a judgment made of total brain death before a person is declared dead.
How does the media add to the confusion over this matter?
The media is often imprecise in the way that they say that a patient who is brain dead "had life support removed, and died." Obviously, one who is dead cannot die again. Reporting such as this shows a careless imprecision in the use of language and a general ignorance about neurological criteria for ascertaining death.