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Vol. 3 No. 2 - Pentecost 2008

A Search for Wholeness:
An Orthodox Response to Organ Donation and Retrieval


"For if truth of God has increased through my lie to His glory why am I also still judged as a sinner? And why not say, 'Let us do evil that good may come?'" - Romans 3:7-8

So far, we have dealt essentially with organ donation after brain death and heart-beating donations (HBD). More recently, there is a resurgence of interest and experimentation with retrieval of organs from patients after cardiocirculatory death. These individual have also been termed non-heart beating donors (NHBD).[4] What is this process and why is there such an interest and urgency among health providers and lawmakers to promote and facilitate such a strategy?

Donation after cardiocirculatory death (DCD) is not a new concept. In fact, this practice was the standard practice of organ retrieval prior to the establishment of NDD. These were the initial organs retrieved from individuals who met the traditional criteria of physical death involving the cessation of the heart and circulation. The Maastricht classification of donation after cardiocirulatory death, published in 1995 (amended in 2003 to include category V), outlines the different groups of NHBD.[16]

• I Brought in dead
• II Unsuccessful resuscitation
• III Awaiting cardiac arrest
• IV Cardiac arrest after brain-stem death
• V Cardiac arrest in a hospital inpatient

Only categories I and II are consistent with the historic definition of death. In categories IV and V, patients in addition to being maintained on life support, have had circulatory arrest at least once but restarted again after cardiopulmonary resuscitation. In regard to transplant and organ preservation, these four categories are termed uncontrolled donation after cardiac death, since warm ischemic time cannot be avoided or minimized. This is in contrast to patients from category III who allow for controlled donation after cardiac death.

Over the last decade, due to the profound discrepancy between the supply of vital organs and the demand from patients with end-organ failures, there has been a concerted and coordinated effort by the international transplant organizations to legitimize and make routine the harvesting of organs from category III individuals who have sustained a significant insult (such as a stroke or respiratory failure) and whose condition is deemed medically irreversible and/or terminal but do not meet the criteria for brain death.[17] These individuals are taken to the operating room before death, disconnected from life support (ventilators) and monitored until the heart finally stops beating, hence the description controlled). At this point, only two to five minutes are permitted for the establishing of the absence of spontaneous recovery before the patient is pronounced dead (hence cardiac death). While the body is still warm, the actual process of removing organs is permitted, forgoing the onerous task of establishing brain death since expediency governs the "success" of organ retrieval and preservation. In some centers, prior to cardiac death, certain interventions such as medications and sternolaparotomy (incision from the neck to the abdomen) and vessel cannulation, may be permitted for the purposes of maximizing organ viability by minimizing warm ischemic time. Of course, this practice violates the dead donor rule which holds that patients must be dead before organ retrieval proceeds and that the person's death must be neither caused nor hastened by retrieval.[15] (Up until 2007, the prosecution of the State of Ohio had filed homicide charges against physicians in Cleveland engaged in controlled cardiac death donations).

Furthermore, the cardiac death of patients cannot be predicted precisely. Beecher recognized this early in the field of transplant science. He wrote: "Dying is a continuous process: while death may occur at a discrete time, we are not able to pinpoint it." The University of Wisconsin had developed a tool to identify DCD individuals who would likely have a cardiac death within two hours after removal of life support. In their experience, about ten percent of identified potential DCD donors were returned to the unit or hospital floor for palliative care.[4]

The ungodly vigil of death during DCD donations is being played out increasingly in operating theatres throughout North America and Europe and shows the depravity of mankind's achievements. In the name of medical and intellectual progress, the process of organ retrieval for transplantation, seen by the world as a great "hope" for life, is, in fact, moral justification for a practice not dissimilar to carrion birds. At the very least, these beasts wait for the death of their prey and their animal subjects do not have immortal souls to reconcile with God. "A good tree cannot bear bad fruit, nor can a bad tree bear good fruit... Therefore by their fruits you will know them." (Matthew 7:18-20) This unnatural fight against decay and time is the hallmark of the worldly man, who has long forgotten God and strives for immortality at all costs. Christ spoke truly about this generation: "For what profit is it to a man if he gains the whole world, and loses his own soul? Or what will a man give in exchange for his soul?" (Mark 9:36-37)


"But even though the devil should transform himself into an angel of light (2 Corinthians. 11:14), or present thoughts which seem most good, the heart will feel a certain lack of clarity, an unrest in its thoughts and a confusion of feeling."[17] - St. Seraphim of Sarov

The Orthodox do not subscribe to the common view that death is a normal or natural phenomenon. Man was not created to die. "The Church sees death as ultimately negative, the consequence of our ontological separation with God, the consequence of our sinful condition."[18] This consequence has a very real impact on the living. At a worldly level, for the health care workers directly involved in the procurement of organs from NDD or DCD individuals, there are psychological and emotion burdens which the advocates of organ donation try to minimize by focusing on the tremendous benefits to living organ recipients. At a minimum, most health care workers experience degrees of sadness and remorse. This is hopefully only transient and outwardly, related to sentimentality. However, there is a more harmful, lasting spiritual consequence of which the secular world, with all its rationalism and carnal intellect, has no knowledge. The mystical understanding of the consequence of participating in death, decay, corruption and sin can only be fully articulated by the Orthodox Church. It alone has preserved the science of the Fathers, which is not based on man-made ideology or theories, but is rooted in the authenticated knowledge and experience of the whole living church from the beginning of time.

The Church Fathers taught that we are made to account for every thought, word and deed. In our whole life we are constantly in a struggle to draw closer to God, Who is Light and Life, or to the Evil One who is Darkness and Death. St. Nikolai Velimirovic writes, "The main thing is that you know and measure how all your deeds, words, and thoughts unavoidably create an impression on all four sides: on God and the spiritual world, on nature, on man, and on your soul. If you train yourself in this knowledge, you will attain a high level of saving vigilance."[19] This vigilance refers to the watchfulness (nepsis) of the nous. The nous is the highest part of the soul, the part of our nature that is capable of true communion with the living God. Anything that darkens the nous can be compared to spiritual poison, which draws us further from God and leads eventually to spiritual death for our immortal soul. This is the meaning of Christ's statement: "The lamp of the body is the eye. If therefore your eye is good, your whole body will be full of light...(but) if the light that is in you is darkness, how great is the darkness." (Matthew 22-23). Involvement with death, in any form, whether voluntarily or involuntarily darkens the nous. Priests are not permitted to be undertakers since "what communion has light with darkness?" (2 Corinthians 6:14)

The modern approach to transplant and organ donation is a tangible battle of man against the laws of nature. From the moment when a patient is diagnosed with irreversible illness the role of the physician (whether as the intensive care physician or anesthesiologist) fights a desperate battle against demise of the vital organs such as the heart, lungs, kidneys and liver. The ensuing decay and corruption is part of the process of death, but it is not death itself. The idea that science and medicine can prolong indefinitely the life of the body by mechanical life support is simply false and ridiculous. Why else is there such urgency for live donor and cardiac death donations? This propaganda is offered to make organ donation more attractive, insisting that death has truly occurred but through marvelous medical progress, the organs can still be salvaged and made to function. Modern man emphasizes illness and death of the physical body (sometimes of the carnal mind). In his quest to be rational, mankind has become the most irrational and foolish of all beasts fearing the one who could kill the body but not the soul, and giving no heed to Him who, "after He has killed, has power to cast into hell; yes, I say to you, fear Him!" (Luke 12:5)


"Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you." (Matthew 7:7)

There are several simple but essential steps Orthodox Christians must take in confronting the question of organ transplants:

1. As Orthodox faithful, we must pray that the world may see the one true great hope that is here and is to come in Christ's Incarnation, Death and Resurrection, and that Orthodox faithful would be granted the faith to live according to God's command, striving to be vessels of holiness and purity in preserving the integrity of the human body. As the Apostle Paul writes: "I do not want you to be ignorant, brethren, concerning those who have fallen asleep, lest you sorrow as others who have no hope." (1 Thessalonians 4:13)

2. Learn more about the Orthodox faith through reading the Sacred Scriptures and texts on the Sacred Tradition and the lives of the Saints. Speak to your spiritual father or mother, confessor, or priest, regarding the issues brought up in the article, to ask for their direction before giving consent to organ donation for yourself or, by proxy, for any loved one, bringing to mind the litany offered at every Orthodox service: "A Christian ending to our life, painless, blameless, peaceful and a good defence before the dread judgment seat of Christ, let us ask of the Lord. Grant this, O Lord."

3. If you are in the difficult position, as an employee or administrator, whereby involvement in some part of the process or promotion of organ retrieval is required, at least speak about it to an Orthodox spiritual guide. Pray that in God's Mercy, He will grant deliverance from such a duty. Ideally, Orthodox Christians should refrain from participation in any way. In addition, offer fervent prayer, and attend the Orthodox funeral services and memorial prayers for the departed.

4. Be a witness to others especially to Orthodox brothers and sisters who are unfamiliar with the realities of organ donation to inform them about this issue in a firm and loving way with "meekness and fear; having a good conscience, that when they defame you as evildoers, those who revile your good conduct in Christ may be ashamed. For it is better, if it is the will of God, to suffer for doing good than for doing evil." (1 Peter. 3:15-17)

[4] National recommendations for donation after cardiocirculatory death in Canada. CMAJ 2006; 175(8): Supplemental S1-24.

[15] Robert D. Truog et al. Role of brain death and the dead-donor rule in the ethics of organ transplant. Crit Care med 2003; 31(9) 2381-6.

[16] Peter L. Abt et al. Donation after Cardiac Death in the US: History and Use. Journal of the American College of Surgeons 2006; 203(2): 208-225.

[17] Constantine Cavarnos and Mary-Barbara Zeldin, Modern Orthodox Saints 5: St. Seraphim of Sarov. Institute for Byzantine and Modern Greek Studies, Massachusetts, 1993.

[18] Stanley S. Harakas, Living the Faith: The Praxis of Eastern Orthodox Ethics. Light and Life Publishing Company, Minnesota, 1992.

[19] Saint Nikolai Velimirovic, The Prologue of Ochrid: Lives of Saints, Hymns, Reflections and Homilies for Every Day of the Year, Volume 1 Jan-June. Serbian Orthodox Archdiocese of Western America, California, 2002.

[20] Constantine Cavarnos, Modern Orthodox Saints 2: St. Nicodemos the Hagiorite. Institute for Byzantine and Modern Greek Studies, Massachusetts, 1974.

Linda Korz is an M.D., specializing in anaesthesiology.
(Pentecost, 2008)

© All Saints of North America Orthodox Church
Orthodox Church in America, 2008.