1. The progress and spread of transplant medicine and surgery nowadays makes possible treatment and cure for many illnesses which, up to a short time ago, could only lead to death or, at best, a painful and limited existence. This “service to life,” which the donation and transplant of organs represents, shows its moral value and legitimizes its medical practice. There are, however, some conditions which must be observed, particularly those regarding donors and the organs donated and implanted. Every organ or human tissue transplant requires an explant which in some way impairs the corporeal integrity of the donor.
2. The present shortage of available organs for transplant has resulted in a number of propositions for improving the situation so as to preserve the life of those in danger of imminent death, and/or to improve the health of those who are suffering from various aliments. These propositions range from state-funding of more Organ Donation coordinators, to the establishment of a free market in organs.
3. Not all options, however, are morally acceptable. Moreover, every option must be subject to clear, coherent and rationally defensible ethical analysis. The approach used in this opinion is that of the authoritative moral teaching of the Magisterium of the Roman Catholic Church and the natural law tradition (specifically that articulated by the Magisterium). It does so on the basis that (a) all other approaches that purport to be based on reason alone are essentially deficient and ultimately incoherent; and (b) that the moral truth of natural law is, by definition, accessible to all.
The Church thus rejects those approaches to morality, such as all forms of utilitarianism, that require people to engage in the epistemologically and intellectually impossible task of measuring and weighing all the certain and possible good and evil effects of an action. To cite John Paul II, “How could an absolute obligation resulting from such debatable calculations be justified?” Instead, the Catholic analysis of a policy’s moral dimension focuses upon asking whether an option is choice-worthy, or if it is excluded from upright choice by its opposition in some way to the human goods (bona humana) to which St. Thomas Aquinas says all people, religious or otherwise, are directed by the first principles of practical reasonableness, the basic reasons for action which the encyclical letter Veritatis Splendor calls “fundamental human goods.”
4. This opinion considers only one proposition: that is, “The Richard M. De Vos Position Paper on Financial Incentives for Organ Donation” (hereafter the Position Paper). This proposition involves the establishment of a tax incentive or an insurance benefit to be received by the designated beneficiary of a donor upon the successful transplant of the donor’s organs following the donor’s natural death. This policy encourages people to designate, unambiguously, if they wish to have their organs recovered after death with the object of an act being the saving of human life.
5. Should there be any change in the composition of the Position Paper, this opinion should be considered null and void until the author has had the opportunity to consider the ethical implications of the changes.
6. Should the Magisterium of the Roman Catholic Church pronounce authoritatively and specifically on the proposition articulated in the Position Paper or a similar proposition, then the author’s position should be henceforth assumed to adhere to that of the Church.
The Catholic Position on Organ Transplantation and Compensation for Donation of Human Organs
There are positive and negative dimensions to the teaching of the Catholic Church on organ transplantation and the question of compensation.
1. Transplantation between species, specifically from animal to human, in general, is not morally forbidden. “It cannot be said that every transplant of tissues (biologically possible) between two individuals of different species is morally reprehensible, but it is even less true that every heterogeneous transplant biologically possible is not forbidden and cannot raise objections. A distinction must be made between cases, depending on which tissue or organ is intended for transplant. The transplant of animal sexual glands to humans must be rejected as immoral; but the transplant of the cornea of a non-human organism to a human organism would not create any problem if it were biologically possible and advisable.”
2. Transplantation from a corpse requires that the corpse be treated with the respect due to the abode of a spiritual and immortal soul, an essential constituent of a human person whose dignity it shared.
3. Transplantation from a corpse to a living being is permissible. Physicians should not, however, be permitted to undertake excisions or other operations on a corpse without the permission of those charged with its care and perhaps even in the face of objections previously expressed by the person in question. “Organ transplants are not morally acceptable if the donor or those who legitimately speak for him have not given their informed consent. Organ transplants conform with the moral law and can be meritorious if the physical and psychological dangers and risks incurred by the donor are proportionate to the good sought for the recipient. It is morally inadmissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons.”
4. People may choose in their wills to dispose of their bodies after natural death for legitimate medical purposes.
5. Organ transplantation from a live donor is also permissible. People are not, however, free to destroy or mutilate their members or in any other way render themselves unfit for their natural functions, except when no other provision can be made for the good of the whole body. This does not rule out live organ donation for transplantation, provided that the donor’s own health, identity, or adequate biological functioning is not endangered. “One can donate only what he can deprive himself of without serious danger to his life or personal identity, and for a just and proportionate reason.” Vital organs may only be donated after death.
6. Organ donation is neither a duty nor “an obligatory act of charity.” But “a transplant, and even a simple blood transfusion, is not like other operations. It must not be separated from the donor’s act of self-giving, from the love that gives life. The physician should always be conscious of the particular nobility of this work; he becomes the mediator of something especially significant, the gift of self which one person has made—even after death—so that another might live.”
7. Specifically regarding the issue of incentives for organ donation, compensation (financial or otherwise) is not in principle ruled out. “In advertising (for cornea donors) an intelligent reserve should be maintained to avoid serious interior and exterior conflicts. Also, is it necessary, as often happens, to refuse any compensation as a matter of principle? The question has arisen. Without doubt there can be grave abuses if recompense is demanded; but it would be an exaggeration to say that any acceptance or requirement of recompense is immoral. The case is analogous to that of blood transfusion; it is to the donor’s credit if he refuses recompense, but it is not necessarily a fault to accept it.” Hence, while organ donation is commendable, acceptance of compensation may be permissible.
1. The following conditions would render compensation for donating human organs morally impermissible: (a) if the compensation were carried out in a manner that obfuscates, denies, or undermines the belief in the divine origin of human life or the dignity thereby due the corpse; (b) if the intention and object of seeking compensation for either oneself or others was an illegal, immoral, or irreligious end, or directly violated one or more of the fundamental human goods; or (c) the act of compensation amounted to merely instrumentalising the donor or the donor’s mere self-instrumentalization.
2. The transplantation of the sexual glands from animals to humans is to be rejected as immoral because such a transplant would directly deny the sacred element in humanity and the goods of human love.
3. Society, specifically in the form of its political organization, the State, may not commandeer the organs of a deceased human being without the prior permission of that person or the consent of his family. The relation of individual human persons to the body politic is moral, not organic. This rules out any form of coercive donation, including organ procurement strategies such as presumed consent in which, absent a specific refusal, one is presumed to have consented to donation.
4. It is forbidden for any form of organ donation, be it by a living donor or from a corpse, to involve any mere instrumentalization of the person from whom the organ is taken. This prohibition includes any mere self-instrumentalization by a living donor. John Paul II states, “The body cannot be treated as a merely physical or biological entity, nor can its organs ever be used as items of sale or exchange. Such a reductive materialist conception would lead to a merely instrumental use of the body and therefore of the person. In such a perspective, organ transplantation and the grating of tissue would no longer correspond to an act of donation but would amount to the dispossession or plundering of the body.” Acceptance of compensation for oneself or others, as described above, however, need not proceed from a choice merely to instrumentalise oneself.
5. It is forbidden to engage in the commercial trafficking of bodies. “Also, in the case of dead fetuses, as for the corpses of adult persons, all commercial trafficking must be considered illicit and should be prohibited.”
6. “Ethically, not all organs can be donated. The brain and the gonads may not be transplanted because they ensure the personal and procreative identity respectively. These are organs which embody the characteristic uniqueness of the person, which medicine is bound to protect.”