FaithWorld

The Vatican has caused a stir by appearing to want to redefine death and then denying any such thing. If where there’s smoke, there’s fire, we haven’t heard the end of this yet.

It all started with a front-page article in the Vatican daily L’Osservatore Romano challenging the widely-accepted concept that brain death — the irreversible end of all brain activity — is the right standard for determining that someone has died. The article argued that doctors developed that standard 40 years ago to enable them to harvest organs for transplantation. The article by Lucetta Scaraffia, an Italian history professor and bioethicist, argued:

“The scientific justification of (the brain death standard) rests on a peculiar definition of the nervous system that is now being questioned by new research, which casts doubt on the fact that brain death leads to the disintegration of the body … The idea that the human person ceases to exist when the brain no longer functions, while the body is kept alive thanks to artificial respiration, implies an identification of the person with brain activity alone. This contradicts the concept of the person according to Catholic doctrine and thus contradicts the directives of the Church in the case of patients in a persistent coma.”

The Vatican accepts organ transplantation and the brain death standard, which is widely used in Catholic hospitals. Declaring the brain death criterion un-Catholic would mean those hospitals would have to revert to the cardiac death standard alone. But that leaves a much smaller window for removing viable organs and would make one kind of transplantation — heart transplants — all but impossible. As it is, there is already such a shortage of organs for transplantation that scandalous black markets for them exist and some experts want to see organs sold like commodities on an open market.

The Vatican has not changed its view on brain death despite holding two scientific conferences (in 2005 and 2006) to discuss it, but there are dissenters among Catholic bioethicists like Scaraffia who want to keep the debate going. She used the 40th anniversary of the pioneering Harvard Report that advocated the brain death standard to call for a reassessment.

Before it slips from the news, take a look at a scandal in India that illustrates one of the biggest bioethical challenges we face in a globalised world. Last weekend, Nepal handed over to Indian authorities an Indian man arrested on suspicion of running a huge illegal kidney transplant racket. It seems this ring duped poor Indians into selling kidneys that could be transplanted into rich Indians and foreigners at many times the fee that the unwitting donors received. At least five foreigners — two U.S. and three Greek citizens — were found in a luxury guesthouse run by the racket in a city of high-tech companies just outside New Delhi.

Demand for cheap kidneys has skyrocketed in recent years in rich countries, mostly because people there are becoming more obese and suffering from kidney failure. This has led to “transplant tourism” where patients from rich countries travel to the developing world to receive new kidneys. It has led to serious proposals to set up a global kidney market to meet the demand.

This black market in kidneys for transplants is widely denounced as illegal and immoral because it exploits poor people. But would creating a worldwide organ trade make the practice any more moral? Is the danger of exploitation of the poor so strong that lawmakers should ensure that money doesn’t end up deciding everything?