To the
participants in an International Congress on Transplants
Respect the dignity of each
and every human being
Distinguished Ladies and Gentlemen,
1. I am happy to greet all of you at this International
Congress, which has brought you together for a reflection on the complex and
delicate theme of transplants. I thank Professor Raffaello
Cortesini and Professor Oscar Salvatierra
for their kind words, and I extend a special greeting to the Italian
Authorities present.
To all of you I express my gratitude for your
kind invitation to take part in this meeting and I very much appreciate the
serious consideration you are giving to the moral teaching of the Church. With
respect for science and being attentive above all to the law of God, the Church
has no other aim but the integral good of the human person.
Transplants are a great step forward in
science's service of man, and not a few people today owe their lives to an
organ transplant. Increasingly, the technique of transplants has proven to be a
valid means of attaining the primary goal of all medicine - the service of
human life. That is why in the Encyclical Letter Evangelium
Vitae I suggested that one way of nurturing a genuine culture of life "is
the donation of organs, performed in an ethically acceptable manner, with a
view to offering a chance of health and even of life itself to the sick who
sometimes have no other hope" (No. 86).
2. As with all human advancement, this
particular field of medical science, for all the hope of health and life it
offers to many, also presents certain critical issues that need to be examined
in the light of a discerning anthropological and ethical reflection.
In this area of medical science too the
fundamental criterion must be the defence and
promotion of the integral good of the human person, in keeping with that unique
dignity which is ours by virtue of our humanity. Consequently, it is evident
that every medical procedure performed on the human person is subject to
limits: not just the limits of what it is technically possible, but also limits
determined by respect for human nature itself, understood in its fullness:
"what is technically possible is not for that reason alone morally
admissible" (Congregation for the Doctrine of the Faith, Donum Vitae, 4).
3. It must first be emphasized, as I observed
on another occasion, that every organ transplant has its source in a decision
of great ethical value: "the decision to offer without reward a part of
one's own body for the health and well-being of another person" (Address
to the Participants in a Congress on Organ Transplants, 20 June 1991, No. 3).
Here precisely lies the nobility of the gesture, a gesture which is a genuine
act of love. It is not just a matter of giving away something that belongs to
us but of giving something of ourselves, for "by virtue of its substantial
union with a spiritual soul, the human body cannot be considered as a mere
complex of tissues, organs and functions . . . rather it is a constitutive part
of the person who manifests and expresses himself through it"
(Congregation for the Doctrine of the Faith, Donum
Vitae, 3).
Accordingly, any procedure which tends to
commercialize human organs or to consider them as items of exchange or trade must
be considered morally unacceptable, because to use the body as an
"object" is to violate the dignity of the human person.
This first point has an immediate consequence
of great ethical import: the need for informed consent. The human
"authenticity" of such a decisive gesture requires that individuals
be properly informed about the processes involved, in order to be in a position
to consent or decline in a free and conscientious manner. The consent of
relatives has its own ethical validity in the absence of a decision on the part
of the donor. Naturally, an analogous consent should be given by the recipients
of donated organs.
4. Acknowledgement of the unique dignity of the
human person has a further underlying consequence: vital organs which occur
singly in the body can be removed only after death, that is from the body of
someone who is certainly dead. This requirement is self-evident, since to act
otherwise would mean intentionally to cause the death of the donor in disposing
of his organs. This gives rise to one of the most debated issues in
contemporary bioethics, as well as to serious concerns in the minds of ordinary
people. I refer to the problem of ascertaining the fact of death.
When can a person be considered dead with
complete certainty?
In this regard, it is helpful to recall that
the death of the person is a single event, consisting in the total
disintegration of that unitary and integrated whole that is the personal self.
It results from the separation of the life-principle (or soul) from the
corporal reality of the person. The death of the person, understood in this
primary sense, is an event which no scientific technique or empirical method
can identify directly.
Yet human experience shows that once death
occurs certain biological signs inevitably follow, which medicine has learnt to
recognize with increasing precision. In this sense, the "criteria"
for ascertaining death used by medicine today should not be understood as the
technical-scientific determination of the exact moment of a person's death, but
as a scientifically secure means of identifying the biological signs that a
person has indeed died.
5. It is a well-known fact that for some time
certain scientific approaches to ascertaining death have shifted the emphasis
from the traditional cardio-respiratory signs to the so-called
"neurological" criterion. Specifically, this consists in
establishing, according to clearly determined parameters commonly held by the
international scientific community, the complete and irreversible cessation of
all brain activity (in the cerebrum, cerebellum and brain stem). This is then
considered the sign that the individual organism has lost its integrative
capacity.
With regard to the parameters used today for
ascertaining death - whether the "encephalic" signs or the more
traditional cardio-respiratory signs - the Church does not make technical
decisions. She limits herself to the Gospel duty of comparing the data offered
by medical science with the Christian understanding of the unity of the person,
bringing out the similarities and the possible conflicts capable of endangering
respect for human dignity.
Here it can be said that the criterion adopted
in more recent times for ascertaining the fact of death, namely the complete
and irreversible cessation of all brain activity, if rigorously applied, does
not seem to conflict with the essential elements of a sound anthropology.
Therefore a health-worker professionally responsible for ascertaining death can
use these criteria in each individual case as the basis for arriving at that
degree of assurance in ethical judgement which moral
teaching describes as "moral certainty". This moral certainty is
considered the necessary and sufficient basis for an ethically correct course
of action. Only where such certainty exists, and where informed consent has
already been given by the donor or the donor's legitimate representatives, is
it morally right to initiate the technical procedures required for the removal
of organs for transplant.
6. Another question of great ethical
significance is that of the allocation of donated organs through waiting-lists
and the assignment of priorities. Despite efforts to promote the practice of
organ-donation, the resources available in many countries are currently
insufficient to meet medical needs. Hence there is a need to compile
waiting-lists for transplants on the basis of clear and properly reasoned
criteria.
From the moral standpoint, an obvious principle
of justice requires that the criteria for assigning donated organs should in no
way be "discriminatory" (i.e. based on age, sex, race, religion,
social standing, etc.) or "utilitarian" (i.e. based on work capacity,
social usefulness, etc.). Instead, in determining who should have precedence in
receiving an organ, judgements should be made on the
basis of immunological and clinical factors. Any other criterion would prove
wholly arbitrary and subjective, and would fail to recognize the intrinsic
value of each human person as such, a value that is independent of any external
circumstances.
7. A final issue concerns a possible
alternative solution to the problem of finding human organs for
transplantation, something still very much in the experimental stage, namely xenotransplants, that is, organ transplants from other
animal species.
It is not my intention to explore in detail the
problems connected with this form of intervention. I would merely recall that
already in 1956 Pope Pius XII raised the question of their legitimacy. He did
so when commenting on the scientific possibility, then being presaged, of
transplanting animal corneas to humans. His response is still enlightening for
us today: in principle, he stated, for a xenotransplant
to be licit, the transplanted organ must not impair the integrity of the
psychological or genetic identity of the person receiving it; and there must
also be a proven biological possibility that the transplant will be successful
and will not expose the recipient to inordinate risk (cf. Address to the
Italian Association of Cornea Donors and to Clinical Oculists and Legal Medical
Practitioners, 14 May 1956).
8. In concluding, I express the hope
that, thanks to the work of so many generous and highly-trained people,
scientific and technological research in the field of transplants will continue
to progress, and extend to experimentation with new therapies which can replace
organ transplants, as some recent developments in prosthetics seem to promise.
In any event, methods that fail to respect the dignity and value of the person
must always be avoided. I am thinking in particular of attempts at human
cloning with a view to obtaining organs for transplants: these techniques,
insofar as they involve the manipulation and destruction of human embryos, are
not morally acceptable, even when their proposed goal is good in itself.
Science itself points to other forms of therapeutic intervention which would
not involve cloning or the use of embryonic cells, but rather would make use of
stem cells taken from adults. This is the direction that research must follow
if it wishes to respect the dignity of each and every human being, even at the
embryonic stage.
In addressing these varied issues, the
contribution of philosophers and theologians is important. Their careful and
competent reflection on the ethical problems associated with transplant therapy
can help to clarify the criteria for assessing what kinds of transplants are
morally acceptable and under what conditions, especially with regard to the
protection of each individual's personal identity.
I am confident that social, political and
educational leaders will renew their commitment to fostering a genuine culture
of generosity and solidarity. There is a need to instil
in people's hearts, especially in the hearts of the young, a genuine and deep
appreciation of the need for brotherly love, a love that can find expression in
the decision to become an organ donor.
May the Lord sustain each one of you in your
work, and guide you in the service of authentic human progress. I accompany
this wish with my Blessing.