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  Organ Transplantation - Do We Know What We Are Doing?

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By: Frank Meyer, MD
Original title: Organtransplantation - wissen wir, was wir tun? Plaedoyer fr erne humane Medizin. Der Merkurstab 1996; 49:171-3. English by A. R Meuss, FIL, MTA

A Plea For Humane Medicine

In view of proposed transplantation legislation in Germany, "brain death" and organ transplantation are currently under discussion. In anthroposophical discussions too, many voices are heard, some contradictory, and initiatives taken.(1) As a rule, those who refuse to accept the expedient "brain death" definition as being unscientific will not permit the removal of organs from people who have reached this point in the dying process unless they have previously agreed to this. Consensus is fairly general on this point. Yet even those who are critical about equating "brain death" with death of a human being are at odds on how to consider organ removal and transplantation with the patient's agreement.(2) Being convinced that patients with irreversible loss of brain function are still alive, is it right to subject them to the intervention of organ removal which actively and purposely puts an end to life, even if they have agreed to this? Should we permit it, must we accept it? These are the ethical and legal questions.

A critical attitude to declaring dying individuals brain dead is not new. The limits set when it comes to defining death were shown in the papers on medical ethics by the philosopher, Hans Jonas, who has always been critical of putting the time of death forward for the sake of organ transplantation: for as long as we do not know the exact border line between life and death we are bound to "incline to a maximum rather than a minimum definition of death in this area of major uncertainty." That means "brain death plus heart death plus any other indication that may be relevant". "The patient", Jonas writes, "must be absolutely certain that his physician will not become his executioner, and that no definition will ever empower him to do so."(3)

Organ donor card - a "license to kill"?
Anyone seeking to approach this "zone of major uncertainty" with reference to organ removal using anthroposophical concepts faces a tremendous challenge. Rudolf Steiner has said much about the process of dying and about developments after death, but even in terms of methodology it is extremely difficult to apply special research findings to current issues. We may feel tempted to apply statements Steiner made on postmortem examinations and the amputation of limbs to the issue of organ transplantation, but it does not help much. Genuine responsibility presupposes certain knowledge that goes beyond mere thinking that things are a certain way. Concerning the "donor", whose organs are removed, we must look for answers to questions such as the following:

•What does it mean for this individual when intense medical efforts aremade (in the phase preparing for organ removal) to create optinum conditions for transplantation? On one hand, the dying process is extended; on the other, it is made mechanical. Will this make dying harder or impede the process?
• What effect does it have on the dying individual when death ensues abruptly, with blood at body temperature exchanged for cooling fluid immediately before or whilst organs are removed, with respiration and circulation maintained?
• Can we actually speak of the death of the whole person when individual parts of the whole are still kept alive? What does it signify to die in parts rather than as a whole? Someone who is not fully incarnated presents with various handicaps in the physical world. What are the consequences for the spiritual human being after death if excarnation is incomplete or delayed in time?
• What effect does it have on the after-death life of explanted subjects if their organs are kept alive and transferred to another person, where they enter into interaction with a foreign organism?

These questions all concern potential consequences for the higher aspects of the human being and life after death. They relate to a horizon that goes well beyond that of purely scientific medicine. They also present a challenge in Anthroposophy. For as long as our answers to the question of what we are doing to an organ donor are not exact, scientific statements, we are duty-bound to look for clinical solutions that eliminate all possible harm to the patient. It does not matter if the organ donation is by genuine consent or obtained by stealth or force. Even if someone has voluntarily offered to donate an organ or organs, this does not release us from the physician's duty of first and foremost doing no harm. If, as anthroposophists, we consider dying to be a process of birth in the spirit and reincarnation and karma to have validity, the following are matters of concern:

Intervention in processes we do not fully understand is unethical. If we see dying and life after death as a complex process of development, the risk of doing harm is too great to allow us to make interventions that no longer come directly under the physician's obligation to this particular individual (to help him, be at his side, relieve his suffering).

The transplanted organ is in interaction with the recipient's organism. We are able to observe the effects on the recipient, at least in physical terms, and to some extent influence them. We do not know the effects on the explanted individual who is already on his way to the world of the spirit nor can we influence them.

Supposing we really give the recipient time and quality of life (the opposite may also be the case), we do not know the karmic consequences this will have for the relationship between donor and recipient in a later incarnation.

It is characteristic of the threshold situation in modem meedicine that we meet these and similar questions also in other decision-making situations. To quote Jonas, we must always endeavor to "incline to maximum rather than minimum" certainty. These areas of certainty shift as the horizon of our questions changes. We know that increasing knowledge also means growing doubt, and that today's certainties will often prove false tomorrow. This, too, is progress in awareness. "Extension" of medicine may also mean resisting the prevailing feasibility approach and therapeutic actionism, and not doing certain things or refusing to share responsibility for them.

It also makes a major difference if we risk stepping out into uncertainty in order to give practical aid to a patient in our care who is in need or if we set aside ethical, anthropological and anthroposophical objections in a situation where we are asked to withdraw a physician's concern from a particular person and use that individual as a spare-parts donor. It matters if we approach a patient to serve him or to suit our own purposes. At such times, the motives of our intent may be more significant than our state of knowledge.

It has become quite common today to speak of the post-humane age with reference to the divisibility, extendibility, exchangeability and consequently marketing of the human body. Materialistic thinking and materialistic medicine have brought this about. We may be passionate in rejecting the superficiality of materialism, but we need to discover the individual as a new criterion and to help this indivisible entity in his need. That is how I see my role as a physician. As long as we take our orientation, to the best of our knowledge and belief, from the individual patient, we may hope to act in accord with this person's destiny and individual intent. This is what a truly humane medicine should seek to achieve, in the face of all post-humane ideologies and temptations. To care for the individual also when facing death is something indivisible. Turning away from the individual, on the other hand, is to fall into sin in modem medicine. It begins, if not before, when we see the dying individual as a "donor".

Notes and References
1 Aerzte fuer die enge Zustimmungslcesung (physicians for a close agreement solution; Dr. Paolo Bavastro, Prof. Linus Geisler and Prof. Peter Petersen), first publication in Info 3 nt. 11/1995; Appell zum Transplantationsgesetz (appeal concerning transplantation legislation;
Dr. Jens Heisterkamp, Frank Schadt, Dr. Frank Meyer), first publication in Info 3 Nr. 12/1995.
2 The two above initiatives differ on this point.
3 Jonas H. Technik, Medizin und Ethik pp. 225 ft. Frankfurt a.M. 1987.

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