Transplants and brain death

Transplants have entered the everyday life of modern society. The positive or negative positions expressed about them by ecclesiastical and theological circles are usually fragmentary in nature. The Orthodox Church has not yet finally taken a position on them. And its position cannot be made by individual individuals or by committees trying to base their views on its tradition, but must be dictated by its universal conscience.

The origins of transplants date back to ancient times. The ancient Egyptians already performed skin transplants.¹. However, the first transplants of vital organs and tissues of the human body took place in our time. Thus, the first successful kidney transplant was carried out in 1954, while the first successful heart transplant in 1967. Subsequently, transplants, as therapeutic methods that are not limited to maintenance, but progress to the radical disappearance of health problems, became widespread and caused excitement on a global scale.

Transplants: The quest for earthly immortality?

This enthusiasm is certainly due to the magnitude of the achievement, but perhaps also to the desire of modern man to achieve some earthly immortality. Therefore, it is not an exaggeration to say that it involves the risk of disorienting man from the ultimate purpose of existence and his deepest problems. If we take into account that the human lives that can be saved by transplants cannot cover even one thousandth of those that are destroyed by abortions, the relativity of the enthusiasm for the protection of man becomes clearer.

Excessive trust in transplants focuses man's interest only on physical integrity and at the same time cultivates the illusion of some relative earthly immortality. However, the search for this immortality is not in harmony with the expectation of eternity and the belief in the victory of death through Christ. This means that the Church cannot set as its goal the dissemination of a slogan of the give and save type that easily fits into consumer or commercial perspectives. Such a position would reveal secularization and integration into the current of the times.

In the perspective of the Church, biological life and biological death lose their dramatic rivalry and become relativized. After all, by their very nature, life and death are intertwined and intertwined. Life unfolds as a process of death. And death exists in every phase of life.². In particular, it exists as a phase of definitive change of life; as a transition from temporary to real life. This perspective not only eliminates the tragedy of death, but also creates the possibility for a positive or even aggressive approach to it. Biological death is common to animals and humans. The Christian does not have to passively await this death. He can also accept it voluntarily, in order to gain life through it.

Just as physical death can serve spiritual life, so too can physical illness serve spiritual health. However, this does not mean that the value of physical health and life is being disregarded. Moreover, the synthetic anthropology of the Church, which insists on the psychosomatic unity of man, naturally views positively not only mental but also physical health. This is also evidenced by the many wishes of the Church for the health of the soul and body of man.³At the same time, however, there was always their medical treatment, which was blessed by the Church.

Modern medicine, despite its amazing achievements, expresses or even extends the humanistic anthropology that was once rejected in the Orthodox world, because it confines man to the limits of creation and mortality. Its interest in man is limited to his biological functions and his life is identified with his biological preservation. This is why it is often observed that where this medicine exclusively dominates, God is displaced.

Nevertheless, the value of medicine, which comes as a gift from God to comfort man in his spiritual and physical illness, cannot be overlooked. Christ himself came into the world as a physician of the souls and bodies of men. The manifestation of the kingdom of God is also marked by healings of the sick. But the various healings performed by the saints in the world are also recognized as consequences of God's special grace. It is characteristic that these healings include the completion of a bodily organ, as in the case of the healing of the man born blind by the Lord.⁴, but also the transplantation of a bodily member, as in the case of the transplantation of a tibia from a corpse to a patient carried out by Saints Cosmas and Damian⁵. Finally, physical illness has a certain analogy to mental illness. And the cure for physical illness is offered as a formula for the mental education and treatment of man. Just as physical illness requires the avoidance of harmful foods, so too does mental illness require the observance of God's commandments.

A Christian has no reason to avoid medicine or not seek out the most experienced doctors.⁶. But whether he resorts to the help of doctors or renounces them, he must ultimately look to God and the benefit of his soul. This is what he must seek with every action: "Whether you eat or drink or whatever you do, do all to the glory of God."⁷The believer therefore resorts to doctors and medical science, whenever necessary, without, however, placing all his expectations there.⁸.

Medicine seeks to restore or improve human health. However, in taking care of these, it also seeks to prolong life. The Church does not hinder medicine in its efforts, but it does not ignore its relevance. At the same time, however, it puts forward its own positions on man and his life. The purpose of the Church is not to give the world a way of survival, but the life that conquers death. In particular, the ascetic tradition of the Church emphasizes the restrained use of medicine and medical drugs to avoid pro-life. Of course, this primarily concerns ascetics. However, it should not be indifferent to every Christian, because he too must have an ascetic disposition. And this disposition is naturally combined with the spiritual maturity of the believer and leads more to giving and less to receiving. This is naturally also true of the issue of transplants.

The application of transplants in humans is carried out in a very wide range and takes various forms. It starts from blood transfusion, which is a transfer of liquid tissue, proceeds to the donation of one of the double organs and reaches the transplantation of liver and heart. More recently, in the context of gene therapy, we also have the transplantation of modified cells to treat diseases, such as fibrocystic disease. Moreover, transplants can concern a single person, when a tissue is transferred from one part of the body to another, or involve another or other people, when the tissues or organs are received from them. Finally, the donor of the transplant can be alive or even dead. Some ecclesiastical and theological circles express serious reservations or even categorical objections to the right of a person to make such donations. And these objections reach their peak, naturally, when it comes to the donation of a central organ, such as the heart, which presupposes the death of the donor.

The negative argument for transplants

The negative argument for transplants primarily invokes the sacredness of the human body and the spiritual dimension of its basic organs according to Old Testament anthropology, which is also preserved in the patristic tradition. The heart, blood, liver, kidneys are associated, especially in the Old Testament, with the spiritual life of the believer.⁹. But also in the Orthodox ascetic tradition the physical heart is directly connected to the spiritual life. And the path to the deepest heart of man passes through his physical heart. Furthermore, the negative argumentation maintains that man owes his body to God and cannot donate it. The body of a Christian is a temple of God or a member of Christ. Besides, the whole Christian does not belong to himself, but is "bought with honor"¹⁰Therefore, it is noted, he cannot manage himself or his body at will.

Nevertheless, the Christian not only can, but must act according to the will of Christ expressed in his commandments. And when man acts according to the commandments of Christ, he acts in the perspective of real life, even if he passes through death. The special characteristic of Christian anthropology is that it sees the real life of man only through the passage of death, which has revolutionary consequences. The question is therefore whether, by donating tissues and organs, the commandments of Christ, which are summarized in the double commandment of love, are observed, or whether his example is followed.

Christ teaches self-sacrifice and sacrifices himself for the world. He himself nourishes people with his body and blood, not of course to prolong their earthly life, but to renew and purify them. Despite this, he also offers an extension of earthly life with his miracles. With these, however, he condescends to human weakness. His purpose is not miraculous healings, but the liberation of man from sin: “But that you may know that the Son of Man has power on earth to take away sin, he says to the paralytic; I say to you, take up your bed and go to your house”¹¹. The miraculous healings or resurrections that Christ performs are at the same time signs of the presence of his kingdom. If man is not led to it, then the sign loses its meaning. And the Church is therefore called to be active at this level by presenting signs of her love, without forgetting her main work. She is also called to save people, without forgetting her purpose. The main purpose of the Church is not the temporary liberation of people from biological death, but their definitive liberation from the fear of death and from death itself. For the Church of the deliverance of death, the conviction of death is much greater than the contempt¹².

However, the constant commitment to the greater, which is particularly imperative in modern secularized society, does not mean indifference to the lesser, which is also imperative precisely because of the secularization of society. The Church does not act only with precision, but also with economy. Theology cannot become economy. But economy does not cease to have its theological justification. The voluntary offering of some bodily tissue or organ, as a self-offering of selfless love, is a respected act and requires serious and delicate pastoral treatment. Who would not praise the sensitivity of the person who, out of love, offers his eye or kidney, so that someone else may see or live? And what could anyone say if this donor were willing to offer his life too, so that his neighbor may live? Of course, in this case we would have a purely charismatic manifestation that is valued in its theological perspective and not in the utilitarian compilation of lists of volunteer donors.

Determining death in the Church and science

In heart transplants, the most critical point is the determination of death. The Church sees human death as a mystery of the separation or exit of the soul from the body.¹³. Modern medicine often equates human death with brain death. This death is defined based on the mechanistic anthropology of modern medicine as irreversible cessation of brain function with permanent loss of consciousness.¹⁴. However, if the irreversible cessation of brain function can be determined on a purely biological level, the definitive loss of consciousness which, according to ecclesiastical anthropology, is traced to the human soul cannot be detected only on this level. The identification of the separation of the soul from the body with the irreversible cessation of brain function, that is, the identification of death, as defined by ecclesiastical anthropology, with brain death is arbitrary. According to ecclesiastical anthropology, the soul, as a special substance, exists in the entire human body and continues it. The brain is not the vessel but the organ of the soul¹⁵. Brain death means cessation of the possibility of active manifestation of the soul, but not necessarily its annihilation. However, according to modern medical anthropology, which reduces the soul to mental phenomena or mental energies, brain death is identified with the necrosis of mental energies, and therefore with the definitive loss of consciousness. It therefore becomes clear that the disagreements surrounding the issue of brain death ultimately come down to confusion regarding the essence and energy of the soul. For ecclesiastical anthropology, the soul has a special essence and energy. For modern medical anthropology, however, the soul is simple energy. Brain death, or brain death, means cessation of mental energy. And while this cessation according to medical anthropology is identified with the definitive loss of consciousness, for ecclesiastical anthropology it is identified with the cessation of its activation.

Ultimately, death as the separation or exit of the soul from the body continues to be a mystery. No one can say with certainty that it coincides with brain death. It may coincide, it may precede, it may even follow brain death. People who were considered clinically dead and came back to life experienced the separation of their soul from the body and had intense out-of-body experiences which they subsequently recounted. This could be considered an indication of the separation or exit of the soul from the body before brain death, since the cessation of brain function is irreversible and the return to life after it is not possible. Others, again, came back to life after the cessation of cardiorespiratory function due to cardiac arrest. This means that even the cessation of cardiorespiratory function does not constitute a definitive and irreversible separation of the soul from the body. So what can be argued for the separation of the soul from the body, when the human cardiorespiratory system operates with mechanical support? The question remains unanswered.

Figurative understanding and appreciation of man

Any donation of bodily tissue or organ constitutes a kind of self-sacrifice. However, it would be untheological to consider such an act as a scriptural imitation of the sacrifice of Christ. Christ offers his body and blood to give people not temporary, but real life, which may even involve the sacrifice of temporary life. Temporary life should not be disconnected from real life and become autonomous. But attachment to temporary life extinguishes the desire for eternal life. “For whoever wants to save his life will lose it, but whoever loses his life for my sake will find it.”¹⁶"He who loves his life will lose it, and he who hates his life in this world will keep it for eternal life."¹⁷. Whoever loves his life loses it. And whoever does not consider his life in this world, preserves it for eternal life. This paradoxical path of the Gospel for human logic, the path that Christ first followed, certainly does not move at the level of the logic of transplants. Nevertheless, the philanthropic or even heroic element that exists in the voluntary donation of tissues or organs for transplantation, does not cease to have its value. Just as the need for pastoral support for people who are in critical health situations cannot be overlooked.

The problematic presented by some about the posthumous integrity of those who donate their organs is of a scholastic nature. Man is not identified with his body, nor with his soul, nor even with their mixture or their sum, but is something that transcends all of these and continues them, without being continued in any way by them and without being defined by any of them.¹⁸As a creation in the image of God, man is always understood figuratively, but also appreciated figuratively.¹⁹. And its figurative understanding and appreciation simultaneously concerns all of humanity, as well as each person and their individual actions. Beyond any dichotomous distinction of matter and spirit, body and soul, individual and society, people, as images of God the Word, keeping the commandment of love, abide in God who is love and constitute the one body of the Church of Christ.

Within this dynamic and multidimensional anthropology, every drop of blood offered out of love for one's neighbor constitutes a universal offering of the whole person. But any meticulous search for the implications that the offering of some bodily tissue or organ may have on the posthumous integrity of one's existence loses its meaning. At the same time, however, it becomes clear how incompatible with this anthropology is the mechanistic view of man and the treatment of the tissues and organs of his body as therapeutic means or replacement materials.

The Orthodox Approach

The theological approach to all contemporary problems is natural to be done with the measure of perfection which is the measure of Christ. However, the measure which the Christian must always have before him, must not be turned into a sword for the exhaustion of the weak in faith.²⁰. Certainly Christian perfection is for everyone and should not be hidden from any believer. But human weakness is also common to all and it is not permissible for anyone to be condemned because of it. The Church respects human freedom without limit and exhausts all the margins of its economy for its preservation. The explicit opposition of the Church begins from the moment when human freedom is disregarded and his holiness is despised. Nothing justifies forcing a person to offer tissues or organs of his body before or after his death. The human body is sacred. And it must be respected, not only alive but also dead. It is not right to treat it as therapeutic material or as a warehouse of spare parts. Nothing confirms his presumed consent to the donation of tissues or organs of his body, or much less the discounting of his consent, when there is no expressed contrary wish. Finally, nothing legitimizes the dogmatic imposition of brain death as the exclusive criterion for determining the moment of death in the consciousnesses of those who see death as a mystery of separation or exit of the soul from the body.

Orthodox theology does not usually present specific rules for dealing with the problems of everyday life, but sets the conditions and points out the basic criteria that can have various applications. And it does this, not because it likes vagueness or bilingualism, but because it respects truth and the person. If the approach to inorganic matter adopts, with quantum mechanics, two mutually exclusive positions as complementary (waves – particles) and requires that the position of the person observing it be always taken into account, how can the one-dimensional and mechanistic approach to man and his health problems be considered satisfactory? The same objective fact can mean two diametrically opposed things for man. The truth of things is not limited to external types. Just as the taking of life can constitute an act of supreme love (self-sacrifice), but also an act of complete self-restraint and ultimate self-denial (suicide), so too can the transplantation of tissues or organs from one person to another be an act of supreme love, but also an act of contempt for man or an ultimate transaction. It can be a victory over death with the voluntary acceptance of death, but it can also be complete compliance with mortality with the simultaneous annihilation of every spiritual element. Orthodox theology cannot accept the transplantation of tissues or organs from one person to another or even the simple transfusion of blood as some mechanistic process. However, it can accept them as acts of self-offering and self-sacrifice. For this reason, it does not address the problem of transplantations with a prescribed case history, but views the various cases with criteria of selfless love and respect for the person.