The statements below have been prepared by Dr John Chan and the Catholic Medical Guild to questions concerning the meaning of brain death in relation to human organ donation, and the morality of organ trading.

When brain death takes place

By Dr John Chan

ON AUG 29, 2000, the late Pope John Paul II, in an address to the 18th International Congress of the Transplantation Society, gave some important comments on this issue of brain death.

He said, "In this regard, it is helpful to recall that the death of the person is a single event, consisting in the totaldisintegration 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."

He continued, "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... [and] 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."

In Singapore, the law allows for certification of death by neurologic criteria, meaning "brain death". To diagnose "brain death", the following must be satisfied:

- A positive diagnosis of a cause of irreversible structural brain damage must be made.

- Confounding factors must be excluded. These include low blood pressure, low body temperature, brain infections, biochemical derangements, effects of sedative drugs or paralytic agents, and disease states affecting neuromuscular function. (This list is not exhaustive.)

- Tests must be done to confirm loss of:

• Cerebral function

• Brainstem function

In addition, supplementary tests to show absence of brain blood flow can be done if any of the above tests cannot be done (e.g. "Doll's reflex cannot be safely elicited due to neck injury.)

Singapore law requires brain death to be certified by two specialists. In the case of diagnosing brain death for the purpose of organ retrieval, two specialists who are not involved in the care of the patient or in the organ retrieval process must perform the tests and agree with the diagnosis.

In the same address in 2000 alluded to above, Pope John Paul II commented on medical criteria of brain death.

He said, "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'."

(Dr John Chan is a consultant in an intensive care unit of a public hospital.)

(continued on page 2)

Organ trading is illicit

By the Catholic Medical Guild of Singapore

WHEN EXPLAINING THE church's teachings on a host of issues, especially those pertaining to human life, sexuality and morality, the late Pope John Paul II always referred to the "truth about man". He taught that every human person, "a manifestation of God in the world", is endowed with an intrinsic dignity that should never be taken from him. He said: "The Book of Genesis.... places man at the summit of God's creative activity, as its crown... Everything in creation is ordered to man and everything is made subject to him... for no reason can he be made subject to other men and almost reduced to the level of a thing."

"Thus with this innate dignity that he possesses, he should never be made use of as a means to an end. Neither should he use others as a means to any end whatsoever.

"To sell one's own organ reduces the body to a mere complex of organs that can be treated as 'spare parts' and given to another as such, for monetary gain. It no longer bears the imprint of the sincere gift of self, but degrades the body and its parts to a mere commodity for 'exchange or trade'".

Which is why Pope John Paul II once said of organ trade: "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."

At this juncture, it is important to note that the church is not against organ donation at all. In fact, the late Pope John Paul II once said:

"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 wellbeing of another person'. 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."

In other words, organ donation is acceptable, even laudable, as an act of charity. In contrast, selling is not an act of charity but a commercial one. Hence, given a proper understanding of the dignity of every human person, the selling of human organs becomes illicit for the reasons given above.

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