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VATICAN-ORGANS Feb-4-2005 (880 words) xxxi

At Vatican meeting, experts debate if brain-dead means death

By Carol Glatz
Catholic News Service

VATICAN CITY (CNS) -- The practice of harvesting vital organs from patients determined to be brain-dead was called into question by a number of Catholic medical experts at a Vatican-sponsored meeting.

Some critics of the procedure, which is legal in the United States and many European countries, cautioned that the complete cessation of brain activity might not indicate the actual death of the person.

"Brain death is not death," said U.S. Dr. Paul Byrne, former president of the Catholic Medical Association.

In a brain-dead patient, "the heart beats, the body is warm, vital organs like the liver and kidney are functioning and there is respiration, albeit supported" by a mechanical ventilator, he said during a Feb. 3-4 meeting sponsored by the Pontifical Academy of Sciences.

Pope John Paul II called for the special meeting "in order to re-study the signs of death and verify at a purely scientific level the validity of the criterion of brain death," said the chancellor of the academy, Bishop Marcelo Sanchez Sorondo.

In 1985 and again in 1989, the Pontifical Academy of Sciences upheld brain death as "the true criterion for death, given that the complete cessation of cardiorespiratory functions leads very quickly to brain death," the bishop said in introductory remarks to the meeting.

Bishop Sanchez told Catholic News Service that the academy "invited those who are critical" of the Vatican's current position on brain death and organ donation in order to hear their arguments and determine whether there is enough new material to warrant another more formal gathering.

The Vatican wants to maintain a "virtuous and just" balance between the two immoral extremes of hastening someone's death and refusing to allow someone to die, he said.

The bishop said people should not impose "death (euthanasia) even with the aim of saving another's life through transplantation," nor should they overuse life-support machines, which the pope has defined as "persistent or aggressive medical treatment."

In an Aug. 28, 2000, speech to an international congress on transplantation, the pope, too, cautiously endorsed total brain death as an indicator of a potential organ donor's death.

In that speech, he agreed with the consensus of the scientific community that "the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem) if rigorously applied, does not seem to conflict with the essential elements of anthropology."

But some doctors and philosophers debate whether a brain-dead patient is truly dead. The definition is important, they say, because if the person is in some way alive or his condition is reversible, then the removal of vital organs for transplant is tantamount to homicide.

"Organs are taken while a person is still alive," Stuart Youngner, head of the Department of Bioethics at Case Western Reserve University in Cleveland, told Catholic News Service.

Otherwise organs such as the heart, lungs and liver would no longer be viable for transplantation, he said, because when an individual's heart and breathing have stopped organs and tissues begin to degenerate.

Some organs "like the heart, lungs and liver deteriorate so quickly they must be obtained from living bodies," said Dr. David Hill, a British anesthetist.

But whether a living body without a functioning brain is equivalent to a living person was the crux of the meeting's debates.

"Human zygotes, human blastocysts and human embryos do not have a brain or brain function," but the church considers these very early stages of a human embryo to still be a human with the right to life, said Bishop Fabian W. Bruskewitz of Lincoln, Neb. A text of his remarks was made available at the meeting.

The bishop even called into question the morality of organ donation.

"In vitro fertilizations, gamete transfer techniques and similar undertakings have been clearly taught as immoral, married couples having been told very clearly that there is no intrinsic right to have children," he wrote.

"Similarly, it may be necessary to determine from a moral as well as canonical point of view whether there is a right to have donated organs from other human beings inserted into one's body," he said.

French Dr. Didier Houssin said in his presentation that the phenomenon of brain death has "resulted from the progress of emergency medical care."

Massive head trauma or a brain hemorrhage and resulting brain damage today no longer always result in immediate death because "modern medical techniques" of ambulatory and intensive care provide for rapid reanimation, he said in his presentation.

The body of a brain-dead patient appears alive because of sophisticated life support measures, such as artificial ventilation, he said.

"Explaining to a whole society that an apparent life, such as brain death, is in fact a state of death ... is not an easy task," said Houssin.

But brain death brought with it the possibility for new life through organ donation, he said.

Taking the living organs from a brain-dead patient is "an act of generosity and gives sense to the brutal and unacceptable end of the deceased for its grieving family," he wrote.

Using organs after brain death is an example of solidarity that entails the "acceptance of death after intense lifesaving efforts" and the will "to fight for the life of patients waiting for an organ transplant," he said.


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