3-13-2016 Bioethics Part 48

Organ donation is an important issue because there is a shortage of donated organs. Every day, 22 people in the US die while waiting for a transplant. The number of people needing transplants is increasing, but the rate of donation has stayed the same. This has led to ethical issues and creative solutions, such as uterus transplants. Organs like the heart, kidney, liver, lungs, pancreas, and intestines can be transplanted. Corneas, skin, and bone marrow can also be transplanted. The two sources for organ donation are deceased donors and living donors. Organs are distributed based on factors like organ type, blood type, distance, urgency, and time on the waiting list. The patient must be available and healthy enough to receive the transplant. Today we are going to start talking about organ donation. A few facts about the donation of organs will frame the importance of the issue. We can talk about this for a crazy long time, but we won't I promise. We will talk about it for some weeks. You might not want to or you might wonder why the heck we would, hopefully it will be clear why we should by the time I am done this morning. By the time this Sunday School is done this morning, five people in the United States will have been put on a transplant list. Every ten minutes somebody goes up on the list. Every day an average of 79 people in the United States receive organ transplants, however an average of 22 people die each day waiting for transplants that can't take place because of the shortage of donations. The rate of those needing transplants is skyrocketing, it is kind of insane to see the chart from just like 1995 until today, it is just astronomically higher than it was just 15 years ago. The rate of donating has remained almost exactly the same over that same period of time. So that number of 22 who are dying every day waiting for an organ is going up very quickly as well. This massive gap that seems likely to continue to rise has led to a very large range of very interesting, at least to me and should be for all of us, interesting bioethical issues that we will touch on some of these. But anytime you have people who are dying or even who are incredibly sick and at the same time you have the technological capability to fix it but you don't have the actual material resources to fix it, then you are going to get creative at how to get the material resources that you can now actually use if you just had them. This is another place where we see the awkward reality of technology being both friend and sometimes foe. If you did not have the possibility of getting an organ transplant, this would not even be a thing worth talking about. But now that organ transplants are something, then they are worth thinking about. 1954 was the first successful transplant of an organ. It was the transplant of a liver from one twin brother into another. When we talk about organ transplants, what are we talking about? Anybody name an organ that you know you can transplant? Heart, kidney, liver, lungs, philatemporal uterus, yes, we'll talk about that one in just a second. Pancreas and intestines are the other ones that we can currently transplant. Uterus is an interesting example. No, they can do corneas, but they can't do whole eyes. We're going to take this example of a uterus just very briefly because it is a hot topic today in the news in general, kind of, but very much in the bioethics sphere. This will get you to just see the very real ethical quandary very quickly. One in 500 women are born without a uterus. I did not know that. That seems like an extraordinarily high number, but that's a real thing. They transplanted a uterus here in the United States for the first time last week. It's already been successful in Sweden. Five children have been born from transplanted uteruses. It's an incredibly difficult procedure, both because of the number of blood vessels that need to be attached. You remember you have to sew every one of those back on to somebody's body, which is mind-blowing, and then also because the uterus is rather deep inside of a woman's body. The plan is something like this, if you don't know, these women, of course, not to be crude or anything, but the plumbing doesn't exactly work, so the uterus serves as essentially a living and alive and semi-functioning place in order to foster a child. There's not going to be any eggs that ever go down in there or anything, so what happens is that they harvest eggs, they perform in vitro fertilization, they then implant those fetuses into the uterus, the uterus that sometimes they implant, sometimes they don't, and then they grow. But they also do not give birth, because they're afraid that essentially everything is just going to tear apart. So they have to, it's automatic, it's going to be a C-section. That's what's going to happen. Then just in case it wasn't awkward enough already, they are actually going to remove the uterus in five years. Essentially the woman is, this is very crude, but she's borrowing it, because it will not stay in her body, because it's too dangerous. So she's essentially, yes, she's essentially getting the thing put in for a while in order to have something that could kind of gestate a child. You have to stay on anti-rejection medicine the entire time, because it is not going to ever be a part of your body. They are terrified that it would just automatically reject, yes. There you go. So this is the hope, is that one day, hope for some people that someday, yes, if you could figure out, now it would be incredibly complicated because of hormones and stuff like that, but yeah, it's at least hypothetically possible for a man to have a uterus, yeah. Go America. So the first US attempt did fail, but they are already planning on doing more of them. So just in case you were wondering why this is an ethical, quandary issue, now you know. There are many more examples like that we're going to touch on some of this morning. There are other things that you could transplant that are a bit different, that aren't exactly medical organs. So you can transplant corneas, you can transplant skin, you can transplant bone marrow. There are other organs that are in the body, but are not transplanted or transplantable, at least not yet. So for example, you could hypothetically transplant a stomach or a gallbladder. Does anybody know why they do not transplant those? And you can live without a stomach, which is a trip, but it is true. You don't have to have a stomach in order to live. So they don't transplant those. What? Yeah, I'm not a doctor, so I could not exactly explain to you how that works. I just know that that's the reason they don't transplant them, and it does work. People live without stomachs. Some people are born without stomachs. So also, they don't transplant things like eyes, and that would be on the spectrum of can't yet, but hope to. That whole optic nerve deal is so incredibly complicated, there's no way to reattach that thing, at least not yet. So those are what can be transplanted. There's two sources for organ donation. What's the most obvious source for transplantable organs? Recently dead people. Yes, absolutely. Dead people, depending on what you mean by dead people, which is something that we're going to talk about in the weeks ahead, because what it means to be dead is not exactly clear. I know that sounds crazy, but it's a real thing. So recently dead people is where you could get things that you very much need to live, like a heart or a whole liver. But what would be the other source? Living person. Now, how could a living person give something if you don't need it? So if you need something that you don't actually need, okay, right. So you don't need both kidneys, you just need one. Or you could get a, they can actually grow liver from a part of your liver, so they can just go in there and snip off a piece of liver and add it to somebody else's liver and then that could help them out. Or you could give things like bone marrow and stuff like that. You can actually put yourself on a list in the United States, a living donor list that essentially has all your medical facts and then they pair up and all that kind of stuff and you can do that. The ethical considerations that come into that, though, will come up in the future. So if that's where the two things come from, then how are these organs distributed to those who need them? There is something called the United Network for Organ Sharing that maintains the national official waiting pool list. All the people get put into the pool and when an organ becomes available, every time an organ becomes available, then that whole program kicks into gear and automatically ranks every single person that's in that system. This is the ranking system. So organ type, blood type, and organ size, that's the first one. That's going to discount most people. If you don't have the right blood type, and if it's not the right organ, of course, then you just get kicked off the list. Then it's the distance from the donor organ to the patient. They of course want to transport that thing as little as possible. The level of medical urgency. If somebody is not on death's door, you're going to be waiting, unless it's a lung. In the case of lungs, that's not a consideration. And then the time on the waiting list. So it's kind of like ranking football teams or something like that. It's very complicated. It's an incredibly intricate system of trying to rank all of these people because if you, for example, are not the sickest, but have been on the list for a longer amount of time, then that puts you in a specific place. Anyways, they rank everybody. Everybody gets ranked. And it doesn't mean that if you're slotted in the first position, you're going to get the organ because there's two additional questions that have to be asked. Number one, is the patient available and willing to be transplanted immediately? Now why would that word immediately be so key? Yes, organs only live for a certain amount of time outside the body. You cannot screw around. This isn't like, hey, take a couple weeks and think about it. It's like there's an organ, we need to transplant it. Can we and are you willing to have it transplanted today, right now? And then the second consideration that's kind of closely tied to that is, is the patient healthy enough to have the transplant? So why would a person not be healthy enough to have a transplant? Cold, infection. If you have a failing organ, you are probably not in very good health. So, and it could be something as small as a cold that would knock you out of the running. You have to be well enough to survive the surgery and, you know, they're going in and taking out a part of your body and putting a part of somebody else's body in your body and you have to actually take drugs that make your body not attack that part of the other person's body and kill it. So you have to be rather well in order to see this happen. If you're not the first one up on the list, then of course it just goes to the next person. It's an incredibly complicated system that's actually pretty impressive, but the question is, is it effective and is it just? Is it fair? And we will be talking about that next week. So what are the ethical difficulties in all of this? If we just need more organs, then why don't we have more organs or what's the deal with the way that it's all set up right now? Here's some questions that begin to scratch the surface of why it makes sense to think about this. There's clearly a lack of organs, so how should we go about getting more organs? You don't have to answer that question. There's the idea of like, should we open up the free market? Open up a free market for organs and you can sell your organs. That's one option. Or should you take them from those who have not given consent? So there are a couple of different ways of doing this. The much more palatable way would be implied consent, which is essentially, you know, on your driver's license today you have, that also serves as your donor card, so you actually have to physically mark on there, yes, you can have my organs when I am, if I'm gone. If you do not do that, then they are not allowed to take your organs, however your family members can say, yes, go ahead and take his or her organs. They can also block it. It depends on the state. I don't know what the law is here in Tennessee, but if a family says no, you cannot have his organs and he has put on his card, yes, you can, the family wins depending on the state, which is maybe a good thing. I'm not going to give my opinion yet. There's also the much more unpalatable opinion of how to get, well, how else would we get organs if there was, oh, sorry, implied consent is simply this, you have to say no, so you would get your driver's license and it's like, in our country, you're going to give your organs unless it's an opt-out system instead of an opt-in system. Some people are arguing for that, saying essentially Americans are inherently lazy and lame, but altruistic if you give them the chance, or generous, so if you just make it so they have to sign the thing at the bottom, then a lot of people would just give up their organs because they'd be like, yeah, fine, whatever, that's one argument. The other thing, much more questionable thing, that was actually going on in China for a while, is that we would just take organs from executed prisoners, that's right, because they don't have any rights according to the state, so we get to do with their organs whatever we want. Shockingly, China was offering a rather large number of prisoners because there was a large number of people willing to pay large amounts of money for organs. So, that's a little problematic, but that's one solution. Who gets the organs? This is a big question that makes this kind of have to be talked about. How should we set the system up, and I'm not a public policy expert, so I'm just going to be touching on kind of broad, very broad things of what we're thinking about. What should we do about black market buying and selling of organs, which is a huge business, there's a big documentary on HBO that was filmed last year, two years ago, that talks all about the illicit black market organ trade. Then should we pursue xenographs? What this is, is taking parts of animals and putting them into your body. This is a real thing that can happen. There was a little girl, back when I was a kid, I don't remember what her name was, baby something. She lived with a baboon heart for like eight days or eight weeks or something, and then died. Pig organs are at least hypothetically viable. There's also the thing where they grow human organs inside of pigs and then take them out of pigs and put them in you. Should we be doing that? Or is that wrong? And then of course, when is a person dead? Those questions might, you might have immediate reactions to those questions, but the minute that you kind of drill down for three seconds, you see that it's a lot more complicated. Let me lay out some questions that kind of, these are kind of thought experiments that we're not going to work through, but show kind of, if you just take those very basic questions and then make them just one step a little bit more directed to a situation, the complications skyrocket through the roof. Here's a couple of them. Number one, should someone who has received one organ transplant be given a second transplant? Or should people who have not had a transplant be given priority over those who already have one? Number two, should people whose lifestyle choices, smoking, drinking, drug use, obesity, et cetera, damage their organs be given a chance to have an organ transplant? Or should we essentially say that you made the choice to live this way, now you get to die? Of course, the most complicated part of that is, and maybe you reactionarily go, of course we should do that. Then the question is, who gets to choose, and if they get to choose, what if they don't like what you do? It's always easy if it's like, yeah, heroin addicts shouldn't get transplants. Well, what if it's people that love the color purple? Should suicidal individuals be given an organ transplant? Because they're just going to quote unquote waste them, right? If they're suicidal. Or how long should somebody be, who was suicidal, not be suicidal, or have attempted suicide in order to receive an organ transplant? Number four, should people who have young children be given an organ transplant over a single person, or an elderly person? Should age, and whether or not a person has ever had children, come into play when we're talking about organ donation? Should people who can't afford expensive anti-rejection drugs be passed over for a transplant? Should people who don't have insurance and can't pay for a transplant be allowed to go on the national waiting list? Or should we just essentially toss poor people off the list? Not probably very surprising to any of you, that's a rather appealing proposition to some people in America today. Number six, should condemned prisoners receive organ transplants? What about those who have been convicted to a sentence of life in prison? Are they entitled to organ transplants? Remember, there is a shortage. So if they get one, what does that mean? Someone else doesn't. So should we take those kinds of things into account? They're not easy questions, and there are definitely no easy answers about it. Maybe the most basic question, and this is what we're going to deal with this morning, at least the negative aspect of it, is, is organ donation morally acceptable, period? Is it something that Christians are allowed to do? And if they are allowed to do it, this is the much more important question, are they morally obligated to do it? Now can anybody think about what would be possibly the strongest argument from obligation? There it is. That's right. Essentially, love your neighbor as yourself. You're dead, so you should be obligated to give up your organs. Now I'm going to give, for the rest of our time this morning, the argument against organ donation. Then next week, I'll give the argument for it. So there's a certain number of arguments that kind of combine together. Some are stronger, some are weaker. This is what I came up with, and I'm stealing from other people as well. Number one, you bear as a human being the image of God. It is not easy to exactly define what it means to bear the image of God. However, as we saw early on in our study in bioethics, it's not simply like the way you think. It seems as if God created us in a very specific way to carry out the very specific tasks that he desired for us to carry out. Your body matters, as we'll get to in a second, therefore you seem to bear the image of God holistically. Your bodies aren't just insignificant extras that your souls just so happen to inhabit for a short time until you just thank God, get rid of them, and become something else, like a squirrel. It is complicated, however, the real question as to whether I should give something away or receive something from somebody is, what does it mean for my body to be my body and then for this body to be made in the image of God? If I receive a part from somebody else, then do I have two images of God in me? What does that look like? And you can easily dismiss that and go, that's stupid, however, it's not, it is actually a very good question because what does it mean to be made in the image of God and be a true, fully made, in the way God wanted you to be made, human being? The uterus example that we talked about at the beginning is a great example. You can want to have children all you want and is wanting to have children something that's bad, no, it's a good thing, however, if we remember back to the virtues for a second, if those are not strongly in your mind, then you will do anything it takes in order to get one and everything becomes permissible. The young woman who received the uterus, and it was just like she said her first name or whatever, she wasn't given her last name, her and her husband, they're like 26, they've already adopted like three kids, these clearly seem to be very quote unquote good people, kind and generous people, and the reason she goes through it is she goes, but I've always wanted to have my own child, which is totally understandable, and not necessarily wrong, however, it was very much like I thank God that he's given me this opportunity to now have a child with my own body, and there are a lot of really hard and difficult questions that come with that, and then probably the most difficult of all is, one of them is do you now thank God that it didn't work, like how does, if you're going to go and praise God for that thing, then do you praise God for all things, what happens now? Our bodies and the way that they are made matters, and to react against that and say, I'm just going to do whatever it takes to make it not this way going forward, is in very large measures speaking loudly about what you believe about the God that you worship. I'll just go ahead and give you a sneak peek to next week, I don't think it's morally wrong to have an organ transplant, it all comes down to what is your motivation behind getting this thing, but that's for next week. So we bear the image of God, that's the first thing, that's an argument against it. Here's another one, even in my death, my body is mine, corpses are named, we feel different around a corpse, if you've ever been around a corpse, there's something clearly, even if you don't know the person, something is different between that dead person and all the alive people who happen to be present at the same time, it's just this existential thing where you're like, I don't even know really why it feels this way, but that person is definitely dead, but that's still a person, they've changed somehow but that's still them. I'll give you a chapter and verse, Luke 23, 52 says, this man went to Pilate and asked for the body of Jesus, Jesus' body was still Jesus, your body is still you, even when you're dead. As Calvin and many others have pointed out, the Bible seems to explain that when we come back, when we are resurrected, we do not receive completely new and different kind of bodies. What we receive are bodies, these bodies, perfected and resurrected, and you go, well what about people who get eaten by sharks, and what about people who get blown up in land mines and all that, and the answer is, I have no stinking idea, however, this junk matters, what is, we currently possess. Nobody is clear on how we all come back, however, our bodies are very much us in many kinds of ways. We are not longing to be, in the language of Paul, unclothed, but further clothed. I'm not looking to shed this garbage, I'm looking to be perfected after the image of God and Jesus Christ, so, even in death, our bodies matter. Number three, organ donation can tend to treat the human body in the same way we treat totaled cars. They are essentially useless things to society, except for the workable parts that remain in them. This argument goes a little something like this, you know what, organs are useless to a person in death, therefore, they must, they are obligated to give them up. This assumes something rather disturbing, that our bodies are only meaningful insofar as they are useful. Which means all kinds of crazy things, you can take that down to all kinds of crazy ways, for people who are alive who have non-functioning parts of their body. Gilbert Mylander says this, we are regularly tempted to suppose that the quote-unquote real person transcends the body, and when we do, dehumanization lies near at hand. An acute sense of the dehumanizing tendency to regard our bodies as collections of alienable parts moved Leon Kass to refer to an organ transplantation as a simple, noble form of cannibalism. Which is, Leon Kass has quite a way with words, it's a great line. We are to see the work in Leon Kass's understanding as a noble thing, however, also a very much disturbing thing, because we are ripping the part of somebody out and putting it into another somebody. That should always leave us uncomfortable, that should never be something that's like, yup, alright, get it all out and we're going to go distribute it all over the place. We should think hard about this. Number four, for some people there's just too many questions. They just can't act in good faith, their conscience bothers them too much. This can come on a number of levels, it might seem like a cop-out, but it's a very real thing. So, even if somebody takes the time to explain to them all of what's going to happen to their organs and what happens, I grew up hearing, maybe you grew up the same way. Anybody grow up, anybody tell you anything about organ donation and why you shouldn't do it? Yeah, maybe it's just a Washington thing. I grew up the same way, if you mark that donor card and the paramedic comes up on the scene, they just keep you alive so they can kill you when they get to the hospital. They're not going to try and save your life, they're just going to try and preserve your life long enough to rip out all your organs. So, it's like, oh, gross, I don't want that to happen, I want them to try and save me. I'm not going to sign that donor card. But for some people there's just questions like that, so you're either like a pseudo conspiracy theorist or it's just like, I don't want to participate in a system that I think is unjust. So I am convinced that the way we currently distribute organs is not fair, and I don't want to participate in that. Or like, I don't know who's going to get it, and I know it's selfish, but I want it to go to a good person, I just can't bear this. It's not a cop out, if there's too many questions and you can't sign up for organ donation with a clear conscience, you shouldn't. The last one is this, the act of organ donation encourages people to avoid death. You're essentially feeding into a system that helps people deny the fact that they're going to die. Now, remember what I said at the beginning, we don't give organs to people who are too sick to receive them. This is not something like, we do some crazy things in this country, like give hip replacements to 95 year old women who have dementia and are never going to get better. That kind of stuff is debatably crazy, however, that would not happen when it comes to an organ, because there's such a shortage, it'd just be like, we're not going to do this, we can't do this, if you're already on the way out and too sick to receive the organ. However, that whole on your way out thing is very slippery slope, because how on your way out do you have to be to not receive an organ? I don't want to help people try to avoid death, I want to help people continue to live, but the number of people on the list is skyrocketing, not because new conditions have come about, it's because medical technology has progressed to the point where we can hypothetically get more organs, so more people get on that list and go, well, I'm just going to put myself on the list and see if I got a shot, where before, those people would have just died because their organ, whatever organ it is that's failing them, would have failed. It is true that our society is desperately trying to avoid death at all costs, and so it makes sense that some people wouldn't want to help those people out, and we still haven't answered the question, and I'm not going to answer the question today, can a Christian participate in organ donation, we're going to get to that next week, but I hope that the second question that I ask is now absolutely, and without a doubt, completely clear. The question is, is a Christian morally obligated to donate their organs, yes or no? No, not in any way, shape, or form. You might want to do that. One of the hard things is not becoming super-judgmental about other people, that's just a general rule in all of life, but particularly when it comes to something like this, where it's, you feel maybe very strongly about this issue, that's one of the reasons I love bioethics is people get really, really worked up about this stuff, like crazy, even if they have no idea what they're talking about, they're very passionate about these things, and it usually comes down to some kind of personal experience, or some family friend or something like that, that had something happen to them. But you should never feel obligated, in any way, shape, or form, to give up your organs. I'm going to encourage you to do so next week, but you should not feel obligated, and there's definitely not any thus saith the Lord. These considerations against the practice are very, very real, but they are not conclusive. Gilbert Mylander has this great term, he says that you and I, when it comes to organ donation, should never feel compelled by the tyranny of the possible. Just because we can do something, does not mean that we ought to do it, nor that we ought to be obligated to do it, ever, for any reason. So, be encouraged to continue to think hard about the practice of organ donation. Are there any questions before we end? Great. Let's pray. We thank you for the bodies that you have given to us, even if they are not perfect, if they are not all that we would like them to be, or if they are not all that they once were. We pray that we would think hard about these kinds of things, knowing how important it is to use the brains that you have given us, and also how important it is seeing all of the very difficult issues that come up in the possibility of doing something as seemingly noble, and without question, as organ donation. We pray that you would help us to be wise in what we do with our bodies in life and in death. In Jesus' name, Amen.