What the Bible Says About Organ TransplantsBobby A. Howard, RN, BSN, MDiv
Journal of Christian Nursing, Vol. 15, No. 4; Permission granted by JCN
In this era of rapidly advancing health care technology, on a daily basis Christian nurses are confronted with critical issues that result in questions and doubt concerning the relationship between Christian ethics and modern medicine. The practice of organ donation and transplantation is one such medical advancement. Since the first successful organ transplant in 1954, the issues surrounding this practice have become increasingly complicated. Superficially, many people quickly accept the idea that donating and receiving organs is morally permissible. Recent Gallup polls indicate that approximately 85 percent of Americans believe that persons should donate organs upon their death. However, evidence of the complicated issues surrounding actual donation is indicated by survey results that report as few as 32 percent of potential donors actually donate organs for transplantation. The United Network for Organ Sharing reports that in potential donor cases when someone has been diagnosed as brain dead, only two out of ten families agree to donate the organs of that family member, because they had never previously discussed the issue. The family felt uncomfortable making the decision for their virtually deceased loved one.
As a trauma ICU nurse. I have become acutely aware that Christians are not exempt from facing such situations. Therefore, it is critical for Christian health care professionals to discover, examine and convey to others the ethical and moral implications of organ donation and transplantation based on scriptural principles.
The issues concerning organ donation and transplantation appear simple and decisive, but actually they are overwhelmingly complex. This complexity begins with the need to differentiate between replaceable tissues, such as blood or bone marrow, and solid organs such as heart and lungs that require the death of the donor. Organs and tissues may be retrieved from living or dead donors, or even animals, as in cases of transplanted heart valves from pigs. Debates rage concerning the criteria for determining death and therefore eligibility for donating.
Other questions and areas of controversy involve who should give consent, how to fairly allocate organs and who should pay the tremendous costs involved in transplantation and maintenance. Although organ donation and transplantation raise numerous issues, I want to address the biblical principles relevant to determining the permissibility, obligation or prohibition of transplanting organs or tissues from one human being to another.
What Does the Bible Say?
The statistics show that the supply of organs and tissues is not meeting the current demand. However, few objections to organ donation and transplantation are made on religious or biblical grounds. Even when a group opposes donation on religious grounds, most will extend their belief systems to allow for donation and receiving of replaceable organs and tissues, such as blood and bone marrow. Most arguments for and against organ donation and transplantation fall into two major categories: those dealing with expressed love to one's neighbor and those dealing with treatment of the body.
In his book Christian Ethics in Health Care, John Wilkinson writes that the first ethical principle on which organ donation and transplantation may be justified is that of "love for one's neighbor." This principle is also cited by Richard Hughes, a tissue recipient himself, when he describes the tangible act of loving one's neighbor.
Although the command to "love your neighbor" was quoted by Jesus (Matthew 5:43), Paul (Romans 13:9) and James (James 2:8), it may be traced back to Leviticus 19:18. This passage justifies its use in the ethics of organ donation and transplantation. The Hebrew word translated love in Leviticus is used in the Old Testament to describe the love one should have for a neighbor, as well as the love one should express toward God (Deut 6:5) and strangers (Deuteronomy 10:19). In examining the meaning of the Hebrew word translated love (ahab), Eugene Merrill says it refers to a covenant love connoting emotion and sensual love, and also a Spirit-led tendency toward obedience to the commands of God.
People are to express this love toward God and one another because of who God is, and because we are created in his image. Jesus extends the scope of who may be one's neighbor in the parable of the Good Samaritan (Luke 10:25-37) and in Matthew 5:43-44. The overarching principle is that we are obligated as Christians to love everyone. Jesus' life and words exhort all people to love brother, sister, neighbor, enemy and stranger. One way to express this love is through the convenient provisions of modern technology that make organ donation and transplantation possible.
Although donation may be permissible or even obligatory based on the principle of loving one's neighbor, does it violate biblical teaching in other areas such as the resurrection of the body, totality, self-mutilation, prolonging life and natural order? The second major category involves issues concerning the body itself.
Many Christians may fail to donate organs because of the idea that a total body will be necessary at the resurrection. This concern is addressed in an editorial by Carroll Simcox entitled The Case of the Missing Liver. In arguing for the permissibility of organ donation, Simcox includes the teachings of Paul concerning the resurrected body. A proper understanding of 1 Corinthians 15:35-49 teaches a tremendous difference between the physical body at death, which may be buried or disposed of in various ways, and the spiritual body of the resurrection. If the end-time resurrection of our bodies means simply the reoccupation of the previous body, then the entire doctrine of resurrection presented in the Bible is erroneous.
Paul uses the analogy of the difference between a seed and the product of that seed to illustrate the difference between the earthly body and the resurrected body. What is planted is not the same as the end product of the seed. Neither is the physical body the same as the future spiritual body. The fact that Jesus' recognizable resurrected body was similar to his crucified and buried body supports an argument against organ donation. Jesus' resurrected body bore scars from crucifixion (Luke 24:39) and was evidently nourished by physical food (Luke 24:42-43), but it also was supernatural and had qualities his physical body did not possess (John 20:19). Simcox concludes that Jesus was in a transitional state between an earthly body and a heavenly body." This is supported by F. F. Bruce's comment that "the form in which Jesus rose from the dead was one in which he could be seen, but his present existence is in the spiritual realm" (1 Timothy 3:16; 1 Peter 3:18). The earthly body will not enter into the heavenly inheritance (1 Corinthians 15:50). Based on these facts, there can be no justification for prohibiting organ donation and transplantation because of the need for a physically intact body prior to entering the resurrected state.
The Principle of Totality
The next moral response to organ donation and transplantation is related to the principle of totality. This principle advocates maintaining the wholeness of the body but is extended to allow for removal of a part of the body, if it is done in the interest of or for the benefit of the whole person. This would permit, for example, the amputation of an extremity in order to save the rest of the body. In addition to the assumed need for totality in the resurrection of the body, the principle of totality includes charitable donation and mutilation of the body.
Some theologians, ethicists and health care professionals currently advocate a further extension of the principle of totality. They begin by redefining benefit of the whole person. This expanded definition provides for the promotion of spiritual and moral well-being of an individual as well as physical, emotional and mental well-being; a person may ultimately benefit if given the opportunity to donate organs or tissues as an act of charity. The resulting conclusion is that charitable giving (usually understood to be giving with no intention of receiving anything in return) of organs and tissues allows for the improved well-being of the giver as well as the recipient.
This position may be criticized as a "perversion of the notion of charity." It describes the existence of a paradox when one acts in charity in order to promote self-fulfillment. This debate focuses on proper understanding of the Greek word for love (agapao), which is the verb used in each of the New Testament quotes from Leviticus 19:18. It describes a love that is more than emotional love for those closest to us. It describes self-denying. Spirit-guided love toward all mankind, whether or not we deem them worthy of such love. If an act of love exemplifies Christlikeness, then it is permissible, but if the motive is giving in order to benefit the wholeness of the giver, then the act is not justified.
The Issue of Mutilation
Finally, it is important to address the issue of mutilation as it relates to the principle of totality. Albert Jonsen reports that the issue of mutilation dates back to the ancient question of whether or not we have the right or authority to mutilate our bodies. Generally the answer is no. As stewards of God's creation, including our bodies, we should typically view self-mutilation and consent for allowing mutilation as detrimental. Some religious leaders, however, have relied on the extended principle of totality to allow for mutilation (or removal of a part) that would benefit the whole.
Wilkinson relies on passages in Matthew 5:29-30, 18:8-9 and Mark 9:43-48 to justify limited mutilation when the end goal is positive benefit to the whole person." In each of these passages, Jesus teaches that we should rid our bodies of hands, feet or eyes if that part causes us to reject the salvation provided through faith in him. Understanding these passages in context will reveal, however, that Jesus is not advocating self-mutilation. In hyperbolic style, Jesus is emphasizing the seriousness of permitting sin into one's life and is encouraging extreme measures to prevent sin. Therefore, these passages do not contextually offer guidelines to either justify or prohibit the mutilation involved in organ donation and transplantation.
Prolongation of life is another moral issue that may be associated with organ donation and transplantation. The obvious goal of this medical advancement is prolonging life that has been potentially shortened by failure of some part of the human body. In some cases, such as transplanting corneas or bone tissue, the immediate goal is improved quality of life, not the extension of life. Several biblical passages appear to support procedures that may prolong life or offer improved quality of life.
The account of Jesus raising Lazarus from the dead (John 11:1-44) parallels the prolongation of life after organ replacement. Although this event did extend Lazarus's life and give him and his family new opportunities, we must be careful to see the major emphasis of the biblical passage. Jesus says, "This illness does not lead to death: rather it is for God's glory, so that the Son of God may be glorified through it" (John 11:4). Glory for God was the motive behind this miraculous resuscitation. He would be glorified through the miraculous raising of the dead, as ultimately only God can be. He would be glorified through the initiation of the events that would lead Jesus to the cross immediately following this event. G. Campbell Morgan says this event represents a supernatural and miraculous resuscitation." Thus, the Bible does not condemn the prolongation of life in certain instances.
The Gospel accounts record twenty-three times that Jesus healed or raised someone from the dead. In some cases, Jesus healed and prolonged life for someone facing imminent death (John 4:46-53). At other times Jesus restored the function of a part of the body to improve the quality of life (Matthew 8:2-4; Mark 2:3-12; Luke 18:35-43 and John 5:1-9). Old Testament passages also offer support for prolongation of life. Elijah prayed to God, and the life of the dead child for whom he prayed was restored (1 Kings 17:19-22). Elisha performed a similar act, as life miraculously returned to a dead child (2 Kings 4:32-35). In summary, providing that motives and methods are consistent with Scripture, the Bible does not prohibit prolonging life through the medical procedures of organ transplantation.
The Natural Order
A final consideration relates to the correlation between organ donation and transplantation and the possibility of interfering with the natural order. Some people feel that organ transplantation is contrary to natural law, supporting the concept on the basis of the inevitable rejection by one's body of a newly transplanted organ or tissue. Developing technology, however, has decreased the risks of rejection. In the early 17th century the practice of blood transfusions resulted in many deaths because incompatible blood was given. Then in 1900 Karl Landsteiner discovered blood types and thus eliminated the extreme risks involved in transfusions.
Technological advances continue to eliminate the rejection of organs through closely screening donors and recipients, and then developing medications that will combat specific rejection of the transplanted organs.
Many medical advances involve tampering with the natural order, which appears to be supported by Genesis 1:28. Here mankind is commanded to kabash, or bring under subjection, the earth. This does not allow for exploitation and abuse but makes us stewards of the earthly resources God has created. John and Paul Feinburg argue that if we are not to intervene and subject the natural order to a Spirit-led dominion, then God has commanded us to do something immoral, namely subduing the natural order. This would be impossible. Therefore, organ donation and transplantation cannot be immoral solely on the grounds that they interfere with God's natural order.
It also may be asserted that the morality or immorality of organ donation and transplantation can partially be determined by the motive behind tampering with the natural order. If we pridefully use technology with the attitude that we know more than God, then the act may be deemed immoral. However, if we humbly use technology in a way that glorifies God, with an understanding that God is in ultimate control, then the act may (but not always) be considered a moral act.
The Scriptural Application
Organ donation and transplantation may be justified using biblical principles in most cases. Certain instances negate this justification, such as improper and ungodly motives and attitudes, allowing a living person to donate vital organs resulting in virtual suicide, and the marketing and improper allocation of the organs and tissues.
Giving organs or tissues may certainly fall within the realm of loving one's neighbor. Giving of essential organs before death that would result in suicide would fall under exceptions to this provision. However, Simcox states that to fail to donate organs and tissues when possible is selfish and contrary to biblical charity. The parable of the Good Samaritan demonstrated the standard that everyone is a neighbor and that people should be willing to love in a way that meets the needs of their neighbor. This includes giving first aid and the best health care possible. In the current era, this includes organ donation and transplantation.
Concerning the resurrection of the body, 1 Corinthians 15 clearly teaches that the bodies we occupy at death are not the same as the glorified bodies we will occupy in the spiritual realm. The belief that the condition of the body at death will be the same as that of the resurrected and glorified body is overly simplistic and unrealistic. An intact, permanent physical body is not required for a perfect, glorified body in the resurrection. The Bible says that we occupy frail physical bodies that were originally created from dust and to dust shall return (Genesis 3:19; Job 34:14-15; Psalm 104:29; Ecclesiastes 3:20, 12:7). The earthly body is uniquely different from the future glorified body. The argument of totality in prohibiting organ donation and transplantation is a vague, weak and changing principle that offers no significant assistance in the debate concerning organ donation and transplantation.
The parable of the Good Samaritan (Luke 10:25-37) demonstrates that the literal example of love from a neighbor consisted of bandaging wounds, pouring on oil and transporting the injured man for help. Archibald Robertson records that anointing with oil was the best medical care available in that day and that this formula testifies to the importance of medical care along with prayer. Today prolonging life through the best medical technology available and with the power of prayer should be the focus of every person in a similar situation. To deny organ donation and transplantation on the grounds that prolonging life is not biblical or moral would also require the denial of all health care and medications that treat abnormal characteristics of the body.
If a practice or procedure is not contradictory to biblical principles, then it should be permissible. This is the case concerning organ donation and transplantation. All arguments for permitting them on biblical grounds have been demonstrated as sound and often irrefutable. Some scholars even promote this practice as not simply permissible but obligatory, based on the biblical mandate to love one another. Those who prohibit organ donation and transplantation on a biblical basis have weaker arguments with a large number of inconsistencies. It may be affirmed on biblical grounds that organ donation and transplantation is at least a permissible practice and may potentially be viewed as obligatory.
Bobby A. Howard, RN, BSN, MDiv, was a trauma ICU staff nurse at North Carolina Baptist Hospital in Winston-Salem for eight years and in the minister of education/youth at Mt. Carmel Baptist Church in Asheville, North Carolina. He designed and taught a trauma nursing seminar in Croatia in 1994.
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