Religious Aspects of Organ Transplantation

P. Bruzzone

ABSTRACT
No religion formally forbids donation or receipt of organs or is against transplantation
from living or deceased donors. Only some orthodox jews may have religious objections to
“opting in.” However, transplantation from deceased donors may be discouraged by Native
Americans, Roma Gypsies, Confucians, Shintoists, and some Orthodox rabbis. Some
South Asia Muslim ulemas (scholars) and muftis (jurists) oppose donation from human
living and deceased donors because the human body is an “amanat” (trusteeship) from
God and must not be desecrated following death, but they encourage xenotransplantation
research. No religion formally obliges one to donate or refuse organs. No religion formally
obliges one to consider cadaveric organs “a societal resource” or considers organ donation
“a religious duty” (except some rabbis and isolated Muslim and Christian scholars) No
religion has a formal position on “bonus points,” which is priority on the waiting list. Living
organ donation is strongly encouraged only between jesus christians (15 of 28 jesus
christians worldwide have donated a kidney). No religion forbids this practice. Directed
organ donation to people of the same religion has been proposed only by some Orthodox
Jews and some Islamic Ulemas/Muftis. Only some Muslim Ulemas/Muftis and some Asian
religions may prefer living donation over cadaveric donation. No religion prefers cadaveric
over living donation. No religion formally forbids non– heart-beating donors (nhbd)
cadaveric donation or cross-over donation. Due to the sacrad of human life, the Catholic
Church is against donation from anencephalic donors or after active euthanasia.
No religion formally forbids xenotransplantation. Addressing the participants of the
First International Congress of the Society for Organ Sharing in 1991, Pope John Paul II
said “There are many questions of an ethical, legal and social nature which need to be
more deeply investigated. There are even shameful abuses which call for determined
action on the part of medical association and donor societies, and especially of competent
legislative bodies” and later on “In effect, the human body is always a personal body, the
body of a person. The body cannot be treated as a merely physical or biological entity, nor
can its organs and tissues ever be used as item for sale or exchange”. Addressing the
participants at the XVIII International Congress of the Transplantation Society in 2000,
Pope John Paul II said “Accordingly, 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” and later on added “The criteria for assigning donated organs should in no way be
discriminatory (i.e. based on age, sex, race, religion, social standing, etc.) or utilitarian (i.e.
based on work capacity, social usefulness, etc.).” To conclude, according to the Catechism
of the Catholic Church Compendium signed by Pope Benedict XVI on june 28, 2005, 476.

From the Divisione Trapianti d’Organo, Dipartimento “Paride

Stefanini,” Università di Roma “La Sapienza,” Rome, Italy.
Address reprint requests to Paolo Bruzzone, MD, Via Santa
Maria Goretti 38/10 00199, Rome, Italy. E-mail: paolo.
bruzzone@fastwebnet.it

0041-1345/08/$–see front matter © 2008 by Elsevier Inc. All rights reserved.

doi:10.1016/j.transproceed.2008.03.049 360 Park Avenue South, New York, NY 10010-1710

1064 Transplantation Proceedings, 40, 1064 –1067 (2008)

RELIGIOUS ASPECTS
Are allowed transplantation and organ donation, before and after death? Organ trans-
plantation is morally acceptable with the consent of the donor and without excessive risks
for him/her. For the noble act of organ donation after death, the real death of the donor
must be fully ascertained.
A CCORDING to the International Transplantation So-
ciety, “organs and tissues should be freely given
without commercial consideration or financial profit.”
The Eighth Plenary Meeting of the Fifty-Seventh World
Health Assembly in Geneva urges Member States “to take
measures to protect the poorest and vulnerable groups from
transplant tourism and the sale of tissues and organs,
including attention to the wider problem of international
trafficking in human tissues and organs.”
According to William R. LaFleur, in 1958 Pope Pius XII,
in the encyclical The Prolongation of Life stated that “any
pronouncement determining the point of death was a
matter not for the church but for the physician.”
Addressing the participants at the First International
Congress of the Society for Organ Sharing in 1991, Pope
John Paul II said “There are many questions of an ethical,
legal and social nature which need to be more deeply
investigated. There are even shameful abuses which call for
determined action on the part of medical association and
donor societies, and especially of competent legislative
bodies” and later on “In effect, the human body is always a
personal body, the body of a person. The body cannot be
treated as a merely physical or biological entity, nor can its
organs and tissues ever be used as item for sale or ex-
change.”
DISCUSSION
David Steinberg from Lahey Clinic and Robert M. Veatch
from the Kennedy Institute of Ethics of Georgetown Uni-
versity suggest an “opting in” paradigm for kidney trans-
plantation with bonus allocation points for those willing to
donate organs. David J. Undis from LifeSharers proposes a
“club” approach. According to Elisa J. Gordon from Loyola
University of Chicago, Steinberg’s “proposal harkens back
to the unethical practice’s of Seattle’s ’God Committee’ of
the 1960s.” She also says that some cultural groups such as
Navajo, “avoid discussing future ѧ adverse events such as
death, ѧ since language and thought have the power to
affect reality.” Jerry Menikoff from University of Kansas
considers Steinberg’s suggestion not “reciprocal altruism”
but “an organ sale by any other name,” even if money is not
involved and compares it to “purchasing health insurance.”
Robert D. Truog from Harvard University states “In gen-
eral, guidelines for allocating organs obtained from living
donors should be modeled on the view that these organs are
the personal property of the donor, whereas those for the
allocation of cadaveric donors should be based on the view
that these organs are a societal resource. Presumed con-
sent” is typically not well accepted by African Americans
and Orthodox Jews.
1065
Veatch opines also on the problems of children, of
exclusion of those who develop contraindications, and of
donation after developing diseases requiring transplanta-
tion i.e., African Americans genetically predisposed to
hypertensions.
According to Dr. Robert Steinbrook, a national corre-
spondent for the New England Journal of Medicine, in the
United States soliciting organs from a living or dead donor
is not unlawful but the National Organ Transplant Act of
1984 prohibits the transfer “of any human organ for valu-
able consideration for use in a human transplantation if the
transfer affects interstate commerce.” Reasonable pay-
ments are permitted for the costs of organ procurement and
storage and for the expenses incurred by living donors in
travel, housing, and lost wages.
In 1987 the revised Uniform Anatomical Gift Act
(adopted by all 50 states) made it a felony to pay for an
organ for the purposes of transplantation in any state,
whether or not the transfer affected interstate commerce.
On its web site, MatchingDonors.com describes itself as
“a venue where patients and potential donors can meet and
communicate, and hopefully expedite a donor agreeing to
give a patient a much needed organ” and states that the
organization “is a nonprofit corporation and 100% of the
money paid for patient memberships is applied to running
this site.”
In Australia, where Jesus Christians were founded by
David McKay, the government for the State of Victoria has
banned them from donating to strangers. Unrelated living
donor kidney transplantation is strictly regulated in the UK,
Germany, and India.1– 8 According to Gohn et al, a Bud-
dhist living altruistic donor did not want her kidney given to
anyone in a killing profession, such as a fisherman, a hunter,
or a soldier. Journalist Annie Cheney published in 2006 a
book, Body Brokers, whose inside flap says “While the
government has controls on organs and tissue meant for
transplantation, those ‘body brokers’ capitalize on the myr-
iad of other uses for dead bodies that receive no federal
oversight whatsoever; commercial seminars to introduce
new medical gadgetry; medical research studies and train-
ing courses; and U.S. Army landmine explosion tests. A
single corpse used for these purposes can generate up to
$10,000.”
In their book “Tissue Economies: Blood, Organs and Cell
Lines in Late Capitalism” published in 2006, Catherine
Waldby and Robert Mitchel point out that “It seems to us
that this speculation about the regenerative biology of the
future puts a kind of ‘retrospective’ pressure on real time
life-extending technologies, notably organ transplantation,
which seeks regenerative capacities in the bodies of others.”
1066
In his book Against Bioethics published in 2006, Jonathan
Baron suggests that bioethics could have a coherent theory
based on utilitarianism and decision analysis. Applying his
theory to organ commercialism, he says “The fact is that
there is a market in organs of living people, and attempts to
discourage the practice simply drive up the price to the
buyer and perhaps lower it to the seller (Finkel 2001)” and
concludes “But it does seem that a simple option that would
help right away is to legalize and regulate organ donation
for money. The regulation would insure that donors were
not deceived in any way. Because much of the trade in
organs is international, treaties may be required as well as
laws.”
Michele Goodwin, Director of the Health Law Institute
at DePaul University College of Law published in 2006 a
book Black Markets, in which she says “The consequence of
ignoring the possible advantages of cadaveric sales for
curing organ deficits and thereby enhancing the health
opportunities for all Americans, especially Black Ameri-
cans, are extreme.” James Stacey Taylor, Assistant Profes-
sor of Philosophy at Louisiana State University published in
2005 a book Stakes and Kidneys: Why Markets in Human
Body Parts are Morally Imperative. Mark J. Cherry, Editor of
Christian Bioethics, and Associate Professor at S. Edward’s
University in Austin, Texas, has published in 2005 a book,
Kidney for Sale by Owner, in which, according to its inside
flap, he tries to demonstrates that, with regard to body
parts, the important core humanitarian values of equality,
liberty, altruism, social solidarity, human dignity, and, ulti-
mately, improved health care are more succesfully sup-
ported by a regulated market rather than by well-meant but
misguided prohibitions.
Rothman et al9 anticipate that “a regulated market in
organs would be extraordinarily difficult to achieve” and
that “organ sale would have a highly detrimental effect on
medicine as a profession.”
Jho et al state “The arguments supporting a regulated
organ market are extremely simplistic, and ignore the
ground realities.”10
Addressing the participants at the Third International
Congress of the Middle East Society for Organ Transplan-
tation in 1992, Sheick M.M. Sellami, Grand Mufti of the
Republic of Tunisia said “ ѧ according to Islam a human
being is not the owner of a part or the whole of his body. In
any case, organs should not be traded, but donated” and
later on “I am afraid that these drug gangs could use their
network overseas to start trading in human organs.”
Farhat Moazam, Professor and Chair of the Center of
Biomedical Ethics and Culture, Sindh Institute of Urology
and Transplantation in Karachi, Pakistan, concludes her
book Bioethics & Organ Transplantation in a Muslim Society,
published in 2006, saying “In Pakistan, healthcare profes-
sionals, chiefly physicians rather than theologians, philoso-
phers, lawyers and others will shape and set the trajectory
for clinical ethics in years to come ѧ Related to this is a
growing desire within the medical community to learn more
about indigenous value systems, especially those that can be
BRUZZONE
traced to Muslim history or be discovered within contem-
porary discourse of Muslim scholars and ulemas.”
Farhat Moazam also says “the words adab and aklaq
(ethics) ѧ by Urdu-speaking Pakistanis ѧ are understood as
describing a virtuous physician, a honorable individual with
good character, who is polite and pleasant in social inter-
actions, and not someone who merely acts ethically. The
words adab and aklaq empasize the character of the acting
agent (akin to Aristotelian virtue ethics) rather than focus-
ing in the act alone.”
In his book Cherry quotes a speach of Pope Pius XII to
a group of ophalmologists concerning corneal donation,
“Moreover, must one, as is often done, refuse on principle
all compensation? This question remains unanswered. It
cannot be doubted that grave abuses could occur if payment
is demanded. But it would be going too far to declare
immoral every acceptance or every demand of payment.
The case is similar to blood transfusions. It is commendable
for the donor to refuse compense; it is not necessarily a
fault to accept it.”11
Addressing the participants at the XVIII International
Congress of the Transplantation Society in 2000, Pope John
Paul II said “Accordingly, any procedure which tends to
commercialize human organs or to consider them as items
of exchange or trade must be considered morally unaccept-
able, because to use the body as an “object” is to violate the
dignity of the human person” and later on added “The
criteria for assigning donated organs should in no way be
’discriminatory’ (i.e. based on age, sex, race, religion, social
standing, etc.) or ’utilitarian’ (i.e. based on work capacity,
social usefulness, etc.).”
Answering the questions of a journalist, Cardinal Joseph
Ratzinger, Prefect of the Congregation for the Doctrine of
the Faith, before becoming Pope Benedict XVI, said “To
donate one’s organs is an act of love that is morally licit, so
long as it is free and spontaneous ѧ . As for myself, I have
agreed to give my organs to whomever might be in need. I
registered years ago and I always carry this document with
me. In addition to personal data, it states that I offer my
organs to help whomever is in need; it is simply an act of
love. But, above all, it means - I repeat - to carry out an act
of love toward someone in need, toward a brother in
difficulty. It is a free act of love, of availability, that every
person of good will can do at any time and for any brother.
That is all. ѧ In my capacity, I do not allow myself to judge
the law of any State. I do not judge laws. I only say that to
give one’s organs spontaneously for transplants, in full
awareness and full knowledge, means to give expression to
a true, deep act of love for one’s neighbor.” Asked about
the informed silence-assent he said “No, I will not answer.
Those are legislative aspects about which I cannot make a
declaration. Moreover, I am still not sufficiently familiar
with all the terminology of the norms regarding the matter.
I will not pass judgement on laws, beyond saying that
donation is a gesture of fraternal love.”
Per the Catechism of the Catholic Church, Compendium,
signed by Pope Benedict XVI on June 28, 2005: 476. “Are
RELIGIOUS ASPECTS
allowed transplantation and organ donation, before and
after death? Organ transplantation is morally acceptable
with the consent of the donor and without excessive risks
for him/her. For the noble act of organ donation after death
the real death of the donor must be fully ascertained.”
In his book Bioethics: A primer for Christians, published in
2005, Gilbert Meilaender highlights the dignity of the
human body as a person and not a “useful precadaver”
(Paul Ramsey), is concerned of the possibility of organ
donation after active euthanasia, and agrees with Renée
Fox when she abhors “the desolate, profanely ’high tech’
death that the patient/donor dies, beneath operating room
lights, amidst masked, gowned, and gloved strangers, who
have prepared his(her) body for the eviscerating surgery
that will follow.”12
In conclusion, no religion formally forbids one to donate
or receive organs or is against transplantation from living or
deceased donors. Only some Orthodox Jews may have
religious objections to “opting in.”
However, transplantation from deceased donors may be
discouraged by Native Americans, Roma Gypsies, Confu-
cians, Shintoists, and some Orthodox rabbis. Some South
Asia muslim ulemas (scholars) and muftis (jurists) oppose
donation from human living and deceased donors because
the human body is an “amanat” (trusteeship) from God and
must not be desacrated following death but encourages
xenotransplantation research. No religion formally obliges
one to donate or refuse organs. No religion formally obliges
one to consider cadaveric organs “A societal resource” or
considers organ donation “A religious duty” (except some
rabbis and isolated Muslim and Christian scholars). No
religion has a formal position on “bonus points.” Living
organ donation is strongly encouraged only between jesus
christians (15 of 28 Jesus Christians worldwide have do-
nated a kidney). No religion forbids this practice. Directed
organ donation to people of the same religion has been
proposed only by some Orthodox Jews and some Islamic
1067
ulemas/muftis. Only some Muslim ulemas/muftis and some
Asian religions may prefer living donation over cadaveric
donation. No religion prefers cadaveric over living dona-
tion. No religion formally forbids non– heart-beating donor
cadaveric donation or cross-over donation. Due to the sacr
nature of human life, the Catholic Church is against dona-
tion from anencephalic donors or after active euthanasia.
The United Network for Organ Sharing allows directed
donation and gives bonus points to living organ donors.
REFERENCES
1. Ciszek M, Paczek L, Rowinski W: Clinical outcome of living
kidney donation. Transplant Proc 35:1179, 2003
2. The Ethics Committee of the Transplantation Society: The
Consensus Statement of the Amsterdam Forum on the Care of the
Live Kidney Donor. Transplantation 78:491, 2004
3. Park L, Moon JI, Kim SI, et al: Exchange donor program in
kidney transplantation. Transplantation 67:336, 1999
4. D’Alessandro AM, Pirsch JD, Knechtle SJ, et al: Living
unrelated renal donation: the University of Winsconsin experience.
Surgery 124:604, 1998
5. Berloco P, Alfani D, Bruzzone P, et al: Is unrelated living
donor a valid organ source in renal transplantation under CyA
therapy? Transplant Proc 23:912, 1991
6. Alfani D, Pretagostini R, Bruzzone P, et al: Kidney transplan-
tation from living unrelated donors. In Cecka JA, Terasaki PI
(eds): Clinical Transplants 1998. Los Angeles, Calif: UCLA Tissue
Typing Laboratory; 1999, P 205
7. Cortesini R, Pretagostini R, Bruzzone P, et al: Living unre-
lated kidney transplantation. World J Surg 26:238, 2002
8. Hilhorst MT: Directed altruistic living organ donation: partial
but not unfair. Ethical Theory Moral Pract 8:197, 2005
9. Rothman SM, Rothman DJ: The hidden cost of organ sale.
Am J Transplant 6:1524, 2006
10. Jha V, Chugh KS: The case against a regulated system of
living kidney sales. Nature Clin Practice Nephrol 2:466, 2006
11. Pius XII: Address to a group of eye specialists, May 14, 1956.
In the Monks of Solesmes (eds): Papal Teachings: The Human
Body. Boston, Mass. The Daughters of Saint Paul; 1960, p 381
12. Fox RC: An ignoble form of cannibalism: reflections on the
Pittsburgh Protocol for procuring organs from non-heart-beating
cadavers. Kennedy Institute of Ethics J 3:236, 1993