English Articles

Organ and tissue transplant

 hart hand

By MA W.J.A. Pijnacker Hordijk     vlag

update January 2017

Although the Promise magazine already dealt with this issue extensively in January 1993, we find it highly desirable to help our readers again to form a well-informed opinion, in response to the topical questions and situations.

We are not the first nor the last who write about this subject.

In this process of organ transplant a transition is taking place which is bio-medically very relevant. The  donating body as a physical unity, is dissected into functional parts. It makes a new physically healthy unity in the body of the recipient, from a failing unity. In  contemplative sense, the condition of the organ is intrinsic, therefore differently appreciated by the body of the donor and recipient.

At the end of the book of Deuteronomy, after many speeches to the Israelites, Moses urged them to choose for life (Deu.30:19 “…that I have set before you life and death, the blessing and the curse. So choose life in order that you may live…”)

There were two trees in paradise: the tree of life and the tree of the knowledge of good and evil. But how could we discern good from evil? We live in the meantime, after the fall, in a broken world, where death seems to be very normal. Do we have the right to live as long as possible or are we to accept our mortality? Are we to accept that some bodies stop earlier to function than we desire?

We make countless choices in life. How can one now choose for life? What is life really about? What is dying? And what does death mean then? What is eternal life? There are a lot of medical, ethnical and religious questions. In order to find answers, we abide by ‘the best book for the way’: the Bible.

Asking for the organs of a person who is brain dead is the most unfortunate  question at the most unfortunate moment to the most unfortunate family. Now that the horrible moment has not come yet (?), it is now the time for us to consider the answers. The Orthodox Protestants and Muslims seem to lag behind in the registration of donors. What are the arguments and doubts?

Organ donation in the Netherlands

Whether or not to donate organs, has caused a lot of political turmoil. The new law for organ and tissue donation aims: that more organs and tissues will become available; secondly, that there will be more legal certainty;  thirdly, that there will be a fair distribution of organs and tissues; and finally, that the organ trafficking will be combated. The Ministry of Health, Welfare and Sports encourages the Dutch people that are older than 18 years (there is no maximum age), to choose whether or not to make their organs and/or tissues (and if so, which one?) available for transplantation. Young people from 12 years are already allowed to fill out a donor information form. However, the parent(s) or guardian(s) are allowed to actually prevent a donation. This choice will then be centrally registered. When a person is not listed in the Donor Register and has no Donor Card nor any surviving relatives, donation cannot take place.

When after the removal of the organ or tissue it appears that it is not suitable for donation, then it still can be used for scientific research. If you do not agree, you can raise objections to it.

In 2016 the number of the Dutch people that has been registered as donors was 40%, of which 11% explicitly does not consent to use their organs and tissue after death; 5%  leaves the choice for donation in the hands of their surviving relatives. The major part does make its organs available, whether or not with the exception of certain organs. The older people get, the more they are willing to make their organs available. In 2016 more than a thousand Dutch people waited for a donor organ.

Until now the Netherlands (like England, Turkey, Germany and Ireland) has the ‘no- unless donor system’. Because 60% of the people does not respond, a new legislative proposal (from D66) should deliver more organ donors. All Dutch people from the age of 18 should be approached with the question whether they want to become a donor. If you do not respond after repeated reminders, you will automatically be registered as a donor. This system looks like the ‘no objection systems’ as in Spain, Austria, Belgium, France, Italy and Sweden, though it still differs from a ‘yes-unless system’ . The government urges that people should make a choice by the means of a ‘yes-unless system’ and in that way infringes on the physical integrity of those who do not want or are not able to make this choice. This would make organs to become a social provision which you would have to donate out of solidarity.

In Austria even the family is not informed about organ transplant.

Still, there should be some research on: the effectiveness of this newly proposed system; the possibility of alternatives (more perfusion rooms where unsuitable organs are still made available for donation and where organs can be preserved more properly); and the rights of the surviving relatives and those who are legally incapable. The CDA is against this proposal of D66, because it affects a fundamental right: the integrity of the human body and the right of man to decide about this by himself.

Because in this way the government takes control over the human body, all Christian parties have voted as a whole against this legislative proposal.

Organ donation is a deed of love for the fellowman, just like giving money to charitable purposes. And it also means that both people who cannot or can hardly read and therefore cannot understand government letters, and people who are legally incapable, will automatically be registered as donors.

The CU, that in itself is in favor of organ donation, also argues that the Active Donor Registration system (ADR) may lead to situations that surviving relatives do not know whether their deceased loved one has actively filled out a ‘yes’ him-/herself, or whether it is a passively governmental ‘yes’. With the introduction of ‘silence implies consent’, the government crosses a border where it does not belong. People are not to be forced, but should be urged to make a choice. Therefore, in the Netherlands the deceased does not automatically belong to the government (yet?). In that case it would not be a free gift anymore. There must come an end to the ‘whatever’ attitude, not to the voluntariness. A donor organ is a gift which is embedded in great sorrow.

Article 11 of the Constitution of the Kingdom of the Netherlands (2008) includes the inviolability of the body.

Therefore, each person is entitled to the inviolability of his/her body, except when  there are limitations or restrictions set under the law. The government is entitled to decide about our bodies in several ways. After a crime one may end up in prison, where his freedom of movement is limited.

The government also intervenes when someone walks naked in the street. But this ‘yes-unless’ regulation goes far beyond that. ‘Our body is not something we need as long as we live and turns into a handy bag with organs when we die. I am my body, with all its dents and scars, even when I don’t breathe anymore.’

This  proposal of D66 (with Pia Dijkstra as its advocate) has been voted off, then adjusted and thereafter, to the surprise or astonishment of most people, has been adopted in the Second Chamber with the minimum possible majority of one vote (75 against 74 members of the Parliament) on 13th September 2016. Shortly after the adoption of the legislative proposal by the Dutch Parliament, it actually seemed to be counterproductive. Actually 4,500 donors withdrew their permission, as a protest.

A small number of 19,000 people indicated after this proposal not to be willing to donate their organs after their death. In addition, 1,626 new people gave permission for organ donation and 1,205 persons gave a limited permission. The requirements of almost 6 million Dutch citizens, concerning organ donations, are registered. In that registration fifty percent gives permission against 1.5 million people who explicitly do not want to give permission. Almost 1.5 million people subject it to conditions. In the Donor Week of 10 – 17 October 2016, the results for the supporters of organ donation were disappointing. The campaign delivered almost 50,000 registrations in the donor register, which is much more than the 27,500 in the two years earlier. However, the result was reverse: 24 percent chose ‘yes’ and 76% ‘no’. Out of almost 32,000 new registrations, only 17% was ‘yes’ and 83% ‘no’. In addition, there were18,000 people who changed their earlier choice in the donor week. Also there the balance was negative: 37% ‘yes’ and 63% ‘no’.

Also in the ADR system it is still up to each person to decide. More than a half year later the Senate would vote on this, before it can be legislated in the Netherlands. If this proposal is also adopted by the Senate, a medical doctor will be able to have an extremely sensitive conversation with the family of the deceased in a totally different way. A strange thing is that most of the members of the Parliament, who are responsible for this legislation, and most of the nurses themselves who are involved with the transplants, do not want to donate! Article 11 demands an informed permission. The government was not clear about the implication of organ donation after the ‘passing away’. In practice, many donors are not dead in traditional sense when their organs are removed, but brain-dead. The question is, how could the citizens be informed with regard to a high-technological practice whereby the developments are taking place at a rapid pace. Brain death protocols should be adjusted due to new developments.

What about registered donors that are not brain-dead (yet), but can no longer be treated and whose death is expected soon. With a view to organ removal, these donors can be disconnected from the life-support machine, which will lead to a cardiac arrest at a certain moment. As soon as the cardiac arrest is considered to be irreversible, the organs will be removed. Today in the Netherlands, a waiting period of five minutes after the cardiac arrest is considered the absolute minimum to be able to continue to comply with the ‘dead-donor standard’. This period is also under pressure due to the shortage of organs. Shall the presumed permission in future also be considered sufficient for the post-mortal donation of body material for the sake of science?

If even the employer is lagging behind the present situation, then how could the government expect the citizens to know what they agree with?

In this way a system of active donor registration does not only run the risk of paving the way for tacit consent, but also for uninformed consent for organ removal. The possible introduction of the obligation for the citizen to choose, also creates an obligation for the government to give information. To be able to remove the waiting lists, it is necessary that at least 7 million Dutch citizens are willing to donate their organs and tissues after their death. Strangely enough, there are many donors among the road fatalities. So the more people get killed in traffic, the more lives can be saved by organ donations. In other words and with a bizarre conclusion: the less road fatalities, the more patients will die, due to a shortage of organ donations.

The Netherlands is very good at ‘donor prevention’: the prevention of brain death, due to the legal obligation to wear car seat belts and helmets by moped drivers and  motor cycles, the maximum speeds and the prohibition of alcohol consumption on the road and such life saving measures. What is in fact the net benefit – if you can call it that?

Patients who die, due to a shortage of organs, are no victims, for that would suggest that there are perpetrators or culprits, namely those who do not donate their organs. I am only a victim when somebody has treated me violently or had wrongfully not supported me, while he was obligated to.

Love (charity) is not an obligation, but the payment of taxes and fines is, as the compulsory military service also was in the past. Those are not voluntary donations. People therefore should be given the freedom to refuse to donate organs and even to refuse to think about death and what happens thereafter and to take a position on that.

The status as a percentage on 17th December 2016:

-        60 percent gives permission;

-        12 percent leaves the decision to surviving relatives or others;

-       and 28 percent gives no permission.

Although churches are generally positive about organ donation, the number of donors in the Bible belt is significantly lower than in the other parts of the Netherlands.

Suppose that the donor recruitment activities deliver a lot of responses, will there then be enough operation teams and facilities? The tension between demand and supply can run high. Although being quite inconsistent, one can become a recipient of one or more organs, but does not have to sign up as a donor in return. Thus the reciprocity principle does not (yet?) apply.

However, this actually selfish and inconsistent opinion is questionable, because in the Netherlands people have the right to use double standards.

Some supporters of the donor registration from the ‘yes, unless’ category, put forward the golden rule of the Lord Jesus as an argument: “Treat people the same way you want them to treat you” (NASB), or “Whatever you want men to do to you, do also to them”(NKJV Mat.7:12).

Is your body really to be compared with an appliance of which you can interchange parts according to your need and capacity? That could include a dualistic view on the relationship between body and spirit. I do not only have a body, I am also one. The body is not only a vehicle for my personality, but is also an expression of it. That’s the reason why we treat the body of deceased people with respect. That we do replace ‘parts’ of the body or add ‘parts’ to the body sometimes, like (dental) crowns, prostheses and cardiac valves, is an exception to the rule, and not removal of it.

The waiting list for donor kidneys is four to five years in the Netherlands. But after an appeal on Face book it appeared to deliver 35 offers within four days. However, it also happens that kidney donors ask a financial competition in return. Additionally, it means that the kidneys are not received by the people who need them the most, but by those who have the saddest story, the best presentation, the most beautiful eyes, etc.

Organ donation after euthanasia

New techniques such as the bio-printing of organs from a 3D printing machine, have the result that the waiting list for human organs is reducing. But can we yield more in a simpler way? In 2015 there were 5,516 cases of euthanasia in the Netherlands. Since 2012 only 18 times organs have been donated after euthanasia. Euthanasia almost always happens at home, but for donation and transplant it is necessary that it happens in a hospital, because the organs are not to be disconnected too long from the blood circulation. After removal the organ or the organs is or are to be transported very quickly to (often) a University Hospital. It is different from cases of tissue transplant. Cornea, heart valves, blood vessels, skin tissue, bone and tendon tissues can be removed and preserved quite well from a home situation. But according to the Dutch Transplant Foundation (NTS), this happens rarely.

It is poignant that a person during life finds his life useless and wants to step out of it, and that only after his death his life seems to be yet meaningful, for due to organ donation(s), patients can get a more pleasant life.

This demonstrates a materialistic human view. It also seems risky to me to use organs from an (often desperately sick) individual who in case of active euthanasia, has been poisoned. Additionally, it can easily result in a conflict of interest between the donor (who consciously wants to step out of life) and recipients (who want to receive an organ which is as healthy as possible).

It is up to you, what do you want?

  1. Do you want to give permission for the removal of (certain) organs after your death?
  2. Reject organ removal at all or partly?
  3. Leave the decision concerning organ removal, to the surviving relatives (partner, family members or other persons, mentioned by their names)?

The question is clear. However, it is difficult to choose. This ethical issue is very complicated, drastic and certainly not clarified. In case a deceased person has not determined his wishes at all, the surviving relatives should decide, according to the current Dutch  Law. If the deceased does not have any relatives, then the deceased cannot be a donor. In a case of disagreement among the relatives concerning the donation of the deceased, the donation will neither take place.

Jewish points of view

For the formation of our opinion, it would be recommendable for us to consider Jewish opinions. They are based on the Old Testament, surrounded by their Jewish writings, such as the Talmud. We actually ought to be aware that they are not enlightened by the Holy Spirit, and that there is no such thing as thé Jewish concept. After all, there is an old saying : ‘ask two Jews, you’ll get three opinions’. Several Rabbis have several opinions, but the consensus of modern ‘ poskiem’ (a term in Jewish law for “decisors”) is that one may take a small risk to save another person from a certain death. The Dutch chief rabbinate does not allow organ donation in general, while the chief rabbinate in Israel does.

When a person’s life can be saved by that, it is allowed, according to the latter.

A corneal operation is actually not allowed. But generally, Jews ought to be against donation, because the integrity of an earthly shell is affected.

However, the liberal Rabbi A. Soetendorp claims that the right to the integrity of one’s body goes together with the duty to help another person.

It is striking, however, that there are great reservations in the Jewish community concerning the donation of organs, but hardly any about the receiving of it.

Many Jews are confronted with memories of the Holocaust and therefore they refuse to have themselves being registered again, which is very understandable.

It is actually not about thé Jewish opinion, concerning physical donations, that is not the case. Among a part of the Jews, there is the opinion that a person is dead, only when the heart doesn’t beat anymore and therefore the blood has stopped flowing. However, there is an increase concerning the acceptance of brain death.

Forms of transplantation

In the meantime, man has built up a lot of experiences with transplantation. It is very clever what medical science seems to be capable to. We can distinguish transplantation in the following four forms:

  1. The donor and the recipient are the same person (auto transplant), e.g. the transplant of a piece of the skin from the leg to the burnt arm, which is often applied in plastic surgery.
  2. The transplant of an organ or a  tissue from a donor who is alive. With the donation of e.g. blood, one kidney, a part of the liver, bone marrow cells (in case of leukemia), sperm and ova and even a uterus, it is the intention that both donor and recipient stay alive. (Kidneys can also be donated after death). Today it is possible to remove a kidney via a keyhole surgery. The kidney comes through a hole, which is comparable to an enlarged buttonhole. In this way the patient recovers quickly, leaving only a small scar.
  3. The transplant of organs and tissues of deceased donors in the body of another person (Allotransplant), e.g. of the heart and the cornea. This form and the next one, ethically raise the most questions.
  4. The donor is an animal. Due to a shortage of organs, there has been a research whether organs of animals can also be used for transplant. In addition to that, tissues could be cultured in animals. The transplant of organs and tissues and living cells from animals to other animals or humans, is called xeno-transplantation. Since animals have a totally different tissue typing, compared to that of humans, the animal organs do not ‘fit’ in man, unless it is genetically manipulated. Then the boundaries of biological species are broken. The evolution theory denies a gap between humans and animals. However, God’s Word says that man is created in God’s image, while an animal is created after its nature.

Also the dying of men and animals is different: the breath (ruach) of men goes up to heaven, turns back to God, Who has given it, while that of animals goes down below into the earth. Beside a body, a human has a spirit and a soul and is able to communicate with God’s Spirit. Apparently, man has the spirit on loan. God takes the spirit of life back. Animals may carry harmless viruses as vehicles, which unfortunately may cause man to become sick. Already in 1984 a baby girl had lived for three weeks with the heart of a young baboon. Genetically, the chimpanzee is the best animal donor for man. However, the chimpanzee is an endangered species; it has a few descendants and is a carrier of viruses that can cause infections. The second choice is the easy to breed….. pig! Whoever needs a new heart valve, can get one of titanium, but also one of a pig. This in turn raises new ethical questions. The Animal Protection Foundation is firmly against the practice of animals as a transporter of sparing parts for man. Is man just a random collection of all kinds of organs? The Jewish tradition finds it acceptable that the heart of an unclean pig is transplanted into a man, because it is about a life-extending operation. Are we shifting from donation to production, because of a shortage? Is this not a mechanical human vision where illness and death are considered damaged tissues and organs?! Here are possibilities for a very profitable organ market (more details on this later), but it is very questionable whether this commerce is desirable… He who commercializes life, also commercializes death. All too often it seems that money does not respect life seriously.

An animal as an incubator

Does it mean that by the activation of animals the quality of life will decrease and that the quantity will increase? These advanced techniques are a very big step in the medical developments. In most cases the recipients have to take medicines for the rest of their lives, in order to avoid rejection symptoms. The side-effects of these medicines (anti-antibodies) happen to be damaging.

The whole immune system can be paralyzed, which creates fear for a simple flu, that nevertheless can be lethal for the organ recipient.

Additionally pig cells may contain viruses against which man have no immunity.

Meanwhile the technology becomes more and more advanced. The American scientist Pablo Ross (University of California) made organ to grow out of human cells. It regards induced embryonic stem cells, made from skin cells, preferably from the patient who needs the organ, so that there is a minor chance for rejection. In order to make this human organ grow in a swine, Ross deactivated the genes of the embryo of the swine that can be crucial for the growth of an organ, by the new genetic technology Crispr/cas9. Such an embryo will therefore not develop a pancreas, liver or kidney, depending on which genes are deactivated. Where Ross added human stem cells to the embryo, these cells then started, without competition of the cells of the swine, to make the deactivated organ. But also in other organs there will be human cells. That leads to the ethical question to what extent the pigs (are allowed) are to be human, in this way. The mixing of human and animal cells up to a ‘chimera’ (a hybrid of human and animal) is controversial.

Tissue donation

Blood transfusion is the oldest form of transplantation. Blood is to be typified as a kind of fluid tissue. Blood donations also take place ‘for free’, but the blood products that are fabricated out of these donations are traded at a commercial price. That also applies in the same way to the skin, bone and cornea donations.

Donation takes place without payment to the donor, but the user does pay for the delivered product. That is by the way not a standard that is recognized and respected all over the world and also in the Netherlands there are supporters of the stimulation of blood and organ donation by the means of material incentives. Although blood transfusion is accepted by most people, including Christians, the Jehovah’s witnesses were strongly against it. Note the word were, because recently it appears that within a relatively short time the Jehovah’s witnesses have been confronted for the third time with a theological review. Until recently, blood transfusion had been strictly out of the question, based on Acts 15:29 (abstention of blood). With the help of the Bulgarian government, with which a ‘friendly settlement’ has been made, the nearly sacred nature of the blood transfusion doctrine, has been undermined. The members of the sect and their children should have a free choice with regard to blood transfusion. Moreover, this is shocking for the surviving relatives of loved ones, who in earlier days had bled to death, because new blood was in no way allowed to be transfused to them. Besides, the Jehovah’s witnesses were formerly not against organ transplantation, as long as no blood was used. And this appeared to be possible with kidney and heart transplantations. Not being allowed to eat or to drink blood is however a cult matter and not a moral one. It concerned the blood offering of the animals and not the blood of men, in order to realize reconciliation. This text therefore does not refer to blood transfusion. In addition, a blood donor gives only a responsibly small part of his blood, so that he himself can move on with his life. The soul of the flesh is in the blood and without shedding of blood there is no forgiveness. This blood is in the religious context. It is not proven that the soul of man is in the blood. While the one group refuses to receive blood, another group demands to be allowed to donate blood.

Homosexuals collide with hemophilia patients, of which 170 were infected with the HIV (AIDS) virus in 1995. Thirty patients have died already from it… The cure appeared to be worse (yes, lethal) than the ailment. It is astonishing and shocking how some homosexuals demand their lifestyle to be accepted and how they force their blood to be used. They do not hesitate to adulterate declaration forms which are needed to be filled out for blood donation.  It seems to them that everyone is entitled to AIDS….We also know about the transplantations of blood vessels, bone tissues, corneas, skin and heart valves. It is necessary for the explantation of the corneas that the eye is totally removed. After the removal, an artificial eye is placed unto the donor and the eyelids are closed, as usual. And  in what stage are the experiments now with nerve tissue, vocal cords and fetal (brain) tissue (see below), extremities, small intestine, and …?

The vital donor donation

Today the following organs can be transplanted: pancreas, heart, liver, lungs and kidneys. Because in ethical sense, one is not allowed to affect the personality or the individuality, the genital organs (ovaries and testicles) are not allowed to be transplanted.  Nevertheless, people do fiddle with genital cells on a large scale. A fertile woman can let herself be inseminated artificially. This embryo is removed from her uterus and this five days old embryo can be transplanted in an infertile woman. This embryo transplantation is possible, and it occurs.

The children, however, will never be able to find out who their biological father and mother are. This is asking for troubles, after all, every individual will search for his or her ‘roots’. Sperm donors deliver their sperm, whether their identity is hidden or not. Ed Houben (Maastricht, 1969) alone has produced about one hundred children, although sperm banks apply a maximum of 25 donations, in order to prevent inbreeding. Ova can also be donated.  The price of a portion of ova is especially in the United States, determined by the profile of the ovum donor, because the candidate parents are hoping that the characteristics of the donor will also be inherited by their future child. Therefore young female students of Harvard University with an attractive look and athletic or musical talents can ask tens of  thousands of dollars for their ova.

But what are the possibilities for a woman who desires to become a mother, but has never had or does not have a uterus anymore? Also regarding this matter, the medical knowledge and capability has improved amazingly. A 30-year old woman gave birth to a baby with a transplanted uterus from her mother. The Swedish transplantation specialist Mats Brännström has implanted together with his team, an embryo which was produced by an in vitro fertilization (IVF), into the transplanted uterus, which ultimately resulted in a delivery of a healthy son.

Medically it is possible and whether it is ethically desirable, seems to be less important. The limitations of a body are reducing more and more and a ‘no’ reply is less and less accepted. Brains are also not allowed to be transplanted. Besides, that is by definition medically and technically not possible with brains. In addition it is ethically objectionable to transplant brain tissue, because it regards the deep identity of man. In case of non-heart-beating donors, the heart has stopped to beat and therefore also the blood circulation. Then heart, liver and lungs may have become unusable, but kidneys can still be transplanted.

Donors

We distinguish two groups of donors: living ones and dead ones. The name of the donor will not be mentioned to the recipients. By definition donation is anonymous, voluntary and free. There is no payment for a gift. Alcoholics are only taken into account for a liver transplant, after they have stopped drinking alcohol for at least six months, but they are therefore no alcoholics anymore.

It seems to be a misconception to think that patients need a donor lung because they have smoked too much cigarettes. However, it is remains clear that smoking cigarettes is harmful for the health. (Smokers with lung cancer as a result, are certainly treated.) Furthermore, people with an increased risk to get infected with the AIDS virus (beside alcoholics, also drug addicts and people with a changing sexual attitude) are not to give permission for donation. The cure is then surely worse than the ailment. A heart patient who has proven to be easily able to commit suicide, is not qualified for a new heart. Nor are those who do not want to take their medicines faithfully and strictly.

Considerations for a Christian

The key question is now: what is the attitude of the Christian concerning organ and tissue donation?  The path of least resistance is not to choose at all and in that way one can possibly burden the surviving relatives with answering the drastic question concerning donation. Let us understand our responsibility and try to formulate an answer ourselves. God wants to give wisdom with and not without our mind. It is too short-sighted to say that one’s body parts can be a great blessing to another person. That is for sure: what a joy can it be for someone who in that way can get off the regular and torturing kidney Dialysis Support. Financially, a transplant will be cheaper on the long run, than the regular cleansing. Nevertheless, our answer should not be pragmatic, but essential. Although we are not the boss of our own lives, neither of our own belly, how could we then be good stewards of our own body? As Christians we do not aim at self-determination, but we’re trying to discover God’s will concerning this. Because at the time of the Bible writers the donation of tissue and organs was totally unfamiliar and unimaginable, we do not find anything about it in God’s Word. The Bible is not a scientific manual. But we can certainly find principles in it which we may relate to our subject. We cannot directly, but indirectly appeal to the Bible. A purely theoretical approach may induce a certain coldness in the heart of men. Therefore, let us try to keep in mind that we are dealing with men of flesh and blood, loved ones, acquaintances. We also should apply the golden rule here: “Do not do unto others what you would not want done to yourself”.

It is a comforting thought for a Christian that we have received eternal life by grace and faith. This real, true LIFE is characterized by an intimate knowledge of the King of Life Jesus Christ (Jn.17:3). Nothing, thus nor death, shall separate us from Him. As a result of the fall, we still have to deal with the arch enemy: death, which is still alive, though conquered. Death will never become something ordinary. We have to recognize death, instead of denying it. Death is and will remain to be a foul spoilsport, a disaster. Christ has conquered death, which the cleverest surgeon will never be able to achieve. Many people are terrified of death, “while the Lord Jesus might destroy him who had the power of death, that is, the devil, and release those who through fear of death were all their lifetime subject to bondage” (Heb.2:15).

The fear of death is also called the engine of life by some people. Fortunately, a Christian doesn’t have to be rushed as if in this life he has to enjoy everything as much as he possibly could. We must see Rome first, and what about Naples? And let’s not forget to visit Delft, museums, amusement parks, pampering health treatment weeks, far places even to the planets. Have you really seen and experienced everything, for you are surely entitled to as a human, aren’t you?!

All the arguments submitted for an endless life here on earth are: as long as it is useful (utilitarianism) and is a contribution to our own earthly happiness (hedonism). No, a Christian lives by and from grace, and God’s wonderful promises endlessly exceed all worldly deals. For if we live, we live to the Lord; and if we die, we die to the Lord.” (Rom.14:8).  Due to eternal life, a Christian is not inconvenienced by the lack of time. Christians do not have to deal desperately with gray hairs and wrinkles that indicate that the time of their death is near. Christ is and remains with us and all other matters become relative. Is every man entitled to a long and carefree life? Looking at it from another side: Are we entitled to die in rest and peace? A life can be prolonged, but is the quality of this life equivalent to the quantity? Who determines the subjective quality of life and on which basis?? Are you entitled to tissues and organs of another person? Does man, the Christian, have the right to self-determination?

“Thou shall not covet, …. nor the organs of another person...? If you hope for the organ of another person, do you in fact hope for the death of another?

The above-mentioned relates to the earthly life. That does not alter the fact that man as vulnerable and lacking as he is and may have an illness, can make use of (technical) aids. I think of a pair of glasses, denture, hearing aid, canes and artificial extremities. No sensible person will worry about that. But prostheses can also be implanted in the inside of the body. Plastic tubes can replace coronary vessels. Artificial heart valves, electric pacemakers, etc are a blessing for man. In addition, machines that take over certain organs such as the kidney dialysis support and the heart lung machine, are functioning. We can hardly keep up with the medical developments and they are really stunning. Even children that have not been born yet, can already be operated. Man seems like God, almost omnipotent and  omniscient, almost creating and ruling life…

What about the tower of Babel? How did that go again?! It must be very challenging and exciting for doctors to push their limits again and again, in order to reduce illnesses and death. Not every doctor is driven by the love for men, but  ambition and competition are surely contributing factors. Are there no limits then? Yes, financially and ethically, although the ethic is often lagging behind the medical developments …

The question we keep asking ourselves is: Is it permitted to do everything because it is possible??  The solution of problems may raise other, new problems.

Arguments for donation

*The commandment to love your neighbor as yourself, is found in the Old Testament (Lev.19:18), and is repeated in the New Testament (Mat.22:40) and even made more stringent in John 13:34. Jesus makes another comparison, namely not only to love as yourself, but as Jesus Himself had loved us. However, organ donation can never be put on the same level as the incomparable work of atonement of Christ. The love for our neighbor and self-sacrifice are Christian arguments for donation. This obligation is equally true as the voluntariness of it. ‘Neighbor’ comes from the word nigh -> near, thus the closest. Literally it makes no sense, because an organ can be transplanted to a person from another country who is totally unfamiliar to the donor. The obligation unto compassion is clearly from the parable of the good (compassionate) Samaritan. Through the ages the church was at the front, concerning care and nursing. Think of  for example the convents and deaconess institutes (hospitals). Christians truly showed solidarity with the sick and incapable people. We are not saved by good works; we then would have been able to save ourselves, and Christ would have died in vain at the horrible cross. When we have been saved, have come to faith, then we are expected to do good works; in that order. Good works are not own achievements, that make us to come into favor with God. It still all comes down to grace.

The opinion of the ultra-orthodox Jews is that Jews after their death are only allowed to make their organs available to and/or accept organs from other Jews. Love cannot be forced. We can be grateful that the Netherlands has not chosen (yet?) for the so-called ‘No objection’ system.

For one will hardly die for a righteous man; though perhaps for the good man someone would dare even to die. But God demonstrates His own love toward us, in that while we were yet sinners, Christ died for us.” (Rom.5:7,8)

The context does not speak about organ donation. David neither thought about organ donation, but would have wanted to die in Absalom’s place.

The family ties seem to be very strong here, for David loved Absalom, despite the fact that Absalom hated his father and wanted to kill him, in spite of his wonderful name.

Because this tie can be so close, it is rather acceptable within the family, that a father for example donates his kidney to his child, and in that way runs a risk, than to donate it to an unfamiliar outsider.

Moses and Paul wanted to sacrifice themselves for their people Israel. They were types of Jesus.

It is better that one man dies for the people, and not a whole nation perishes. The context here is, however, soteriological and not biological. Jesus did not only come to heal bodies and to prolong lives, He came to reconcile sinners with God and to give them eternal life.

We know love by this, that He laid down His life for us; and we ought to lay down our lives for the brethren. But whoever has the world’s goods, and sees his brother in need and closes his heart against him, how does the love of God abide in him?” (1Jn.3:16,17).

Although John could not have thought about organ donation, this text can certainly be related to it.

*Donating an organ is a possibility to prolong one’s time of mercy.

It may possibly lead the recipient to conversion.

The extra time to live, however, can equally be misused. That way, the life of king Hezekiah was prolonged with 15 years, but during that time awful things happened.

*Opponents of donation claim wrongly in my opinion, that bodies are to be “buried” intact.

Rabbi Jechezkeel Landau (18th century), stated that every part of a deceased must be buried.

According to the Jewish tradition, the soul suffers from watching how the earthly component of a man is being dishonored after death. This is confirmed by the modern psychiatrist Dr. E. Kubler-Ross. After conversations with people who have been apparently dead, it seemed that the soul knows about what happens to the body after an apparent death.

Another argument for burying the body intact, is the expectation of the resurrection from the dead.

This argument is however, unsustainable:

 - Firstly, every human dies because of a physical lack, an illness or an accident. - Secondly, there are martyrs who have been cruelly killed by animals, have been burnt, drowned etc., but nevertheless are heartily welcomed into God’s heaven.

-Thirdly, there are people, who are not accidentally, but consciously buried “incomplete”. Examples are Jacob and his son Joseph, who, according to the Egyptian tradition, were embalmed (mummified) (Gen.50:2,26). Dead organs were therefore removed from their bodies, and these parts were filled with cloths drenched in resins. This was described without valuation, and was not prescribed. For the sake of clarity, there is no mention of organ donation here.

-And what would  – fourthly - happen with all of those who try to escape from God by having their body to be cremated after their death and have their ashes to be scattered? Finally, after some thirty years all cells of a living human being are replaced by other cells and additionally after a course of time, each body has totally decomposed, disappeared.

Jesus says that it is better for you to enter life crippled or lame than to have two hands or two feet and be cast into eternal fire. (Mat.18:8)  Mind you, this is not a plea for self-mutilation, but this hyperbole is primarily intended for us not to allow ourselves into temptation.  Oh, is anything too hard for the Lord?

God is omnipotent. He is able to form dry dead bones and even less than that, form them effortlessly into full human beings. After all, the Lord Jesus Himself has been buried wounded and mutilated. Nevertheless, He rose with a glorified body, in which the scars were still to be seen, but which were no hindrance to Him. The resurrection body is a different (glorified) body. It is sown a perishable body, it is raised an imperishable body; it is sown in dishonor, it is raised in glory; it is sown in weakness, it is raised in power; it is sown a natural body, it is raised a spiritual body..” (1Cor.15: 42-44).

Will then the ‘harvested’ and donated organs be returned? And will the received organs be kept in that resurrection body?

*In Gal.4:15 it is said: For I [Paul] bear you witness that, if possible, you would have plucked out your own eyes and given them to me”. Paul had a physical infirmity (v.13). He probably had an eye disease. The eye, the pupil of an eye is precious and vulnerable. Blindness was not uncommon in those dry places. It is (yet?) not possible to transplant a complete eye. “…if it were possible…”, it was not possible.

It is not clear whether there is mention here of a hyperbole, a metaphor to describe the great love of the Galations towards Paul, or whether they really thought of literal eyes. Paul does not reject this act of love, but has a great appreciation for it.

Objections against donation

*What does nature teach us? (1Cor.11:14) The body responds to the transplanting of organs and tissue with the tendency to reject them. Apparently the body considers this to be unnatural, undesirable. Anti antibodies are activated to suppress the natural immune system.

The anti antibodies will become less severe in case the strange transplanted organ is less strange or less different.

This can be achieved by genetic manipulation. But is this ethically accountable?

*The image that the doctors have of men seems to be very technical and materialistic. All kinds of loose ‘components’ are restorable and replaceable. Is man reduced to a machine, which is comparable to a wrecked car?

Is a hospital a garage for men?

An assistant of the surgery room had experienced a lot of transplantations. Despite the respectfulness and the atmosphere of integrity during such a procedure, it had always moved her. When her husband passes away, she herself gets the question to answer: whether or not to donate. After the necessary hesitations, for not really knowing to what she says ‘yes’, she gives permission. Because she doesn’t want to leave her husband alone, she is present at the examinations prior to the transplant. She describes all of the degrading abomination, the lashing and trifling with the dead body.

*The seat of the personality

From the oriental view, the kidneys were the place of emotions and symbolize the deepest part of the inner man. For the modern man the heart also speaks more to one’s imagination. Because the kidneys are of less emotional value than a heart, people are more prepared to donate a kidney than a heart. In our (Dutch) language there are more than forty positively inspired proverbs with the word ‘heart’. This word is mentioned more than eight hundred times in the Bible. However, the heart has an exclusively allegorical meaning here. When we read: “Give me your heart, my son”, we should not take that literally, but allegorically. The heart is in biological sense, but also in religious sense, the center of our lives.  But is the heart not more than a replaceable blood pump? A person changes physically after a heart transplant: your face gets fatter, your hair growth increases, and you run the risk to get cancer. Professor MA Reverend U. Eibach also claims that with heart transplantations often changes in the personality structure appear, because different expressions of the nerves cannot function normally anymore. Then the heart transplant would be a kind of reincarnation to a certain sense. Pranger states that patients with a donor heart indeed often identify themselves with the donor, but which feeling would soon stop.

Actually, people have learnt from experiences that donor heart patients still have the same personality, although the new heart cannot respond to emotions like the own heart did before. Psychologist Paul Pearsall has collected many stories about people who after a heart transplant, underwent a drastic personality change, but also in cases of liver, kidney or lung transplants. His findings are based on 73 cases of heart transplant. An organ donor seems to receive a lot more from the personality of the donor, both positive and negative tendencies. Sometimes one’s behavior and often even one’s whole character seems to change. It is also interesting that Pearsall comes to the conclusion that in fact the heart has an own ‘brain’ more or less. From profound research it appeared that there are neurotransmitters (neuropeptides) in the heart, which initially were considered to be found only in the brain.

These peptides behave like small parts of the brains that even seem to be wavering through the whole body and function as a key to cell memory.

What should we think of the documented story of an eight year old Jewish boy that got killed at a car accident?

His death led to the rescue of a three year old Arabian girl with a serious heart defect. The moment that this girl Reem, woke up from anesthesia, she asks her mother for a Jewish candy of which she could not possibly know the name … These and similar startling testimonies ask for explanations and are of great importance in the ethical discussion of organ donation.

Is the soul seated in the heart or in the brains?  It is possible to remove the small brains by surgery without resulting in the death of the patient. The big brains, specifically the external side, the cerebral cortex, have everything to do with our thinking, our will, our consciousness, our emotions, our ‘I’, summarized in our psychological life. We cannot find the word ‘brains’ anywhere in the Bible.

The great meaning of these organs was not known in those days. Jochemsen states that body, psyche (soul) and spirit are inextricably related to one another.

What is typically human doesn’t coincide with the spirit or with the consciousness which is in the cerebral cortex. After all, otherwise we would be allowed to declare patients who are in an irreversible coma, to be dead and with their permission, use their organs. When one passes away, the organism doesn’t function as a whole anymore. From American researches it appeared that in the vital organs of men (heart, lungs, kidneys) there are spiritual energies.

A human organ contains a print of one’s individuality and there are indications that the recipient can also experience a personality transfer.

Is this imagination and autosuggestion?

According to Rabbi Evers, Judaism considers the soul and the body to be ‘parellel’ units: all components of the soul have a material counterpart in the body. The body is a physical expression and precipitation of higher heavenly data.

*Brain dead

With coma, also called ‘apparently dead’ there is still some electrical activity in the brains. The heart beats normally, the blood pressure is ruled by medicines, and artificial respiration is applied.

The brains often still function a little bit.

In case the brains lack oxygen for longer than 4 to 6 minutes, they will die. This is the clinical death. Afterwards the biological death follows. The total brain death enters after a quarter, the kidney death after an hour, the muscle death after some hours and the death of the skin after many hours. We speak of brain death when there is a full and irreparable loss of all functions of the big and small brains, including the brain stem and the lower half of the brainstem.

To determine brain death, there is a so-called ‘Brain death protocol’ in which the records are to be found of among others: the electro-encephalogram (EEG; the test of the brain activity must repeatedly show a flat-line) and the apnea test (in relation to the breathing). An angiogram  (a measurement of the blood flow in the brains) is only applied when the EEG is not possible or when the apnea test is not practicable.

An angiogram, the ultimate test, is unfortunately non-routine in the Netherlands though, but it is in Norway. The surviving relatives may demand this test before they give permission for organ donation. Furthermore, the light reflex in the pupils of the eyes can be checked (pupil reflexes) beside a test for cough reflex and sound stimuli. Humanly, brain death is irreversible (!).

A vegetative life suggests that that  particular person has been lapsed to the level of a plant, but despite the decline, he or she remains to be a human.

When is a person dead? Velema believes that a hypothetically beheaded person  whose body is preserved intact artificially, is not a living human anymore. Thus it is a deceased and not one who has survived.

James says, the body without spirit is dead (James 2:26). Jesus committed His Spirit in the hands of His Father, and breathed His last (Luke 23:46). A Roman soldier ascertained His death by piercing His side with a spear.

And immediately blood and water came out. Conversely: when the dead little daughter of Jairus was brought back to life by the Lord Jesus, “the spirit returned”. When the son of the widow was brought back to life by Elijah “the soul turned back”. But when exactly does the spirit or soul leave the body? The soul and the spirit are immeasurable, mysterious realities.

The question remains: when is someone really dead? Is it when he is brain dead or only when all physical functions have stopped? Or when decay enters?

One can derive the time of death from the state of decay in which the body of the dead is.

I must admit: the comparison is not an ideal one, because man is not a machine, but you may nevertheless somewhat compare it to a vehicle of which the engine fails due to defect. The movement that the vehicle had, gradually reduces (it doesn’t stop with a shock), the engine still feels warm.

There seem to be remarkable differences in the time of death that is filled out on the death certificates of patients that have been declared brain dead.

If they do not want to be organ donors, the machines are stopped.

Then the breathing stops and later the heart stops beating.

That is the moment of death.

However, with people who are brain dead and who are organ donors, the moment that the brain death has been determined, is filled out on the certificate as the time of death…

A brain dead person can (artificially) be kept alive. How can a dead body be alive? Is the brain dead a patient or a dead person? Or: when is a living body dead? The confusing thing about it is that a brain “dead” can still breathe, has no corpse color, feels warm, has a beating heart and a blood circulation and produces urine. The muscles can still move. Very remarkable is the phenomena that a brain dead woman could be kept alive, in order to make her fetus survive.

Her hormone regulation for the proper course of the pregnancy still worked perfectly. How can a dead person bring forth a living child??

During the removal of the organs, the brain dead is put under full anesthesia, but not against the pain, for this person doesn’t feel anything anymore, but in order to weaken the muscles.

To be able to feel, a brain stem must be active, which is not the case with a brain dead. With a ‘real dead’, the hair and nails continue to grow for some hours.

With coma ( a deep sleep, unconsciousness, independent respiration), apparent death and clinical death (no spontaneous circulation nor respiration anymore, but due to active intervention, this can be restored) the brains still carry out some functions. According to the booklet of the Foundation for Donor Information, someone is dead “when his physical-spiritual unity has stopped totally and permanently” (page 74).

Is a brain dead indeed dead or a dying person? Dying is rather a process than a moment. Or is it a combination?

Medical practitioners are not unanimous about this difficult matter of brain death. In among others Portugal and England, a person is already brain dead when only the brain stem is not active anymore. Some Dutch doctors argue that deep in the so-called mid-brain there is still some cell activity to be measured. They therefore rather speak of presumed brain death. The brain stem where the breathing center lies, is not to be measured with an EEG. With about 20 to 40 % of the patients that were declared brain dead, there is still some residual function.

MD Kompanje states that the still active hypothalamus, as a part of the brains, plays an important role in the hormone systems. Briefly, why are there globally different criteria regarding the idea of ‘brain death’?

What can be said about several publications of near-death experiences with situations where there was a brain death and that the patient could tell it afterwards, because he regained consciousness?

Jan Kerkhoffs (59 years) from Limburg was declared brain dead in 1992.

One week after he was disconnected from the machine, in the expectation that it soon would be over for him, he recovered consciousness…. It appeared that he woke up from his coma! A mistake due to a wrong diagnosis.

On 16 October 2011, Carina Melchior, who at the age of 19 ended up in the hospital in the Danish city Aarhus. The doctors noted a serious brain damage and thought that the occurrence of brain death was inevitable.  Carina’s parents agree with the donation and transplant of the organs of their daughter. The parents of Carina heard from the doctors that there is absolutely no hope for their daughter to survive. And in case she would wake up from coma against all expectations, she will be severely disabled and not be able to lead an existence that is worthy of human dignity. Also on the basis of this diagnosis, the parents of Carina agree with the organ donation. But shortly afterwards, a miracle happens: Carina wakes up from her deep coma and recovers surprisingly quick. She learns to talk, eat and walk again. Some months later Carina rides on her horse again. Why did they make such a great error of judgment about Carina’s chances? Were they seeking to get the organs of Carina as soon as they possibly could for transplant?  And is it a medical miracle or is it nonetheless mainly a medical failure? In the meantime, Carina’s parents have submitted their complaint against the doctors of the hospital. Additionally some five hundred Danish organ donors withdrew their permission after the broadcast of the documentary. In Denmark a heated debate has also raised about the way in which hospitals deal with brain death and organ donation.

What applies everywhere, including in hospitals, is that man is fallible. Despite all precision, (fatal) errors may be made and are made. Fortunately medical errors are exceptions.

We are not to allow these lethal mistakes to develop into uncontrollably scaremongering stories. Koekoek states: “..while sometimes brain dead people have turned back to life”, unfortunately without documenting them. Besides, from several (missionary) stories, it appears that miraculous resurrections from death still do occur.

The Foundation of Consideration on Organ Donation (Stichting Bezinning Orgaandonatie)  claims that it is not evident that a person is dead, when the neurologist says that brain death has entered. “Judicially, a donor is first declared dead, when after the removal of the organs, life-support has been stopped and the heart failure enters”. The brain dead person is really dead, only when his organs have been removed.  Does the removing of an organ also contribute to one’s (the donor’s) death? Even if we may say one man’s loss being another man’s gain, then it still comes down to murder. It is prohibited to murder, even when the intention is to save another one’s life. ‘Brain dead’ means that 4% of the body has been damaged irrecoverably.  With organ donation 96% is kept alive so that the organs can be removed. Anesthesia is administered to patients before the organs are removed.

The law says: ‘brain dead is dead.’ However, there are stories known of certainly twelve women who were brain dead and were on life-support until they delivered their child. The law speaks about the artificial respiration of the mortal remains. But a corpse doesn’t need to be given anesthesia or respiration, does it?! A corpse is not able to deliver a child. Therefore you can ask questions concerning the diagnosis ‘brain dead is dead’. Between the moment of life and death, there is a period of dying which lasts for hours, sometimes for days. That stage of dying is shortened by the removing of organs. When that happens with love, it is alright. I am not an opponent on principle of organ donation. But I am a proponent of people being aware of what they have decided about. The information on organ donation is too ‘one-sided’, according to the cardiologist P. van Lommel, who has examined near-death experiences and published about it.  Van Lommel further states that the own dying process can be strongly influenced and speeded up by removing the organs surgically. He asks the next questions:  what about the dying stage of people which can last for hours to days? When is a person brain dead according to the guidelines? The dying process is different for each person and takes place on the level of organs to cellular and sub-cellular levels, whereby each system has an own process and pace of degradation.

When the diagnosis of ‘brain death’ is made, one should realize that 96% of the body is ‘alive’ and is kept alive, while according to the law the patient is ‘dead’. In legal terms it is referred to as ‘putting the dead body on life-support’, while every doctor and layman knows that it is impossible to put a ‘real’ corpse from the mortuary on life-support successfully.

At removing the organs from ‘dead’ patients, often anesthesia (narcosis) is necessary, because of the so-called ‘Lazarus syndrome’, which means the heavy gestures of resistance that comes from the officially already dead organ donor.  A corpse wouldn’t need any anesthesia, would it?

Patients that are declared brain dead, also show significant changes in blood pressure, vascular resistance and heartbeat during their surgery, due to the removal of their organs for donation, which is only possible when parts of the brains and spinal reflexes are still intact.

He who has the opinion that a brain dead person is a dying person who still has a soul, cannot be a donor, or can he? Should we not, because we do not know when the spirit and/or the soul leaves a man, leave the dying man alone?! Kidneys (in contrast to the heart, liver and lungs) can be suitable to other patients after death, up to 45 minutes (and tissues even longer thereafter).

In the field of life, dying and death there are more questions to be asked than to answer. Isn’t it therefore important that we abide by the safe, secure side?!

Precisely because of this vague transition field, it scares many potential organ donors to death to make a choice for donation and refuse to enlist themselves.

*We should not idealize a new organ. Despite the receiving of a new organ, one will by no means have a normal life expectancy, because for the rest of his life the recipient will be subject to an intensively medical control system, due to the danger of rejection responses, side-effects of anti-rejection medications and he has an increased risk to suffer from malignant diseases, high blood pressure, diabetes or serious infections, which are even apart from the possible and unknown psychological consequences.

*The protocols give the whole a legal support. The medical team that treats the donor until the moment of death, ought to fight for his/her life, and according to the protocol, it must be strictly separated from the medical team that takes care of the removal of the organs.

It will however, still have to become clear how things work out in practice.

How often had it not occurred that the prescriptions of induced abortion and euthanasia …..have been disregarded?!

Nobody can guarantee that all doctors will operate very carefully. It is not inconceivable that for example in five years the criteria of brain death will be changed. Therefore we must stay alert to the unstoppable developments on the area of body donation, and adjust our opinion and choice, if necessary.

*With abortion the line between life and death is often crossed. The tissue of an unborn child from an early pregnancy can be manipulated in such a way that it can be transplanted in another human, for example in the brain stem of Parkinson patients. The fetus is thus the donor.

The symptoms of Parkinson are trembling, stiffness and slowness. In itself this illness is not lethal. The brains of fetuses (little humans!) after an induced abortion, a spontaneous abortion or miscarriages, are used as medicine.

The embryos must preferably still be alive… However, from the conception onward, there is a respectful human life.

The end (cure) doesn’t justify the means (“material”! of a fetus).

That this practice is not fictional, but really does happen, appears from a shocking news from the United States.

Planned Parenthood has been accused of selling body parts from aborted babies, for example to a biomedical company that wants to use the body parts for research. There is a great demand for the livers, but the heads of unborn babies are the most expensive. In order to get undamaged heads, the babies are first partly delivered (partial birth) before they are killed. We will get into more details about organ trafficking later.

*The Christians body is like a temple

The temple of the Holy Spirit is mentioned by Paul in contrast to a temple of idols, where fornication was committed. Should we, because our body is a temple of the Holy Spirit (1Cor.6:19), condemn donation? It is similar to the question: Is it then allowed to operate on a human, and if necessary, to amputate something from his or her body (e.g. a breast), to pull a rotten tooth out, to treat a cancerous lump with radiotherapy, to remove an appendix? This is not a mutilation, but a surgery, which prevents something worse. The Christian faith is not in conflict with the medical world. Luke was a medical doctor, medicines were recommended, etc. The Holy Spirit dwells also in someone who is physically deficient. Is the Holy Spirit still in a man when he is dead? No, the human spirit and God’s Spirit have left his body. Although a dead person does not have a spirit anymore, he/she is still a person. The body is not the useless ‘mortal remains’ or ‘shell’.

After His horrible death on the cross, not only His ‘mortal remains’, but Jesus Himself was laid in the grave (John 19:42). The human body is therefore to be treated in piety.

*Organ trafficking

The Netherlands works together with seven other European countries like Belgium, Germany, Croatia, Hungary, Luxemburg, Austria and Slovenia for organ donation. These countries are united in the organization Euro Transplant. Organ donation is by definition a donation, which means a voluntary, priceless gift. The commercial trade in organs leads to inequalities, because then the organs go to the highest bidder instead of to the patient that needs them the most. Due to the great shortage of organs, the black market in organs is growing alarmingly. People can make big money with it. China, Pakistan and India are in the top three of illegal kidney trafficking. In the Third World countries  such as Pakistan, Mexico, India, Columbia and Egypt, it is possible to buy a kidney at a high price (illegally). In China, the organs of executed prisoners are removed and sold, without their permission. But since November 2013 China had gradually made an end to the controversial practice to use the organs of executed prisoners for transplantations.

The authorities have denied these practices for a long time.

Human right organizations estimate that annually thousands of prisoners are executed. This is unfortunately confirmed. Despite the fact that in 2014 China promised to stop with systematically ‘harvesting’ of organs from executed prisoners, the Chinese hospitals are still trading in human organs on a large scale.

This ‘industry’ annually sells 60,000 to 100,000 organs (liver, kidneys, heart, hands, pancreas, corneas, intestines, thyroids, hairs and bone marrow), from non-voluntary donors. The organs are especially from executed prisoners (prisoners of conscience, critics from the Communist Party, supporters of the prohibited Falun Gong Movement, Uighur Muslims, Tibetans and Christians), according to the detailed report of 800 pages of ‘The Bloody harvest/The slaughter, an update’.

Some donors were possibly not dead yet or have not even been anesthetized. This is  not about an achievement, but an ideology, a mass murder. People who wanted to expose all these atrocities, were killed. Peking calls the suspicions ‘nonsense and unfounded’, but keeps the annual number of death sentences secret.

Also somewhere else in Asia the atrocities with donors are demonstrable. Some people who were sentenced to death could expect to be granted pardon if they would donate a kidney. In that way they could buy their freedom. Recipients pay 10,000 to 200,000  euro, while donors receive zero to 13,000 euro.

Organ trafficking is all over the world (except for Iran), thus also in The Netherlands, legally prohibited, which therefore fortunately doesn’t occur, …..what people thought. The law prescribes that it is not allowed to donate a kidney with a commercial purpose. However, not everything is just black and white. ‘Why should anyone be hindered to trade an organ?  We are the owner of our own body after all?! In that way the waiting lists can be reduced.’  - according to the arguments of the supporters of organ trafficking. The big question is whether that trading is voluntary or forced. In the Netherlands the maximum penalty  is one year imprisonment or a fine of 19,000 euro. However, organ trafficking is a fact in The Netherlands too. Two criminologists, researchers from the Erasmus MC, find that there must be contact point where doctors can report misdeeds to the police, without compromising their professional secrecy.  The Health Insurer Unive has been indirectly involved with the commercial trafficking by financing an organ transplantation, which took place in Pakistan against payment. Although the trade in organs is also legally forbidden in the countries like India and Pakistan, the practice gives a totally different picture. The existence of illicit commercial networks of organ trafficking in countries like Moldavia, Turkey, Ukraine and Israel was also confirmed by Europol. Besides, the Israelite Chief Rabbi Israel Lau actually has given his blessing to the sale of human organs that are intended for transplantations, provided that the life of the donor is not jeopardized. It often happens that after a medical treatment there are all kinds of remains of body materials such as blood that has been collected for examination or a tumor that has been surgically removed. The question is whether these materials are still useful for other purposes like medical research and do they have some commercial value.

*Between 0.3% and 0.6 % of the potential donors will indeed give one or more organs or tissues. Successfully transplanting is in fact only possible if ‘enough people die prematurely as a result of violent accidents…’. Therefore, the less safety, the greater the success of organ transplantations. Far before a possible tragic accident one can give an approval for donation soberly; when the moment really comes, it will of course be very emotional and possibly traumatic.

Try to imagine: how does it seem to you to say goodbye to a loved one who is still on life-support and still feels warm, briefly said: seems to be alive?

Be aware that doctors are no pastors. The surviving relatives therefore, ought to consider the process of mourning very well. The dead donor whose heart is still beating, and who is breathing with active organs is being taken away and will return later totally lifeless. The surviving relatives are not welcome at the operation(s) for removing the organs. Who will comfort you then? Mourning is the natural price of love. How to say goodbye? Some feel remorse because they have the idea that they have forsaken the dead at the last moments of his life.

Before you fill out the form, it is wise for you to reveal your opinions and wishes to your relatives and/or friends, because personal wishes cannot be recorded in the Donor Register.

Therefore the Donor Register advices you to discuss your personal wishes with your relatives, so that they are informed about it. They can tell your doctor about your wishes after your death. However, this is not a guarantee that the doctor will carry out your personal wishes.

The new law and protocol may be renewed or adjusted again. Therefore, be alert. It is possible to indicate your wish for a living donation, but to object against donation after death.

In case you want to revise your opinion and will, concerning donor and tissue transplant, you can always report a change on the site www.donorregister.nl (A digital signature (DigiD is required) or you can send it to the Donor Register: Postbus 12115, 100 AC Amsterdam (Telephone 0900-82121.66). You can get a blank form at your family doctor and Pharmacy.

Tip: Make a copy for yourself and your surviving relatives of your reply form, although people who have had their choice recorded in the Donor Register, will receive a confirmation letter. With the letter they receive a paper bag on which their name and the choices they have made, are written. It is not necessary to carry this card with you, but it is intended to be able to verify later what one has had recorded. So choose life! We wish you a lot of wisdom and peace at making your choice.

Let each be fully convinced in his own mind… .For none of us lives to himself, and no one dies to himself.  For if we live, we live to the Lord; and if we die, we die to the Lord. Therefore, whether we live or die, we are the Lord’s.  For to this end Christ died and rose and lived again, that He might be Lord of both the dead and the living”. Romans 14: 5-9

MA W.J.A. Pijnacker Hordijk

Update January 2017

 translated by Ursula Moestapa

Recommended literature:

* dr. J. Douma,  Rondom de dood (Kampen: van den Berg, 1984), 172 pp.

* Dirk van Genderen, Opnieuw: orgaandonatie, Visie, 3-9 mei 1998

* dr. M. Heideveld, Na “toestemming” en “geen bezwaar” -celbiologische ontwikkelingen vragen om nieuwe ethische bezinning rond orgaandonatie, Reformatorisch Dagblad, 6-7-1995

* dr. ir. H. Jochemsen, Gave van een overledene, Schuilplaats, datum?

* ds. H.G. Koekkoek, Orgaandonatie de Bijbel en ik (Alphen a/d Rijn: st. Het Licht des Levens, 1998), 50 pp.

* dr. W.J. Ouweneel, Operatie supermens, (Amsterdam: Buijten en Schipperheijn, Groningen: de Vuurbaak, 1975), 272 pp.

* Paul Pearsall, Het Geheugen Van Het Hart (Rotterdam: Lemniscaat, zj),271 pp., vertaling van The Heart’s Code – Tapping the Wisdom and Power of Our Heart Energy The New Findings About Cellular Memoires and Their Role in the Mind/Body/Spirit Connection (New York: Broadway Books, 1998)

* dr. D. Pranger, Kerken en Orgaandonatie -feiten en meningen ter ondersteuning van de discussie binnen de kerken (Bussum: Nierstichting Nederland, 1995), 27 pp.

* Teun J. de Ruiter, Vlugschrift: Voorlichting inzake de wettelijke regeling ‘Donorcodicil’, 6-3-1998

* dr.  R. Seldenrijk, Organen en weefsels op reis, (Leiden: Groen & Zoon, 1993), 222 pp.

* J. Slabbekoorn, Orgaandonatie vraagt om bezinning, Reformatorisch Dagblad 16-4-1998

* drs. A.A. Teeuw, Wilt u donor zijn? -een praktisch-pastorale handreiking bij orgaandonatie(Heerenveen: Groen & Zoon, 1998), 64 pp.

* dr. W.H. Velema, Rondom het levenseinde -ethische en pastorale overwegingen (Kampen: Kok, 1971), 77 pp.

* drs. R.J.F. van der Ven (arts), lezing op 22-4-1998 in de Vrije Baptisten Gemeente te Papendrecht

* drs. P.J. Vergunst, Als de dominee over de dam is, Reformatorisch Dagblad, 18-6-1993, interview met de biomedicus dr. R. Seldenrijk, n.a.v. zijn boek Organen en weefsels op reis.

* ?, De meest gestelde vragen over orgaan- en weefseldonatie (Hilversum: St. Donorvoorlichting, 1998), 116 pp.


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