Organ Sales

Question: I enclose an article from The New York Times Magazine (5/27/01) on the sale and marketing of kidneys from live donors for transplant. My impression was that the sale of organs from live donors was both illegal and immoral. Does the Church have a teaching on this?

Answer: I would agree that the commercial sale of human organs is both illegal and immoral; however, popular and professional opposition to this commerce may be weakening.

The Times Magazine article, “Complications” by M. Finkel (5/27/01) is a good example. While some pros and cons are duly noted, the basic utilitarian shift and drift in the wrong direction is pretty obvious. (Indeed, a prior Ethics Column in the British medical journal The Lancet, “The Case for Allowing Kidney Sales” v. 351 [6/27/98] pp. 1950-52 went pretty much unnoticed in our country.

The Times Magazine reports that the sale of human organs is against the law in virtually every country with perhaps the exception of Iraq. It has been condemned by all of the world’s medical associations. Yet, in Israel, and a few other nations, including India, Turkey, China, Russia and Iraq, organ sales take place without excessive secrecy. China apparently sells cadaver organs from dead prisoners. Some insurance providers see a quiet benefit here — while the short term cost of kidney surgery is high, the long term cost of dialysis may be more.

Very few transplants (legal or illegal) take place in Israel, but they can take place as an arranged package deal (trip-surgery-recovery-return) in Istanbul, Turkey and in Iraq. An American entrepreneur, Jim Cohan of Los Angeles, does not like to be called an “organ broker” since he prefers the title “international transplant coordinator” used to accompany clients on their transplant trips until he was arrested in Italy in March of 1999. The Italian courts ultimately let him go since they concluded that he broke no laws.

The Lancet and some other advocates of organ sales duly register some cautions about “potential abuse” but almost all of the Times article’s examples document actual abuse. There is the tragic case of a fourty-four-year-old Turk who sold a kidney to help pay for some corrective surgery for his youngest child which he could never possibly afford. He received half ($10,000) of the promised price and his child never did get the needed surgery for a degenerative bone disease. Turning one’s poverty into another’s opportunity is simply a violation of the most basic standards of ethics.

Only a small portion of money goes to the person selling the organ — as little as $800 and not more than $10,000. In fact, there may even be a surplus of kidneys in some places — sellers in India and Iraq actually line up at hospitals willing to part with a kidney for less than $1,000. Most studies and follow-ups report on the recipients, not on the donors. The last category may not be problem-free since those who live in abject poverty usually live in conditions of poor diet, low-quality drinking water and increased risk of infectious diseases. No one seems to say much or report much about these sellers.

Along with the above factors, consider the pertinent directives for Catholic teaching and practice. Directive #30 of the NCCB Ethical and Religious Directives (1994) states in part: “. . . Furthermore, the freedom of the prospective donor must be respected, and economic advantages should not accrue to the donor.”

The Vatican Charter for Health Care Workers (1995) also proscribes commercialization: “the medical intervention in transplants ‘is inseparable from a human act of donation’ (John Paul II [6/20/91])” . . . “It is a decision to offer, without recompense, part of someone’s body for the health and well-being of another person. In this sense, the medical art of transplanting makes possible the act of donation of the donor, that sincere gift of himself which expresses our essential call to love and communion” (CHCW, n. 90) (The quotation is again from John Paul II [6/20/91]).

Footnote #185 of the same Charter for Health Care Workers n. 90 makes further reference to a teaching of P. Pius XII (May 14, 1956) urging some “intelligent reserve” in this matter. Pope Pius agreed that demanded recompense (for an organ) would be an abuse, but it would also be an exaggeration to say that the acceptance of any recompense is immoral. He argued the case is analogous to that of blood transfusions.

On the one hand, I know of no moralist who would argue against the donor receiving compensation (cost coverage) for the medical expenses and perhaps loss of wages or other inconvenience for making the organ available, but the payment (purchase) of the organ itself. On the other hand, it is not truly analogous to blood transfusions. In a healthy person, blood donations do replace themselves, whereas kidneys do not. (For some early cautions and then increased clarity on this confer: Ethics & Medics [Jan. ‘84] pp. 2-3; and next [Feb. ‘90] pp. 1-2).

The Code of Medical Ethics (2000-2001) of the American Medical Association takes a similar position: “The voluntary donation of organs in appropriate circumstances is to be encouraged. However, it is not ethical to participate in a procedure to enable a living donor to receive payment, other than for the reimbursement of expenses necessarily incurred in connection with removal, for any of the donor’s non-renewable organs” (n. 2.15; p. 42).

More recently, and more in accord with a sound Christian anthropology, Pope John Paul II addressed this question directly in an address to a Transplant Congress in Rome (Aug. 29, 2000). In part, the Pope taught: “It must first be emphasized, as I observed on another occasion, that every organ transplant has its source in a decision of great ethical value: ‘The decision to offer without reward a part of one’s own body for the health and well-being of another person’ (6/20/91; n. 3). Here precisely lies the nobility of the gesture, a gesture which is a genuine act of love. It is not just a matter of giving away something of ourselves, for by virtue of its substantial union with a spiritual soul, the human body cannot be considered as a mere complex of tissues, organs and functions . . . rather it is a constitutive part of the person who manifests and expresses himself through it’ (Donum Vitae [1987] n. 3).”

“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” (8/29/00, n. 3) (The Pope Speaks 46:1 [2001] p. 22).

In view of the above, I would judge the sale of organs from living donors immoral and hope that it remains illegal as well.

Oat Wafers?

Question: My sister-in-law is seriously allergic to wheat and wheat products. An official suggested that special wafers made of oat flour could substitute. Is this legitimate?

Answer: Unfortunately but certainly the answer to that question is no. Wheat bread and oat bread are not the same. Indeed, as plants, they are a different genus: wheat is genus triticum; oats — genus avena.

The General Instruction of the Roman Missal is quite explicit: “the bread must be made from wheat” (Panis . . . triticeus) (GIRM, n. 282). This is not merely a liturgical rubric but is the formal teaching of the Council of Florence (DS 1320) and the constant universal practice of the Church.

All of the “approved authors” are explicit about the valid matter for the Eucharist. For example, H. Davis writes: For the validity of the Sacrifice, the bread should be made from pure wheaten flour, not from barley, rye, oats or vegetables” Moral Pastoral Theology v. 3 (1959) p. 119. M. Zalba considers oats (avena) to be certainly invalid matter (Theologiae Moralis Compendium II [1958] n. 735, 1, p. 409) as do Noldin Schmitt, Summa Theologiae Moralis v. 3 [1962] n. 106, 1, p. 93).

Please address questions to Msgr. Wm. B. Smith, St. Joseph’s Seminary, Dunwoodie, Yonkers, NY 10704. 

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