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The Unknown Harvest: Organ Donation and the Definition of Death

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Abigail Nobel
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Answers in Genesis publishes here the most thoroughly-sourced research article I've seen on organ donation, with 91 end-note citations.

NOTE: a previous thread on this topic has become unwieldy, making a fresh post necessary. Both are tagged and searchable with "organ donation."

Much too long to quote in full. Well worth having on file as a reference on this topic.

The Unknown Harvest: Organ Donation and the Definition of Death

With life-and-death issues at stake, Christians must be aware of current medical practices to draw biblical boundaries.

by Patricia Engler on October 6, 2023


On questions of organ donation ethics and the definition of death, the stakes could hardly be higher. Thousands of lives hang in the balance amid a firestorm of controversy fueled by myriad questions. What exactly is death, and how do we know it has happened? Does being “brain-dead” truly mean a person has died? And have organ donation practices been skirting ethical principles, moral mandates, and national laws for the noble cause of saving lives?

Because such questions will only grow more relevant as medical technology advances, everyday Christians need biblical understanding, scientific knowledge, and practical wisdom in response. The following discussion contrasts biblical and secular frameworks for thinking about death definitions and organ donation, outlines key medical facts to consider, and suggests practical responses. To start, a closer look at the scale of these issues’ significance is in order.

High Stakes, Vital Boundaries

Since the first successful kidney transplant in 1954, organ donation has become a means of yearly saving thousands of lives.1 In the USA alone, where the wait list for organs has over 100,000 names, 17 people per day die awaiting a transplant.2 While many organs including kidneys, liver segments, lung lobes, and portions of pancreases and intestines may come from living donors,3 hearts can (understandably) come only from deceased donors. This point highlights a vital concept: the dead donor rule.

Although not a law, the dead donor rule is an ethical standard mandating that a person cannot be killed for or through organ donation.4 As John Robertson observed, “The dead donor rule is a centerpiece of the social order’s commitment to respect for persons and human life. It is also the ethical linchpin of a voluntary system of organ donation, and helps maintain public trust in the organ procurement system.”5 Even so, the need for lifesaving organs inspires multiple work-arounds.

One work-around is simply to redefine death, so that even people with heartbeats or certain types of brain activity can be deemed “dead.” Another way to increase organ availability without ditching the dead donor rule is by allowing euthanasia or assisted suicide. In Canada, for instance, where over 31,000 people were killed by physicians from 2016 to 2021, 6 rates of post-euthanasia organ donation surpass those of all other countries.7 A third work-around is “organ conscription,” where organs become government property upon a person’s demise. According to Oxford bioethicists Dominic Wilkinson andJulian Savulescu, “Organ Conscription would have the greatest potential to increase the numbers of organs available for transplantation, though it would come at the cost of patient and family autonomy.”8 These ethicists added that the next best way to increase organ availability “would be Organ Donation Euthanasia (ODE),”9 in which an anesthetized person is killedbyorgan removal—an open rejection of the dead donor rule. 10

While Wilkinson and Savulescu champion voluntary ODE, the reality is that even in countries with “safeguards” for legal euthanasia, not all euthanasia is voluntary. In the Netherlands, for instance, data as of 2021 reveals 517 cases of “terminating life without the express request of the patient.”11 Meanwhile in China, where euthanasia remains illegal,12 a “transplantation tourism” market is evidently fueled by involuntary harvest from prisoners.13

All these means to “extend” the dead donor rule underscore why Christians need to be involved in thinking about organ donation ethics and highlight how even lifesaving actions must take place within ethical boundaries. How can a biblical worldview help with drawing those boundaries? The answer requires first contrasting biblical and secular thinking about life and death.

Life, Death, and Worldviews

A biblical worldview recognizes humans as embodied, relational,createdbeings made in God’s image. As finite image bearers, humans have inherent dignity, contingency, and accountability to their Creator. Human rebellion resulted in a fallen world, where death and suffering are unnatural but inevitable. Yet Jesus’ victory over death offers ultimate hope, enabling us to view death as a “conquered enemy,” to be neither sought through suicide nor futilely resisted at any expense (vitalism).14 Importantly, a biblical view of death also allows for delineating a valid distinction between withdrawing futile treatment and actively killing someone.15




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