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You asked for a sermon on The Ethics of Organ Transplant

 

John 10:7-18

[1] I have already done it; I have already signed page three of my driver’s licence, “Consent Under The Human Tissue Gift Act”. Because I have consented, upon my death any one — or all — of several organs (body parts) may be removed from my corpse and used for transplant purposes in someone whose body parts don’t function as well as mine did.

 

[2] Why have I done it? Why have I decided to donate my organs to someone else? I have done it because I want someone else to enjoy the good health — and all that good health makes possible — as I have been able to enjoy it all. I know how good it feels to have a body that works well; I know how much life is eased by a body that works well; I know what good health allows us to do, where it allows us to go, how it allows us to feel, even how it allows us to think. (Who among us, after all, ever did her best thinking with so much as a migraine headache or severe back pain?) I can only imagine how frustrated people must be, how they feel stalled, how they look upon themselves as unproductive (or at least underproductive) if their health is poor. If I can do anything to help such a person, I am determined to do it. For this reason I am glad to will my organs to someone else.

I have done what I have done inasmuch as I am a Christian. Christians know that the body matters. Or at least Christians should know that the body matters. Our Hebrew foreparents, after all, knew that God willed us to be embodied creatures and pronounced our bodiliness “good”. This is not to deny that from time-to-time there have been Christians who sawed off the Hebrew limb on which they were sitting and then fell into an un-Hebraic rejection of the body; and not merely rejection of the body, outright contempt for the body. Think of those misguided hermits (or some of them), centuries ago, who thought it was God-honouring and a sign of devotion to God to sit in a hovel surrounded by filth while vermin crawled all over their body only to drop off inasmuch as there wasn’t one square inch of skin that was vermin-free and where vermin could alight. That which God created and called “good” we must never despise. The body is good; the body matters.

Not only must we not despise the body, we must even glory in it; and in glorying in our body we shall glorify God by means of it. “Glorify God in your bodies!”, the apostle Paul urges the church in Corinth. Plainly, if we are to glorify God in our body, glorify God by means of our body, then our body must have been created glorious.

The body matters. Anyone who reads the written gospels cannot fail to notice the attention Jesus gave to people’s bodies. Jesus spent much time restoring the bodies of people whose bodies weren’t functioning properly: the blind, the deaf, the mute, the lame, the curled-over, the menhorragic. The body matters.

Yet from a Christian perspective the most telling affirmation of the body arises from the simple fact of the incarnation. In Jesus Christ God himself took on our flesh and blood and bone. It isn’t merely that God used the human body of Jesus (the way God used the peculiar bush that startled Moses). God didn’t use a man; he came among us as man. Since there is no humanity that is not embodied humanity, the simple fact of the incarnation is the strongest possible endorsement of our bodiliness. The body matters.

 

[3] A minute ago I said that I had signed the consent form on my driver’s licence whereby my organs will be made available, upon my premature death, to someone else. A minute ago I said too that I was glad to have made this arrangement. Nevertheless, I haven’t done all of this without a great deal of thought; and I must tell you that having done what I have I remain haunted by numerous misgivings.

To be sure, I am glad to donate my organs, just as I am glad to donate my blood (my next visit to the Red Cross Blood Donor Clinic will be my 90th). But I’m not going to sell my blood! In the same way I don’t want to sell my right kidney. What I mean is, I don’t want my daughter to sell it from my remains after I have died, and I don’t want to sell it while I’m alive in order to finance my new car.

Yet there are many people who do sell body parts, and many more who are going to. When I was in India last January I learned that India traffics in the buying and selling of body parts. The India Institute of Medical Sciences is located in New Delhi, the capital city. A kidney specialist there, Dr. Atma Ram, himself sells the kidneys he removes from people. “We are doing a thriving business”, he enthuses.

Business isn’t thriving only in India, we should note; it thrives in North America too. In 1983 the New Jersey Times newspaper carried the following ad:

Kidney for sale.
From 32 yr. old Caucasian
female in excellent health.
Write P.O. Box….

The Los Angeles Times had already run the ad,

Eyes for sale or transplant.
$50,000 each — help someone you care for see
and in return you’ll be helping others.
Only sincere parties apply please….

Do not think that these are isolated cases. In the early 1980s a man in Georgia offered to sell a kidney for $25,000 in order to buy a fastfood restaurant. Other people in Georgia had offered to sell a kidney for as little as $5,000. Kidneys were more expensive in California, however: $16,000. An American physician, Dr. Barry Jacobs, attempted to set up an organization that would purchase kidneys from people anywhere in the world and sell them to anyone who could pay. There was an uproar in the USA over this, and in order to quell the uproar the US Congress passed the National Organ Transplant Act. Be sure to note, however, that the Act does not prohibit the sale of human organs for research purposes.

What happens in one part of the world sooner or later happens elsewhere. Right now the Russian Medical Institute is offering kidneys for sale in Germany. German patients are to pay the equivalent of $68,570 (US dollars) in German marks. Right now organs are bought and sold — scores of thousands of them — in India, Africa, Latin America and eastern Europe. The body parts sold are corneas, inner ear components, jawbone, heart, heart pericardium, heart valves, lungs, liver, kidneys, pancreas, stomach, bones, ligaments, skin, blood vessels, and bone marrow.

What do people do with the money they gain through selling their body parts? Some purchase food and shelter; some pay off old debts; some provide themselves an education. Very often what people do with the money depends on how much they acquire; how much they acquire depends on which part they sell. In India a kidney from a live donor (note: a live donor) sells for $1500; a cornea for $4000; a patch of skin for $50. In India and Pakistan people state in the newspapers what they are willing to pay for an organ; readers decide what they are willing to sell for.

If it’s medically needy people who buy, who sells? Poor people. Overwhelmingly it is poor people, desperately poor people, who sell. Poor labourers will gain more money by selling one of their two kidneys than they would ever be able to save over a lifetime. One woman, mother of two children, found herself in desperate financial straits when her husband lost his job. She sold one of her kidneys, remarking as she did so, “It was the only thing I could sell and keep my self-respect.”

One spot in the world where the business of body parts thrives extraordinarily is Bombay, on the west coast of India. Wealthy Arabs go there to receive the organs that poor Indians sell. Madras, on the east coast of India, is the city of choice for people from Thailand and Singapore who need replacement organs. In all of this the Indian government has refused repeatedly to pass any legislation prohibiting the commercial traffic in body parts.

So huge is the demand for transplantable organs that some societies don’t even wait for donors to die; such societies don’t even wait for sellers to sell; they simply kill people and remove organs. Recently the British Medical Journal exposed a scam in Argentina wherein organs were removed from patients in a state psychiatric hospital. The hospital authorities reported to relatives that the patient had died of natural causes or had escaped. From 1976 to 1991 hospital authorities maintained that 1400 had escaped and almost 1400 had died of natural causes. When relatives complained vociferously and persistently the hospital was investigated — whereupon there turned up the remains of several people who had been reported as “escaped”, including the remains of a 16-yr. old supposed escapee whose eyes were missing.

It’s easy for us to say, “Nations like Argentina and India are a long way from us in many respects. Those people think differently. What happens there could never happen here.” But it can happen here. A recent editorial in the newspaper USA Today advocated paying the families of deceased donors. The article suggested that paying families for the organs of their deceased relatives would make more body parts available. The editorial opined that a “death benefit might provide incentives that altruism could not.” In other words, people will do for money — make available the body parts of their dead relatives — what they would otherwise not do at all.

It’s plain that the commercialization of organs has landed us in a market system with respect to the human body, a market system governed by the laws of supply and demand. The demand is always increasing. What about the supply? The most elementary student in economics knows that according to the market system as more and more money is offered for organs, more and more organs will be supplied. We may cringe at the crass commercialization of the human body. Market advocates don’t cringe, however; so far from cringing, market advocates extol the market system’s effectiveness in proliferating available organs. Market advocate (and legal expert) Mr. Lloyd Cohen enthuses,

Markets are most effective at transferring goods from low-
valued uses to high-valued ones. And I can think of no good
that fits that category better than a cadaveric organ. The
difference in the value of a kidney to the dead versus a
kidney to the ill means that there is an enormous price range
over which a mutually satisfactory transfer can take place.

“There is an enormous price range over which a mutually satisfactory transfer can take place.” The meaning of this sentence is simple: when the price is high, people sell.

Ms. Lori Andrews, also an American lawyer, insists that the debate about body parts should unfold in the context of legal discussions concerning property. Body parts, in a legal context, are property. To nobody’s surprise Dr. Jack Kevorkian (better known to us these days as “Dr. Death”) states bluntly, “Body parts are property. The person owns them and has the absolute right over what will be done with them in every situation.”

Let’s pause right here. Are body parts property? Surely not. Our society (that is, the Canadian society with which I am acquainted) clearly recognizes that the human body is not property. The penalty for stealing my bicycle is nowhere near as severe as the penalty for assaulting my body. Why? Because to steal my bicycle is to deprive me of a thing; but to assault my body is to violate my person. We recognize the category-distinction between thing and person. When someone is assaulted we say, “Mr. Jonathan Johnson was assaulted”. We never say, “Johnson’s body was assaulted.” We know that Johnson himself was violated, and violated in a way he is not violated if his bicycle is pilfered. We say, “Johnson was murdered”. We never say, “Johnson’s body was rendered non-functional.”

Our society has never legalized prostitution, even though we all know that prostitution is here to stay. We haven’t legalized it for one reason: we know intuitively that to legalize prostitution is to “thingify” a woman’s body, and to “thingify” her body is to “thingify” her, “thingify” the person; in other words, to destroy the person as person.

“But it’s my body and I may do with it as I wish!” No! My body isn’t my property and I may not do with it as I wish. For instance, I am not allowed to sell my body into slavery, for to sell my body into slavery is to enslave myself. And this our society will not permit us to do. (Not only may I not sell my body into slavery, I’m not even allowed to sell my labour for a price so low that my person is deemed to be violated.)

In the USA it has been argued that if long-term prisoners give up body parts then their prison sentences should be shortened. I am outraged at this proposal. Objections to it flood me. Let me say this much: I regard this proposal as the crassest “thingification” of a human being, when the criminal justice system was designed precisely to ensure that such “thingification” doesn’t occur. What about the prisoner whose kidneys or corneas aren’t the best? What can he sell to shorten his sentence?

Needless to say, once body parts are commercialized and the market system appears, the market system will triumph; the market system will become the dominant factor in the trade, if not the only factor. What this means is that throughout the world poor people will exchange their body parts for rich people’s money.

 

[4] Perhaps you are thinking now that you shouldn’t make your organs available for transplant upon your death. If you are thinking you shouldn’t, no one is going to fault you for it.

Nonetheless, despite having said all that I have said this morning, I have not torn up the organ donor consent form that I signed and always carry with me. For when I have considered again the profoundest issues pertaining to the body and the person; when I have surveyed again the horrific abuses around the world, I still want to will my usable organs to a needy person.

I admit, we could argue that donating blood is not the same as donating a kidney (blood is replenishable, while kidneys are not), but I’m not going to develop such an argument today.

I do know that if I am killed in a motor-vehicle accident this afternoon, and if someone can be helped to see by means of my corneas, I want them used. If tomorrow my daughter or my wife develops irreversible kidney problems and someone’s kidney is available for her, I can only be grateful. And if no kidney is available, I should never hesitate to give one of mine.

Jesus said, “No one takes my life from me; I lay it down of my own accord.” While our Lord was plainly willing to lay his life down, he wasn’t willing to squander it or throw it away or fritter it. He didn’t think for a minute that he was only a helpless victim who could only submit passively to violation at the hands of others. He gave up his life. Since no one takes it from him, then when he said his body was broken for us he meant that he broke it himself for us. In saying that his blood was shed he meant that he poured it out himself for us.

Following the example of my Lord I insist on retaining a similar privilege. I insist on the privilege of doing something, however slight, that reflects my Lord’s self-giving, however slightly.

                                                                  Victor A. Shepherd
June 1996

 (Awarded “Second Best Opinion Piece”, 1997, Canadian Church Press)