The New Definitions of Death for Organ Donation

A Multidisciplinary Analysis from the Perspective of Christian Ethics. Foreword by Professor Josef M. Seifert

by Doyen Nguyen (Author)
©2018 Edited Collection XXII, 590 Pages


This book critically examines the moral soundness of the two definitions of death used in organ donation-transplantation: "brain death" (heart-beating) and "controlled cardiac/circulatory death" (non-heart-beating). The author carries out a multidisciplinary study of the crucial moral issues surrounding these new definitions to answer the question: are the donors truly dead at the time of organ removal?
The book probes the history of these protocols, and the rationales of pro-"brain death" Catholic scholars who assert that brain-dead individuals are dead because, without a functioning brain, they have undergone a substantial change. The author’s arguments, firmly grounded in both classical metaphysics and contemporary biophilosophy, demonstrate that the new definitions of death are unsound because they contradict both Aristotelian-Thomistic anthropology and holistic biophilosophy.
The book also looks at the new definitions in terms of Christian ethics. It provides a detailed critical analysis of John Paul II’s 2000 Address to the Transplantation Society, showing that, contrary to popular belief, the Catholic Church has not given any formal approval to the "brain death" protocol.

Table Of Contents

  • Cover
  • Title
  • Copyright
  • About the author(s)/editor(s)
  • About the book
  • This eBook can be cited
  • Contents
  • Foreword
  • Preface
  • Acknowledgements
  • Introduction
  • Part I Ethical Positions Advocating the New Definitions of Death
  • Chapter 1 The Position of the Pontificia Academia Scientiarum
  • 1.1 Summary Statement of the Pontifical Academy of Sciences
  • 1.1.1 Medical Assertions in the Academy’s Statement
  • 1.1.2 Other Arguments in the Academy’s Statement
  • Argument on Consensus
  • Argument Concerning the Genesis of “Brain Death”
  • Philosophical Basis of the Academy’s Position
  • 1.2 Anthropological Premise of the Academy’s Position
  • 1.2.1 Death is an Event
  • 1.2.2 Biological Definition of Death—Death of the Organism as a Whole
  • The Organism as a Whole—Integrative Unity
  • Death—Unintegrated Parts
  • 1.2.3 Supremacy of the Brain, the Anthropological Premise for “Whole Brain Death” as the Criterion for Death
  • 1.3 Speculative Arguments in Defense of the Supremacy of the Brain
  • 1.3.1 Arguments Based on Thermodynamics and Control System Theory
  • 1.3.2 Arguments Using Thought Experiments
  • 1.4 Medical Arguments Advanced to Defend the Supremacy of the Brain
  • 1.4.1 Purported Inadequacy of the Traditional Cardiopulmonary Standard
  • 1.4.2 Arguments Based on the Pathophysiology of Severe Brain Injury
  • 1.4.3 From the Argument of Somatic Instabilities to the “Masking Death” Assertion
  • Somatic Instabilities
  • “Masking Death”
  • 1.4.4 Arguments Based on Neuropathology
  • 1.5 Revision of the Biological Definition of Death—Selective Discarding of Functions
  • 1.5.1 Purported Insignificant Brain Functions
  • 1.5.2 Purported Insignificant Spinal Reflexes and Spontaneous Movements
  • 1.5.3 Difficulties with Selective Discarding of Functions
  • 1.6 On Irreversibility
  • 1.6.1 Irreversibility in the Context of “Controlled Cardiac/Circulatory Death”
  • Patient’s Autonomy as the Reason for Irreversibility
  • Permanence as a Stand-In for Irreversibility
  • Other Arguments in Defense of “Controlled Cardiac/Circulatory Death”
  • 1.6.2 Irreversibility in the Context of “Brain Death”
  • Chapter 2 The Positions of Specific Catholic Scholars
  • 2.1 Seeking to Harmonize “Brain Death” with Catholic Anthropology
  • 2.2 The Argument of Edward Furton—the Organ of Intellectual Cognition as the Locus of Body-Soul Union
  • 2.3 The Position of Germain Grisez’s School
  • 2.3.1 The Position of Germain Grisez and Joseph Boyle in the 1970s
  • 2.3.2 The Current Position of Patrick Lee and Germain Grisez since 2012—Loss of the Radical Capacity for Sentience
  • 2.3.3 Difficulties with the Rationale of Radical Capacity for Conscious Sentience
  • From Sentience to Conscious Sentience
  • On Consciousness and the Radical Capacity for Consciousness
  • Anthropological Considerations
  • 2.4 A New Defense of “Whole Brain Death”
  • 2.4.1 Maureen Condic’s Argument—The Organization in Brain-Dead Bodies is Only a Semblance of True Somatic Integration
  • 2.4.2 Difficulties with Maureen Condic’s Argument
  • Difficulties Regarding the Cell Culture Analogy
  • Conceptual Difficulties
  • 2.4.3 A Problematic Corollary—Anencephalic (“Brain-Absent”) Fetus/Newborn
  • 2.5 Implications of “Whole Brain Death” on Questions about the Beginning of Life—the Pro-Life, Pro-“Brain Death” Inconsistency
  • 2.5.1 “Brain Life” Theory
  • 2.5.2 Can Pro-“Brain Death” be Harmonized with Pro-Life?
  • On Dependency
  • The Brain, an Organ as any Other Organ, a Part of the Organic Whole
  • 2.6 The Position of Catholic Scholars on “Controlled Cardiac/Circulatory Death”
  • 2.6.1 James DuBois’s Arguments in Defense of “Controlled Cardiac/Circulatory Death”
  • 2.6.2 Additional Ethical Issues in “Controlled Cardiac/Circulatory Death”
  • Part II Sed Contra to the New Definitions of Death—Life and Death in Aristotelian-Thomistic Thought and Contemporary Biophilosophy
  • Chapter 3 Metaphysical Conceptions of the Human Person
  • 3.1 Conception of the Soul and Body According to the “Teachers” of St. Thomas Aquinas
  • 3.1.1 St. Augustine’s Conception of the Soul and Body
  • 3.1.2 Aristotle’s Teaching on the Soul in De Anima—an Overview
  • 3.2 St. Thomas Aquinas’s Teaching on the Nature of the Human Person
  • 3.2.1 A Global View of Aquinas’s Conception of the Human Person
  • 3.2.2 Aquinas’s Realism-Based Methodology—Its Implications with Respect to the Paradigm Shifts in the Determination of Death
  • 3.2.3 Unicity of the Soul and Substantial Union of the Soul and Body
  • Unicity of the Soul
  • Substantial Union of Body and Soul
  • Implications of Body-Soul Substantial Union in the “Brain Death” Controversy
  • 3.2.4 Separability of the Soul and the Issue of Early Dehominization
  • The Soul as Self-Subsisting and the Unnatural State of the Disembodied Soul
  • The Issue of Early Dehominization
  • 3.2.5 Aquinas’s Teaching on the Powers of the Soul
  • 3.2.6 Evaluation of Melissa Moschella’s Rationale in Light of Aquinas’s Teaching
  • Moschella’s Rationale in Defense of “Brain Death”
  • Difficulties with Moschella’s Argumentation
  • 3.2.7 The Issue of the Primary Organ in Aristotelian-Thomistic Teaching
  • The “Primary Organ” Arguments of Benedict Ashley and Jason Eberl
  • Aristotelian-Thomistic Notion of the Primary Organ
  • Is There a Primary Organ?
  • 3.3 Metaphysical Anthropology According to Descartes and Locke—an Overview
  • 3.3.1 The Legacy of John Locke with Respect to the “Brain Death” Debate
  • 3.3.2 The Legacy of Descartes in Biomedical Sciences
  • Chapter 4 Contemporary Biophilosophical Understanding about Life and Death
  • 4.1 From a Mechanistic to a Holistic Vision of Life and Organism
  • 4.1.1 Pioneering Efforts toward a Holistic Vision of Life
  • 4.1.2 Reduction of Life Phenomena to Cause-Effect Mechanisms and Physico-Chemical Properties
  • Claude Bernard—Mechanism, Absolute Determinism, and Vital Force
  • Jacques Loeb—a Precursor of Bernat’s Doctrine of “Brain Death”
  • 4.1.3 Holistic Vision of Life—Organisms as Anti-Entropic and Hierarchically Organized Living Systems
  • Joseph Woodger—Understanding Life in Terms of Organizing Relations
  • Life as Biological Anti-Entropy
  • 4.1.4 Some Important Characteristics of Hierarchically Organized Living Systems
  • The Concept of Emergence
  • The Concepts of Homeostasis and Robustness
  • The Incoherent Notion of a “Decider”
  • 4.2 Biophilosophical Arguments of Catholic Scholars
  • 4.2.1 Alan Shewmon’s Philosophy of Organismic Integration
  • 4.2.2 Austriaco’s Understanding of Life and Death from the Systems Perspective
  • 4.2.3 A Global Biophilosophical Approach—Autopoiesis
  • Autopoietic Understanding of the Phenomenon of Life
  • Autopoietic Understanding of Death and the Question of Artificial Life
  • 4.3 Connecting Contemporary Biophilosophy (Theoretical Biology) with Aristotelian-Thomistic Anthropology—a Brief Comment
  • Part III The New Definitions of Death in the Context of Christian Ethics
  • Chapter 5 Human Dignity, Sacredness of Life, and the Papal Pronouncements on Life, Death, and Organ Donation
  • 5.1 Human Dignity, Sacredness of Life, and the New Paradigms of Death
  • 5.1.1 Human Dignity and Sacredness of Life in the Judeo-Christian Theistic Worldview
  • 5.1.2 Human Dignity and Human Life in a Worldview without the Transcendence
  • 5.1.3 The Catholic Response to Death and Dying
  • 5.2 John Paul II’s Teaching on Life—The Incarnation and the Value of Human Life
  • 5.3 John Paul II and the Neurological Standard for the Determination of Death
  • 5.3.1 The Magisterium’s Balanced and Prudential Teaching on Organ Donation
  • 5.3.2 Critical Analysis of John Paul II’s Address to the 18th International Congress of the Transplantation Society
  • The First Presupposition in John Paul II’s Address to the Transplantation Society
  • The Second Presupposition in John Paul II’s Address to the Transplantation Society
  • The Third Presupposition in John Paul II’s Address to the Transplantation Society
  • 5.3.3 The Teaching of John Paul II on the Determination of Death in 2005
  • 5.4 The Teaching of Pius XII and Benedict XVI regarding Deep Coma and Organ Donation
  • 5.4.1 Benedict XVI’s Admonition on Organ Donation
  • 5.4.2 Pius XII’s Admonition on the End-of-Life Care of the Irreversibly Comatose
  • Conclusion
  • Bibliography
  • Index

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I consider it an honor to have been asked to write a Foreword to this excellent work of Dr. Doyen Nguyen. After reading and studying her entire monumental work, I came to the conclusion that this is the most important book ever to come out about “brain death.” It is scholarly, well organized and reasoned, and well researched and referenced. Furthermore, the tone is perfect, very respectful of those she disagrees with, not at all strident, but completely calm and objective.

This book impresses the reader chiefly by the “sober passion for the truth” that underlies the most comprehensive and well-reasoned critique to date of “brain death” and other definitions of human death that seek to replace the classical understanding of that fundamental event which we call “death.” The fact that the author uses with equal competence methods of natural science, of logic and philosophical anthropology, ethics, and metaphysics, as well as of theology, makes this work a singularly complete and competent book on this complex topic.

Her simple, yet complex, straightforward and yet highly dialectical way of discussing the different utterances on “brain death” and on the cardiopulmonary death linked to non-resuscitation orders (used in the extraction of organs from non-heart-beating donors) from a medical, philosophical, and religious perspective makes the present work a real treasure, and its reading a scientific and philosophical pleasure. She minutely analyses secular and Catholic utterances on death from the perspective of Christian ethics and the Catholic faith, but at the same time applying a thorough labor of ratio.

Her keen analysis and equally precise and complete account of empirical research stands in sharp contrast to the imprecisions and incompleteness among many who speak on “brain death” without taking all empirical facts into account. In the same manner, she submits the unavoidable philosophical interpretations of the empirical facts to a rigorous logical, anthropological, and metaphysical scrutiny.

The sharp analysis from the scientific, legal, and ethical contexts, of ambiguities, equivocations of terms, logical contradictions, and non sequiturs, makes it overwhelmingly clear that purely pragmatic and utilitarian ← xv | xvi → arguments for the use of organ donors, cannot be a justification for calling them dead.

The author seeks passionately and sine ira et studio the truth about human death. Her calm logical analyses uncover many sophisms and intrinsic incoherences in the arguments advanced for the defense of the new definitions of death, and demonstrate the massive contradictions between these definitions and both empirical science and philosophical knowledge. She draws her own philosophical knowledge from an intelligent and highly differentiated understanding of the Aristotelian-Thomistic anthropology, some of the most central tenets of which are confirmed by the doctrine of the Catholic Church. In this anthropology, the unicity of the human soul and the intimate union between body and soul are understood in terms of the rational human soul being the only substantial form of the human person, bestowing on the body esse (being), vegetative, sentient, and rational life.

Against this background, and on the basis of her multidisciplinary approach, she analyses in a calm and admirable sharpness the views of various authors. In spite of her obvious deep and uncompromising Catholic faith, she is entirely objective in her rational analysis to critically examine not only the utterances of the Pontifical Academy of Sciences (a consultative body to the Holy See with no magisterial authority whatsoever), but also the pronouncements of Saint John Paul II on the issue of “brain death.”

In this regard, she follows in some way the example of Professor Alan Shewmon, who, in his response to Tonti Filippini’s charges in Communio, has shown why the address of John Paul II to the 18th International Congress of the Transplantation Society, was not meant to raise the so-called adoption of the whole brain death criterion to the rank of magisterial teaching.

Unbiased by her orthodox Catholic faith and her devotion toward Saint John Paul II, Dr. Nguyen analyses first of all the precise meaning of what John Paul II says, the premises and contents of his utterances, and the obvious incorrectness of some of his remarks, for example, on a universal consensus of the medical scientific community on “brain death.” Focusing on the “ifs” and “seems” in his statement, she demonstrates that the opinion promoted by many (such as the Pontifical Academy of Sciences) that Pope John Paul II had made acceptance of “brain death definitions” an article of Catholic faith, is completely mistaken.

The careful scrutiny of the various declarations and results of four distinct sessions of the Pontifical Academy of Sciences dedicated to “brain ← xvi | xvii → death,” her sharp and objective analyses of Bernat’s, Grisez’s, Lee’s, Moschella’s, Condic’s and many other defenders’ opinions and arguments for the identity of “brain death” with human death make this book a singularly important scientific and philosophical contribution to the debate.

Its high value is largely due to the philosophical rigor and profundity of the book. While some readers, for example myself, might consider her book too Thomistic, or may find her judgments on Duns Scotus, Descartes, John Locke, and other philosophers harsh and partly unjustifiedly so, the book’s historical knowledge and scholarship, as well as its philosophical depth, are astounding. Dr. Nguyen’s profound understanding of the nature of human life, of the person, of soul, and of ethical insights of Hippocratic medicine, make this book the most balanced and well-rounded work written on the subject I have seen. Moreover, she is in no way a “closed-minded Thomist,” but shows herself quite open to many insights of bio-philosophy of the 19th and 20th century that have no Thomistic roots.

The book excels through its multidisciplinary approach. It meets the highest standards of science, philosophy, and theology, being an extremely careful and well-researched compendium scientiarum omnium mortis humanae (of all sciences regarding human death).

One can only recommend its careful study to every person interested in the truth about human life and death, and in the ethics of organ transplantation, and in particular to every serious scholar, who raises his or her voice in this discussion. Nobody should speak on “brain death” any longer in serious scientific conversations without having read this work.

With singular sobriety and a thoughtful foundation in medical and philosophical research, the author presents a vision that tends to bring about a Hippocratic revolution of the anti-Hippocratic transplantation medicine that surges from a spirit of disregard of the dignity of each living human being, by reducing many human beings to mere open fields of organ-harvesting, and by muddying the borders between transplantation medicine and euthanasia.

As it behooves a pure dedication to the truth, the author stays completely free of wishful thinking that distorts reality for the sake of political or economic gains and concludes the book with a magnificent appeal to restore a truly Christian and truly Hippocratic ethics that shows the limits of anyone’s “right to organs,” by not allowing committing any evil so that good may come from it. ← xvii | xviii →

This ethics of moral absolutes, imbued with an impressive respect for the life of each human person makes the work wonderful and fascinating reading, even in some of its dry scientific and historical parts.

Dr. Nguyen’s work is profoundly inspired by both the respect for the dignity of the human person and the Hippocratic Oath with its perennial ethical wisdom. The book reminds physicians to keep in mind the good of the patient and never to treat him or her as a mere means to an end, even if this end is for the noble purpose of saving lives and restoring the health of organ recipients. With a logic and consistency that is beautiful, sharp, and transparent as a diamond, she unmasks the many compromises dominating contemporary medicine, showing that the multitude of benefits and blessings of medicine can never justify killing nor damaging patients.

Her work also echoes the extraordinary ethical and medical analyses owed to Professor Cicero Coimbra’s research on the dangers entailed in the apnea test. This test, performed in order to see whether the patients are really dead, clearly and demonstrably risks killing organ donors. This danger, proven empirically by careful research on animals, is nonetheless conveniently ignored by many in the medical community. Irrespective of one’s position towards “brain death,” the apnea test puts beneficence to the patient second on a scale of values, and as such, contradicts Hippocratic medicine.

In virtue of its strong ethical dimension, this book can also be highly recommended as an ethical vade mecum for physicians, and furthermore, as an important educational, ethical tool and textbook for students of medicine.

Professor Josef Seifert, DDr. phil. hábil., Dr. h.c.

Founding Rector of the International Academy of Philosophy in the Principality Liechtenstein

| xix →


The present work is about medical ethics written by a moral theologian who was also a physician with practical medical experience. Although medical ethics is a vast field marked by numerous ethical issues spanning the whole of human life from its beginning to its end, this book limits itself to the issue of death. More specifically, it is an in-depth investigation of death with respect to organ donation. Although life and death are ontological realities standing at opposite ends to one another, nowhere in medicine are life and death so tightly intertwined with each other as in organ donation-transplantation. Indeed, as St. Pope John Paul II stated in his address to the 1989 Working Group on The Determination of Brain Death and its Relationship to Human Death, “it is conceivable that in order to escape certain and imminent death a patient may need to receive an organ which could be provided by another patient, who may be lying next to him in hospital, but about whose death there still remains some doubt.”

The current strategies of organ procurement rest on two pillars, each of which involves a new definition of death: (i) heart-beating donation which corresponds to “brain death,” and (ii) non-heart-beating donation which, in the United States, is obtained primarily by way of the “controlled cardiac/circulatory death” protocol. In such instances, death no longer comes uninvited but is carefully orchestrated, instead. Today, most fresh organs are still obtained from brain-dead donors.

Much of the general public has remained largely uninformed about the real nature of the above-mentioned new definitions of death. Nevertheless, both paradigms have raised considerable moral controversies as they are fraught with numerous difficulties, both on the empirical and conceptual level. At the heart of the ongoing controversies is the unsettling question: are donors truly dead when they are declared dead by either protocol; are they truly dead at the time of the removal of their organs?

To address this crucial question requires a multidisciplinary approach because life, death, and the human being are the most complex ontological realities in the visible created world. Getting to the heart of moral issues in medicine thus requires delving into their ontological and anthropological underpinnings. Therefore, in this book, the ethical issues raised by the new ← xix | xx → definitions of death are scrutinized under the lens of various disciplines including medicine, biology, biophilosophy, and most importantly, philosophical anthropology.

Using a multidisciplinary approach, the originality of the present work is at least three-fold. It brings under “one roof” the different ethical positions with regard to “brain death” and “controlled cardiac/circulatory death,” and analyzes these positions critically in terms of their fittingness to the Christian teaching on the human person, as well as to the empirical medical/scientific evidence. The book also demonstrates that the holistic vision of human beings according to contemporary biophilosophy agrees with the classical Thomistic substance view of human nature which is held and taught by the Catholic Church. Finally, the book also provides a systematic analysis of the Church teaching on organ donation, including John Paul II’s Address to the 18th International Congress of the Transplantation Society.

It is envisioned that this book, written in the spirit of seeking Truth, will contribute to a coherent approach for the protection of human life since it will become apparent to the reader that the new definitions of death do not correspond to the reality of death per se as confirmed by the evidence drawn from empirical medical science, classical metaphysics, and contemporary biophilosophy. Given its multidisciplinary approach, the book is directed to an audience engaged in the fields of medicine, ethics, and philosophy. Because of its in-depth analysis, it will also be useful as a supplemental text to foster learning and critical thinking in courses on bioethics, especially those conducted in Catholic institutions. The layperson with a basic background in philosophy who would like to take a deeper look at “brain death” or “controlled cardiac death” will also benefit from this book.

| xxi →


In bringing this project to completion, I owe an intellectual debt to the giants upon whose shoulders I stand, namely scholars and thinkers—both contemporary and of preceding centuries—whose writings have contributed to shedding light on the ethical problems raised by the new paradigms of death for organ donation-transplantation. Most notable among them are St. Thomas Aquinas and Aristotle, both of whom I turn to for help when I need to think through the difficult questions touching on human nature.

I am indebted to each and every one of my professors—both at the Pontifical University of St. Thomas Aquinas (Angelicum) and the Franciscan University of Steubenville—for the formation I have received in Philosophy and Theology, and for deepening my knowledge of the teaching of Aquinas. I am particularly grateful to Sister Catherine Droste, O.P., my primary mentor in Theology, for supporting me with encouragement from the very inception of this project, and for commenting on the manuscript at various stages of its development.

My deepest gratitude goes to Dr. Lawrence Diamond without whom this book would not be possible—who was my first professor in Hematopathology and taught me to think critically, who became my colleague and my spouse, and who, for the last several years, has selflessly humbled himself to be my librarian, editor, and personal secretary all-in-one, besides providing other necessary and practical infrastructure.

| 1 →


Why the necessity for a critical analysis of death and organ donation?

A major achievement in the medical field over the course of the last century has been the development of organ transplantation to treat organ failure. The first successful kidney transplant took place in 1954;1 it was an operation performed on identical twins which circumvented the problems of organ preservation and graft rejection altogether. Since that time, organ transplantation has greatly expanded to become the success it is today, having progressed from isograft to allograft, and from kidney transplants to the transplant of other solid organs, including unpaired vital organs, especially the heart. Contributing factors to this spectacular achievement include not only the many advances in medical and pharmaceutical technology,2 but also the decisive involvement of legislative bodies to enact statutes and public policies legalizing organ procurement from two new categories of “dead” donors. Along with these measures are intensive campaigns and strategies to expand the donor pool.3 The reason for this is simple: since the ← 1 | 2 → beginning of transplantation, the number of patients on the waiting lists has steadily increased, resulting in an unquenchable demand for suitably viable donor organs, especially as the gap between supply and demand continues to widen.4 ← 2 | 3 →

My phrasing, new categories of “dead” donors, refers to the fact that the determination of death in such donors is not based on the time immemorial criteria of total and irreversible cessation of all vital functions, according to which death is declared when respiration has ceased, the heartbeat has stopped, and the body soon turns grey and cold, followed by other overt signs indicative of a corpse. As the situation currently stands, the bulk of transplanted organs are derived from the new categories of “dead” donors,5 which include both heart-beating and non-heart-beating donors, that is, patients whose deaths are determined by the “brain death” criterion,6 or by the “controlled cardiac/circulatory death” ← 3 | 4 → criterion (a revised formulation of the old cardiorespiratory standard), respectively.7 Organ harvesting from such donors has been incorporated into medical praxis and legal statutes for several decades. Yet, even today, a serious medical and moral question still persists, are the donors unquestionably dead prior to the removal of their organs? In this regard, even health care professionals involved in organ procurement have expressed ← 4 | 5 → doubts and anxiety.8 Moreover, in the early days of heart-beating donation, some leading heart-transplant surgeons openly acknowledged feeling that they indeed had killed the donors, all the while rationalizing that their action was justified by the benefit to the recipients.9

The Magisterial teaching of the Catholic Church on organ donation and transplantation reflects a balanced position, with emphasis both on charity/solidarity (through the gift of self) and on the sacredness of life. In his 1991 address to the Society for Organ Sharing, St. Pope John Paul II praised transplantation as a new way for man to make a sincere gift of himself in service to life through the donation of his organ(s), thereby fulfilling his “constitutive calling to love and communion.”10 In particular, the gift of vital organs, which can occur only after death, gives the donors the possibility “to project beyond death their vocation to love.”11 Thus, the Church exalts organ donation as a “noble and meritorious act [… and] an ← 5 | 6 → expression of generous solidarity,”12 a great act of love that follows the example of Christ’s offering of Himself by giving life to others. The Church’s enthusiastic endorsement of organ donation and transplantation is tempered with prudential warning, however, namely that it must be “in conformity with the moral law,”13 and above all it must not “bring about the disabling mutilation or death of [the donor].”14 Moreover, John Paul II could intuit that organ transplantation, irrespective of whether it comes from living or “deceased” donors, has both light and shadow.15 For this reason, he made it explicitly clear that there remain “many questions of an ethical, legal and social nature which need to be more deeply and widely investigated.”16 Although pronounced more than two decades ago, these words of the Pope still remain valid and have become even more urgent today, especially in view of his subsequent prophetic warning in Evangelium Vitae:

Nor can we remain silent in the face of other more furtive, but no less serious and real, forms of euthanasia. These could occur for example when, in order to increase the availability of organs for transplants, organs are removed without respecting objective and adequate criteria which verify the death of the donor.17

The aforementioned persistent moral concern, whether “deceased” donors are in fact dead before the excision of their organs, finds its echoes in the above insightful utterance of the Pope. Such a moral concern is not merely at the conceptual level, discussed among scholars involved in the death debate; it is also an actual source of additional distress compounding ← 6 | 7 → the bereavement grief of the donor’s relatives. It is not infrequent, among those who work with the families of donors, to encounter families who subsequently express negative feelings about their experience of donation, and who “doubt whether their [loved one] was in fact dead at the time [of the declaration of death].”18 Such doubts only surface after the family has had enough time to reflect, and in the process, to question the information which health professionals have told them concerning the death of their loved one. This points to the fact that, overall, there has been a lack of transparency toward the public at large with regard to the disclosure of critical information regarding the means and procedures used in organ harvesting.19 In the same vein, organ-procurement organizations have ← 7 | 8 → carefully kept the public uninformed with regard to the many controversies surrounding both “brain death” and the new version of cardiac/circulatory death. In summary, the seriousness of the moral question concerning the donor’s death, coupled with the insightful warning of John Paul II, explains why it is necessary to pursue an in-depth investigation on death and organ donation.

Scope and Methodology

The fact that the new concepts of death, that is, “brain death” and “controlled cardiac/circulatory death,” have both won the day through widespread legal and medical endorsement does not necessarily mean that the rationales which have been put forth in their defense are sound, however persuasive they might seem at first, especially to unfamiliar eyes. This project seeks therefore to carry out a critical examination of the major arguments which have been advanced by various contemporary Christian theologians (on both sides, for and against) with regard to heart-beating and non-heart beating donation. As will be apparent in later discussion, in most instances, the arguments did not originate from the Christian theologians or bioethicists themselves. Rather, they are largely appropriated from the positions already formulated by philosophers, ethicists, and physicians in secular medical bioethics. In turn, the ideas of these scholars often reflect, whether implicitly or explicitly, the influence of thinkers from centuries past, such as St. Thomas Aquinas, Aristotle, and some of the Enlightenment philosophers. Interestingly, Aquinas’s teaching has been cited by authors on both sides of the debate to defend their respective positions.

The point of reference for the evaluation of the different philosophical/ethical positions is the Judeo-Christian understanding of the unity of body and soul, as revealed in Sacred Scripture, amply developed by Aquinas, ← 8 | 9 → and taught by the Catholic Church. Moreover, any Christian moral position must be corroborated by the reality of: (i) empirical medical evidence, and/or (ii) current scientific knowledge about what physical life is. This requirement flows from the nature of death itself. On the one hand, death is an anthropological problem, which in turn involves philosophy, namely metaphysics; on the other hand, it is the role of medical science to ascertain the manifestations of death. The interdisciplinary nature of death makes it necessary that this study also includes salient aspects of medicine and biology. These elements are incorporated into the discussion insofar as they contribute to the philosophical and moral thrust of this investigation. Specifically, they are introduced where they are needed in order to confirm or disprove the particular Christian ethical position under consideration. The aim of the critical analysis is to answer the question: which position, whether for or against the new concepts of death, is the most coherent—philosophically, morally, and scientifically speaking? Put another way, which position best reflects both the Church’s teaching on the human person as well as the empirical medical and scientific reality?

Donation after “controlled cardiac/circulatory death” (non-heart-beating donation) has its own specific ethical issues, some of which evoke the specter of euthanasia. From a conceptual viewpoint, however, the arguments for its defense piggyback the rationales which have been put forth in defense of “brain death.”20 As such, they stand or fall together; they are therefore treated together in this project.

The book consists of five chapters grouped in three parts. Part I examines the major arguments in support of the new definitions of death. They can be classified into two broad groups. Chapter 1 presents the position of the Pontifical Academy of Sciences, which is none other than an adoption in toto of the prevalent thesis (that is, the “whole brain concept of death”) held by secular advocates of “brain death” and “controlled cardiac/circulatory death.” Chapter 2 considers the various rationales which Catholic ethicists, philosophers, and theologians have advanced to defend “brain death,” such as the position known as “radical capacity for sentience” held ← 9 | 10 → by Germain Grisez and Patrick Lee who also assert that their argument coheres with Aquinas’s teaching on body and soul. Part II presents the sed contra position held by Catholic philosophers, theologians, and medical scientists. The sed contra arguments are of two broad categories. The arguments presented in Chapter 3 are grounded in the teaching on human nature by Aristotle and Aquinas. The arguments presented in Chapter 4 are based on the contemporary biophilosophical understanding of the human organism from the systems perspective, a scientific notion which closely reflects the traditional substance view (that is, the classical doctrine of hylomorphism).

The analysis carried out in Parts I and II should shed light on whether or not the new concepts of death are in accord with our two most fundamental Christian values, human dignity and the sacredness of life. It also paves the way to Chapter 5 in Part III, in which the papal teaching on death and organ donation is closely examined. Special attention is devoted to Pope John Paul II’s address to the 18th International Congress of the Transplantation Society in 2000, in order to assess the validity of the assertion, made by some theologians/bioethicists, that the Pope’s address marks the Church’s official endorsement of the legitimacy of “brain death” (and therefore, derivatively, the legitimacy of “controlled cardiac/circulatory death”).21

An important aspect in the methodology of this research is that I have to meet my interlocutors on their grounds and “speak their language,” whether it is the language of medicine and science or that of philosophy and ethics. Both the “brain death” and “controlled cardiac/circulatory death” controversies involve scholars of diverse disciplines; these scholars are my interlocutors. Furthermore, death is both a biological and metaphysical issue. For these reasons, the moral discussion in this book must necessarily encompass both the empirical field of medicine/biological sciences, and the speculative realm of metaphysical anthropology.


XXII, 590
ISBN (Softcover)
Publication date
2018 (May)
Brain death Catholic Church Controlled cardiac/circulatory death End-of-life ethics Euthanasia Heart-beating donation Holistic biophilosophy Human dignity Hylomorphism Natural law Non-heart-beating donation
Berlin, Bern, Bruxelles, New York, Oxford, Warszawa, Wien, 2018. XXII, 590 pp.

Biographical notes

Doyen Nguyen (Author)

Doyen Nguyen, MD, STD is both a theologian and a hematopathologist. A graduate of Temple University Medical School and a scholar of the Leopold Schepp Foundation, she is a lay Dominican and, currently, an independent academic researcher associated with the Pontifical University of St. Thomas Aquinas in Rome where she obtained her doctorate in moral theology, specializing in end-of-life ethics.


Title: The New Definitions of Death for Organ Donation
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614 pages