Organ donation is the act of donating one or more bodily organs to another person so that they may be used in the recipient's body to increase the chance of survival and/or health of the recipient. Such a transfer is called an organ transplant. Other donations of a similar nature include blood and bone marrow donations. The following will address organ donation by exploring both patristic and contemporary theological thought so as to gain an Orthodox perspective on the subject.
As humans with a fallen nature, our human bodies are subject to corruption, decay, and death. Often, death of the physical body is brought about as a result of this corruption and decay in the organs of the body. Advances in medical and surgical technology in the past century, however, now allow the prevention of death and the improvement in health of persons afflicted with diseased organs by the receiving of new organs, which then replace the old. This is widely utilized as the method of healing for such afflicted persons. The organ donor may be one of the following:
- a live volunteer, typically a relative of the recipient;
- a person clinically diagnosed as brain dead, whose brain is no longer functioning, including the brain stem and cortex, which renders them unable to breathe unassisted;
- a person whose organs were removed and preserved upon death until the need arises;
- an animal such as a pig, often for its heart valves.
A healthy human can donate a kidney, part of his or her liver, bone marrow, and blood without serious long term health risks. Surgeons can transplant many additional organs, such as the heart and lungs, intestines, pancreas, and the corneas, if the donor is already dead.
Scriptural and Patristic Thought
St. Paul says that we are called to glorify God in body and spirit, saying that our bodies are "members of Christ" (1 Corinthians 6:15 NKJ). He goes on to say that "the body is… for the Lord, and the Lord for the body" (1 Corinthians 6:13 NKJ), and the "body is the temple of the Holy Spirit who is in you" (1 Corinthians 6:18 NKJ). Though speaking specifically of fornication and gluttony, St. Paul makes it clear that the sanctity of the body is imperative and inviolate, as in and through it we are joined to the Lord and become one spirit with Him.
St. John Chrysostom says of 1 Corinthians 6 that the body was formed "that it might follow Christ as a Head, and that the Lord might be set over the body." Likewise, Irenaeus of Lyons asserts that "God will bestow salvation upon the whole nature of man, consisting of body and soul in close union, since the Word took it upon him, and adorned with the gifts of the Holy Spirit, of whom our bodies are, and are termed, the temples."
Specifically in reference to medicine, history has shown that the church does not reject secular medicine. St. Luke the Evangelist, for instance, was known to be a physician (Col 4:14). Other saints, fathers, hierarchs, patriarchs, and priests were also known to be physicians by trade. The Church has always commemorated such physicians as Ss. Cosmas and Damianos, Ss. John and Cyrus, and Ss. Panteleimon and Hermolaus, recognized for their theology and piety, as well as healing skills. In fact, St. Basil the Great blessed the use of secular medicine, saying that God worked just as much through the visible world as the invisible. Therefore, God’s grace is made manifest in the ability to heal through medicine just as much as through miraculous cures. Further, as long as the goal of pleasing God and tending to spiritual health remains primary, medicine is in absolute harmony with Christianity. It even makes us more acutely aware of God’s power. St. John Chrysostom also stressed that those with the ability to relieve the suffering of others and save them from death had a responsibility to do so.
However, there are also instances where the fathers specifically expressed that the use of medicine, regarded so highly as a Christian virtue, should be limited or even avoided at times, and that prayer and piety should be employed as methods for a cure. The emphasis in healing has always been on prayer, even in conjunction with secular medicine. St. Basil says “do not forget that without God there is no healing for anyone,” and, “Those who resort to physicians, may they resort to them while relying on God, saying: ‘It is in the name of God that we entrust ourselves to physicians, believing that He will grant us healing through them.”
Thus the emphasis in the writings of the fathers has always been placed on healing in conjunction with prayer and awe at the Lord’s miracles. The illnesses of the body are never attended to without attention to the illnesses of the soul, which are far more paramount. And the sanctity of the body, as the temple of the Holy Spirit, must always be respected and honored by the physicians and the patients.
Current Orthodox Positions
It is this sanctity that must be considered in organ donation and transplantation. This sanctity must be respected by all parties involved, be they doctor, donor, recipient, or bystanders such as relatives and friends. And while this is still a controversial topic about which the Orthodox Church as a whole has no unified stance, there are several factors that noted theologians insist must be considered if the donation of organs is to be carried out in a Christian manner, with full respect for the bodies and souls of both donor and recipient.
All parties should consider the matter in prayer and in consultation with their spiritual father. As the body and soul are one, both must be ministered to. While the power of reason and human effort should not be put aside in efforts to heal the sick, nor should the Lord’s power to heal be forgotten. St. James says "Is anyone among you suffering? Let him pray. Is anyone cheerful? Let him sing psalms. Is anyone among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith will save the sick, and the Lord will raise him up. And if he has committed sins, he will be forgiven." (James 5:13-15 NKJ) This must be the first of all considerations when contemplating the possibility of organ donation.
Donation of an organ should always be an uncoerced act of love. To willingly give of one's life for God or neighbor is the ultimate expression of this love. "Greater love has no one than this, than to lay down one's life for his friends" (John 15:13 NKJ). This self-sacrificing Christian love for one's neighbor should be the motivation for such a decision, emulating the sacrifice of Christ Himself. Therefore, such a decision should never be made on the basis of coercion, nor should it be reduced to a transaction of any kind (such as for money).
So that the giving and receiving of life through such a donation should always be an act of love, and so the body's sanctity be considered and respected, theologians note that the following factors are of vital importance when prayerfully considering such a procedure.
- All other medical treatments should first be considered and attempted, such that a donation and transplant is a last resort remedy for the afflicted person.
- Specific therapeutic goals, such as the prolonging or saving of the recipient's life should be at the forefront, not medical experimentation or curiosity, or political and/or economic gain.
- The benefits and risks should be taken into account and weighed carefully. No donor is morally obligated to give of himself when it may risk his or her life or wellbeing. At the same time, the quality of life of the recipient prior to and following the transplant must be taken into consideration with the risks and benefits. Organ donation and transplantation should only be done to improve the quality of life for the recipient.
- Various national Orthodox synods differ on their stance on life-ending donation of one’s organs. For example, The Church of Romania states that no donor may end his or her life to donate an organ (such as a heart), even if it is done to save another's life. To them, such an act is tantamount to suicide and is unacceptable. However, The Church of Greece states strongly that a life-ending donation denotes an act of self-sacrificing love, citing "by this we know love, that He laid down His life for us; and we ought to lay down our lives for the brethren" (1 John 3:16 NKJ). This is a perfect example of why the consultation of one’s spiritual father is essential in making such an important decision.
- On the subject of transplantations of artificial organs, xenografts (processed animal organs), or cloned organs, again the synods differ. The Church of Greece has not yet established an official position on this subject, saying that more research must be done before the Church can voice Her opinion. The Church of Romania explicitly states that no transplant is permitted that changes or confuses the nature of the recipient. For example, animal parts such as pig heart valves transplanted into a human body would be unacceptable. The Greek Orthodox Archdiocese of America states clearly that no transplant should ever “place in jeopardy the identity of the donor or recipient, such as the use of animal organs.”
- Donation must be done with the rights of the patients and families in mind. Willing and informed consent must be given by the donor and recipient, or by family members (with legal rights) acting on behalf of a patient who is unable to give consent themselves. In such a case, the rights and wishes of the patients should always be considered first, as well as their best interests both spiritually and physically. Interestingly, The Church of Greece notes that an organ donation made with the consent of family members (when the donor is unable to give consent), transfers the sacrificial virtue of donation to the consenting relatives. This is because the effect that love for a family member has can make such a decision to donate the body of a loved one even harder than donating one’s own body.
- As organ donation must be done with express consent, the donation of cells or tissues from an embryo is unacceptable. An embryo is a living being, and is unable to give consent. Therefore, such a procedure should not be allowed.
Additionally, in the case of heart transplants and lung transplants, it should be noted that some Orthodox theologians and hierarchs have objected to such transplants on the basis that the heart and lungs have deeper theological meaning for the body. As well, these transplants do not yet have a high rate of success, which should be considered as a valid moral criterion with reference to potential procedures.
While The Greek Orthodox Archdiocese of America has not issued a formal statement or official stance on matters such as this, it does offer some guidelines in the links found below. The Church of Greece, however, stresses the importance of the act of willing donation by the donor as an act of love which is far more important than the act of receiving by one in need of organs, stating, “The spiritual benefit of the donor is greater than the biological gain of the recipient to the same extent as the soul is superior to the body. ‘It is more blessed to give than to receive.’ (Acts 20:35 NKJ)”
The Church of Greece also emphasizes that the doctors involved should perform such life saving acts with humility, seeing themselves as instruments of God, and that the recipient of such a wonderful gift as an organ should see themselves as blessed by God, and receive humbly the gift that is being given to them, and realize that the greater act is the virtue of donation from the immortal soul of the donor, rather than the receipt of a body part for one’s biological, mortal body.
Pastoral Considerations and Concerns
While some believe that organ donation is a desecration of the temple of the Holy Spirit, others believe that it is a wonderful, self-sacrificial way of showing love for God and neighbor. Though there are differing perspectives on the matters within the Church as a whole, they are all united in emphasizing that, when weighing such a heavy decision, it is absolutely imperative to consult a spiritual father, and pray unceasingly on the matter. As Orthodox Christians, we are called to faith in Christ, who is the Physician of our souls. He has given us the gift of life, and the sanctity of that gift should always be at the forefront of the minds of doctors, patients, families, and spiritual fathers, when that gift of life and love is passed on through the free giving of an organ for the benefit of one's brother. "So let each one give as he purposes in his heart, not grudgingly or of necessity; for God loves a cheerful giver" (2 Corinthians 9:7 NKJ).
- Pastoral Guidelines: Church Positions Regarding the Sanctity of Human Life by Rev. Dr. Stanley S. Harakas (GOARCH)
- Resources in preparation for dying, death and burial (PDF) (p.15) from the St. Nicholas Orthodox Church (OCA) in Portland, Oregon
- The Gift of Life by Laryssa Grinenko (Jun. '02) (Antiochian)
- Ask Abouna (with Fr. Anthony Yazge) regarding organ donation (Antiochian)
- The commerce of human body parts: an Eastern Orthodox response - by Fr. Reardon
- How Much Is A Kidney Worth? by Abraham McLaughlin, Ilene R. Prusher, and Andrew Downie
- Basic Positions of the Ethics of Transplantation by the Holy Synod of The Church of Greece, Bioethics committee
- Transplantul De Organe by the Church of Romania
- Orthodox Christian Beliefs and Practices by the Ukrainian Orthodox Church of Canada
- The Theology of Illness by Jean-Claude Larchet (St. Vladimir's Seminary Press, 2002)
- The Birth of the Hospital in the Byzantine Empire by T.S. Miller (The Johns Hopkins University Press, 1985)
- For The Health of Body and Soul: An Eastern Orthodox Introduction to Bioethics by Fr. Stanley Harakas (Holy Cross Orthodox Press, 1980)
- Homilies on First Corinthians by St. John Chrysostom
- Letter 327 by St. Basil the Great
- Letter 508 by St. Basil the Great
- Against Heresies by St. Irenaeus of Lyons