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The increasingly permissive and unethical standard for organ harvesting

As Catholics, we oppose the utilitarian mindset that the end justifies the means. The desire to save human lives is laudable, but we cannot do so by deliberately ending the life of innocent human persons.

(Image: Piron Guillaume/

There is tremendous societal pressure to obtain organs for transplantation. Approximately 43,000 organ transplants were performed in 2022, but as of February 27, 2023, approximately 104,000 patients remained on the organ transplant waiting list. Organ demand exceeds supply.

Of the organ transplants performed in 2022, the majority (85%) were from “dead donors.” But these “dead donors” are not the cadavers we associate in our minds with death. Cadavers cannot be a source of fresh, viable organs. New definitions of death have been created to provide legal justification for organ harvesting from patients who in the past would have been considered alive. In the words of one group of transplantation advocates, “Donor shortage worldwide has led to the development of different strategies to increase the organ donor pool.”

The most recent innovation in pursuit of fresh organs is termed “normothermic regional perfusion with controlled donation after circulatory death” (NRP-cDCD). A more accurate description of this procedure is found in a position statement opposing NRP-cDCD by the American College of Physicians, the nation’s second-largest physician organization: “organ retrieval after cardiopulmonary arrest and the induction of brain death.”

In NRP-cDCD, a patient on life support who does not meet “brain death” criteria, and for whom a decision independent of organ donation was made to discontinue life support, is taken to the operating room. The patient is removed from life support and doctors wait for the patient’s heart to stop. If the patient’s heart stops, doctors wait a brief period (typically two to five minutes) and then begin invasive surgery.

First, surgeons cut open the chest cavity to prepare to harvest the heart and lungs. Then surgeons occlude the arteries carrying blood to the patient’s brain, either by directly clamping the blood vessels or by inflating balloons within the vessel lumens, with the specific goal of preventing blood flow to the brain.

Circulation of warm, oxygenated blood throughout the body is then re-established either via cardiopulmonary bypass or Extracorporeal Membrane Oxygenation (ECMO) and a heartbeat is restored. This keeps the patient’s organs, including the heart itself, fresh and viable for transplantation.

I strongly encourage readers to watch this short video showing surgeons perform this procedure before continuing to read.

Currently NRP-cDCD is being utilized in many states, including Arizona, California, Nebraska, New York, and Tennessee. There is enthusiasm for this technique in the transplant community because of the quality of the organs obtained, and it seems likely that NRP-cDCD will become more broadly utilized in the absence of public opposition.

However, NRP-cDCD raises grave ethical concerns.

Recall that under the Uniform Determination of Death Act (UDDA), which serves as the legal basis for a declaration of death in the USA, death can be determined in two ways: “(1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem….” The UDDA works in complement with the dead donor rule (DDR), a widely accepted bioethical principle stating that donors must be dead before vital organs may be harvested.

In NRP-cDCD, the patient is initially declared dead based on the first arm of the UDDA, the irreversible cessation of circulatory function. But once circulation is re-established, doctors can no longer claim the patient is dead using circulatory criteria. The only way to “keep” the patient legally dead is to use the second arm of the UDDA and declare the patient “brain dead,” a state which the doctors have caused by occluding the arteries to the patient’s brain.

I and many others are convinced that “brain dead” patients are living, but wounded, human persons. If one accepts this, then patients undergoing NRP-cDCD are subjected to a severe brain insult, and then subsequently killed by the act of organ harvesting.

However, even if one were to unquestioningly accept that “brain dead” patients are dead, the ethical issue arises that “brain death” was intentionally caused in NRP-cDCD patients. Some proponents of NRP-cDCD claim that inducing “brain death” cannot kill the patient because death has already been established using circulatory criteria – the very same patient whose heart is now beating and in whom blood is circulating.

Other proponents of NRP-cDCD claim that occluding the arteries to the patient’s brain is analogous to withdrawal of life support, and therefore morally permissible. But we Catholics know there is a substantial difference between withdrawal of extraordinary care measures so as to allow a seriously ill patient to die naturally, and directly intervening to cause a patient’s death.

Moreover, while it is certain that blood flow to the brain ceases the moment doctors intentionally and effectively stop it, it is not known when all brain function will irreversibly cease. This does not occur instantaneously after the arteries to the brain are occluded, but some unknown number of minutes afterward, and it may not even have occurred before organ harvesting begins – in which case, the patient would still be alive according to both the circulatory and neurologic criteria of the UDDA.

Brain function has certainly not irreversibly ceased when the patient’s chest is cut open with a saw, as this occurs before doctors occlude the arteries to the patient’s brain. There is no standard anesthesia/sedation regimen for these patients – after all, they are supposedly dead when the sawing occurs. If inadequate anesthesia/sedation were provided (or none were provided), it is possible that the patient could have some level of awareness when the chest is cut open. An unresponsive patient is not necessarily unconscious, and there is no reliable way in medicine to determine whether an unresponsive patient is inwardly conscious or not.

At this point, readers can see that NRP-cDCD violates the DDR – doctors directly intervene to end the organ donor’s life. However, is this any different from what is already being done to obtain organs for transplantation using “brain death” and donation after circulatory death (DCD)? Have we, in fact, already abandoned the DDR? Dr. Robert Sade, Distinguished University Professor of Surgery and Director of the Institute of Human Values in Health Care at the Medical University of South Carolina, argues:

The facts that brain dead patients are not really dead before organs are recovered and that DCD donors are imminently dying but not yet dead means that current practices of organ donation from both brain dead and DCD donors are not consistent with the DDR, yet these practices are ethically and legally well-grounded. Once this is recognized and accepted, the DDR, being neither a statute nor a regulation, can be discarded and physicians need not feel as though they are ethically or legally at fault. (Emphasis added)

The claim that a patient is dead two to five minutes after the heart has stopped is unsupportable both medicolegally and from the viewpoint of Catholic moral theology. Legally, circulatory function must have irreversibly ceased for a patient to be declared dead – that is to say, it cannot be restarted. Clearly, this is false insofar as in NRP-cDCD circulation can and is restarted!

Moreover, Catholic moral theology manuals have taught for generations that the soul may remain united with the body for some time after clinical death, perhaps even as long as three hours (p 350). Death, defined as the moment when the soul leaves the body, has almost certainly not occurred minutes after the heart stops, particularly when circulation is shortly thereafter restarted.

In summary, NRP-cDCD violates Catholic moral principles, and brings to the forefront the pre-existing ethical concerns with DCD and “brain death” criteria. As Catholics, we oppose the utilitarian mindset that the end justifies the means. The desire to save human lives is laudable, but we cannot do so by deliberately ending the life of innocent human persons.

We Catholics must present a clear and unified voice to society upholding the sacredness of human life. Let us stand united in opposition to NRP-cDCD and closely scrutinize the morality of its constituent predecessors, DCD and “brain death.” Let us advocate for transparency in the process of organ donation by providing comprehensive information to persons at the Department of Motor Vehicles about the various ways they can be declared “dead” if they become organ donors, including NRP-cDCD.

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About Joseph M. Eble, MD 3 Articles
Joseph M. Eble, MD, is President of the Tulsa Guild of the Catholic Medical Association and Vice President of Fidelis Radiology. He is passionate about the subjects of end of life care, adoption, and building bridges between persons of different ethnicity. He has authored or co-authored articles in the National Catholic Register, Homiletic and Pastoral Review, Catholic World Report, and Crisis Magazine. He may be reached at


  1. “We Catholics must present a clear and unified voice to society upholding the sacredness of human life.”
    Pretty sure that ship sailed a l.o.n.g. time ago when the Church decided that using the HEK cell line (among others) was permissible because it happened so long ago and it is, at best, remote co-operation with abortion. A letter expressing outrage at taking various vaccines and/or medical treatments suffices to expunge whatever tiny speck of “guilt” one has for using said medical treaments, etc

  2. Thank you for this information. It is imperative that people understand the process of organ donation in their state and when it is ethically and morally permissible.

  3. More or less modest enhancers, like more modest genetic therapists and technologies, eschew grandiose goals, pursuing not some faraway positive good, but the positive elimination of evils: diseases, pain, suffering, the likelihood of death. But let us not be deceived. Hidden in all this avoidance of evil is nothing less than the quasi-messianic goal of a painless, suffering-free and, finally, immortal existence. Only the presence of such a goal (the Philip Rieff’s therapeutic society) justifies the sweeping-aside of any opposition to the relentless march of medical science. Only such a goal gives trumping moral power to the principle “cure disease, relieve suffering.” “Deliberately ending the life of innocent human persons is unethical and dehumanizing, you say? Never mind: it will help us provide perfect materials for organ replacement.” I forbear mentioning what is rapidly becoming another trumping argument: increasing the profits of biotech company and its shareholders, an argument often presented in more public-spirited dress: if we don’t do it, other countries will, and we will lose our competitive edge in biotech issues.
    The same argument will also justify creating and growing human embryos for experimentation, revising the definition of death to increase the supply of organs for transplantation, growing human body parts in the peritoneal cavities of animals, perfusing newly dead bodies as factories for useful biological substances, or reprogramming the human body and mind with genetic or neurobiological engineering. Who can sustain an objection if these practices will help us live longer and with less overt suffering?
    Even the more modest biogenetic engineer, whether he knows it or not, is in the immortality business, proceeding on the basis of a quasi-religious faith that all innovations are by definition progress, no matter what is sacrificed to attain it.
    As L.R. Kass made clear,What the enthusiasts do not see is that their utopian project will not eliminate suffering but merely shift it around. Forgetting that contentment requires that our desires so not outpace our powers, they have not noticed that the enormous medical progress of the last half century has not left the present generation satisfied. Indeed, we are already witnessing a certain measure of public discontent as a paradoxical result of rising expectations in the health-care field: although their actual health has improved substantially in recent decades, people’s satisfaction with their current health status has remained the same or declined. But that is hardly the highest cost of success in the medical/humanitarian project. Aldous Huxley observed in his prophetic Brave New World (Without God, I’d add), the road chosen and driven by compassionate humaneness paved by tech, if traveled to the end, leads not to human fulfillment but to human debasement.

    • I am a retired, practising Catholic, transplant surgeon. I began my career at the very origins of transplant surgery, operating on dogs in the experimental laboratories where only 2 of 140 dogs survived with a functioning transplant! My superior said when the second dog survived, ‘Right! Now we are ready to do it in people!” At the time there was no established civil or, indeed, formal moral law applicable to organ transplantation and in particular to organ harvesting. In my uncertainty, I refused to be part of a transplantation service in human beings and was threatened with dismissal from the university. I sought the advice of a Jesuit priest/philosopher, the rector of the university college I attended as a medical student. His advice was indeed very lucid. “If there is one human life that you are absolutely certain cannot be saved, I would have thought that our God would not object to saving one little part of that life, for example a kidney, in order to save the life of another suffering human being”. I became a transplant surgeon.
      At the International Transplantation Society meeting held in Rome in 2000, Pope John II in an address to the meeting defined death as “the loss of the integrated whole that is the personal self”. Life correspondingly was “the continued possession of that integrated whole that is the personal self”. This definition defined the concept of brain death, a situation wherein the patient has no responses to the surrounding world, and where he requires artificial means of maintaining a beating heart and adequate nutrition, a situation which the Catholic doctor has never been morally obliged to maintain. The heart is not the centre of life. Rather it is the brain that keeps the body systems working and the only body system that enables God’s creation to “know, love and serve the Creator”, the very reason why that person was created in Catholic teaching. When the brain is dead, the patient is dead regardless of a beating heart. The heart will continue beating when removed from the body provided it is provided with sufficient nutrient, oxygen and an environment similar in water content and various other chemicals to the interior milieu of the living body. Ethical and Catholic moral practice allows organ removal in the brain dead dependent on artificial scientific means of maintaining function of body organs, including the heart.

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