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Vol. 3 No. 1 - Pascha 2008

A Search for Wholeness:
An Orthodox Response to Organ Donation and Retrieval


Holy Tradition reminds us again and again that redemption was God's plan from the beginning. The Scriptures tell us, "God created man for incorruption and made him to be an image of His own eternity." (Wisdom 2:24). Through the holy relics of the saints, the world is given dramatic illustrations of this original state. In the Old Testament it is written: "As they came to pass, as they were burying a man, that, behold, they spied a band of men, and they cast the man into the sepulcher of Elisha, and when the man let down, and touched the bones of Elisha, he revived, and stood up on his feet."(4 Kings 13:21) In the ancient west, the relics of saints like Edward the Martyr (reposed 979), remained incorrupt from decomposition for centuries, even though they were unembalmed in keeping with the standard Christian practice in most times and places up to the last century, and manifested miraculous examples of God's grace. The body of this Holy King of England, from the beginning of his untimely and treacherous death, was known to give sight to the blind, and heal the lame.[5]

Modern examples of the sanctified bodies of incorrupt saints are numerous. Saint Alexander of Svir (reposed 1533), whose relics survived the Soviet era, can still be venerated, incorrupt, at the monastery of Svir in the Transfiguration church in Russia [6]. The incorrupt relics of Saint John Maximovich of San Francisco (1966) can still be visited in the local cathedral in that city. Pilgrims flock to the relics of the Serbian Saint Basil (reposed 1631) in the monastery at Ostrog, and are witnesses to similar outpourings of grace. Numerous other examples could be given. (It is important to point out that for Orthodox Christians, mere incorruption of the bodily remains of an individual may be accepted as a Divine sign, but does not vouchsafe the sanctity of the person; nor implies that all Saints must be incorrupt.)[7] It is the ongoing revelation from the Holy Spirit of miraculous signs such as myrrh streaming from bones and other remains, and healings, attributed to the intercessory prayers of the saint that indicate favour in the sight of God. In the case of all the aforementioned saints, healing and other miracles have occurred and continue to occur.

What does this mean, as far as the sanctity of the body is concerned? In The Soul After Death by Father Seraphim Rose, Saint John of Damascus speaks about the connection between the holiness of the soul and the sanctity of the body:

"Now, if the soul had engaged alone in the contest for virtue, then it would also be crowned alone; and if it alone had indulged in pleasures, then it alone could be justly punished. However, since the soul followed neither virtue nor vice without the body, it will be just for them to receive their recompense together."[8]


The Church Fathers see every person as a creature of God, with a unique and eternal nature of soul, with value as an eternal human being not a human doing - a mere collection of actions and experiences, like some atheistic philosophers suggest (For a discussion of this, see also Letter for Sanctity of Life Sunday, Metropolitan Herman, Orthodox Church in America, January 2007,www.oca.org). Christ chastised the Sadducees, reminding them that the soul continues to live after death: "You are mistaken, not knowing Scriptures nor the power of God... God is not the God of the dead but of the living." (Matthew 22:29-32) After the personal judgment, each soul awaits in Hades or Paradise the Final Judgment at the end of time. The Orthodox Church offers their remembrance in tangible ways such as prayer for the dead individual, particularly in the Memorial Prayer, the observance of Thomas Sunday (the first Sunday after the feast of the Lord's Resurrection), and the observance of Soul Saturdays, dedicated to prayers for the dead.

These are not idle activities to comfort the bereaved: like the Orthodox funeral service, their entire focus is on the preparation of the soul for the day it is reunited with the body, and stands before the judgment of God. The traditional colour for the Orthodox funeral is bright (white), not dark (black), as it is in contemporary non-Orthodox funerals. The colour marks the proclamation of our hope in the resurrection of the body, just as we accept the bodily resurrection of Christ. Anything else would simply not be Christian. The main purpose of the Orthodox funeral is for the welfare of the soul of the dead person, not to address the sentiments of the family. (For example, there is traditionally no eulogy, and the priest faces the open casket bearing the body of the deceased loved one.) Family and friends pay their respects to the departed person by offering a touch or - more traditionally - a last kiss, affirming by this act that the body is forever the person they loved. The effects of non-Orthodox views have permeated so deeply, even among Orthodox, that at many funerals, even Orthodox Christians hesitate to kiss or touch the body of the person they loved, somehow ceasing to believe in the integrity of the whole person.

The comfort of the family comes from their participation and prayerful work on behalf of the soul of their loved one - a sharp contrast to the saccharine sense of paralysis that often afflicts the sterilized modern funeral. As stated by Father Seraphim Rose, "every one of us who desires to manifest his love for the dead and give them real help, can do this best of all through prayer for them, and in particular by commemorating them at the Liturgy....The funeral need not be performed elaborately, but most definitely it should be complete, without abbreviations; think at this time not of yourself and your convenience but of the deceased, with whom you are parting forever."[8]


Some will argue that the greatest gift one can offer is to give ones life for another. Surely the Church teaches that, doesn't it? The Lord Himself tells us, "Greater love has no man than this, that a man lay down his life for his friends."(John 15:13) But does this apply to the state of organ retrieval at the present time? Does the harvesting of organs from one individual at the point of death as it currently occurs in North American hospitals, constitute a sacrifice to save life, or a sin that takes a life?

Currently, in Canada and the United States of America there are two legal definitions of death: the traditional definition of death, irreversible cessation of circulatory and respiratory functions (cardiac death) or cessation of the brain whether as a whole or in part (neurological determination of death, NDD or brain death).[9] In 1971, the historic ad hoc committee of the Harvard Medical School presented its report on the definition of Brain Death and described scientific and medical criteria on which to base the diagnosis. This landmark paper opened the door for legislation to sanction the removal and use of organs for transplantation from patients who did not fit the medical criteria for cardiac death, but were found to have severe irreversible brain injuries leading to a state of prolonged coma. These patients were successfully resuscitated and kept alive by advances in circulatory medicine and mechanical ventilation.

It was expedient that a more liberal and utilitarian definition of death be ethically, morally, and, more importantly legally, accepted. "Brain death has proved to be a most important concept for the progress of organ transplantation.... In parts of the world where brain death was given legal standing and became standard practice, vital organ transplantation increased rapidly."[2] During the process of brain death donations, the duration of oxygen deprivation (known in medical literature as warm ischemic time) and the extent of loss of viable cells in the body are minimized since the heart continues to perfuse and nourish the tissues while mechanical ventilation sustains breathing (recently, the more descriptive term of heart-beating donation is preferred). In North America and most parts of Europe, organ retrieval from NDD individuals is by far the leading source of all organs for transplantation.[18]

Over three decades later, there is still disagreement worldwide regarding the definition of brain death and, unsurprisingly, how to diagnosis it. Henry Beecher, chairman of the historic ad hoc committee of the Harvard Medical School to examine the definition of Brain Death stated:

"At whatever level we choose to call death, it is an arbitrary decision. Death of the heart? The hair still grows. Death of the brain? The heart may still beat. The need is to choose an irreversible state where the brain no longer functions. It is best to choose a level where, although the brain is dead, usefulness of other organs is still present. This, we have tried to make clear in what we have called the new definition of death(...). Here we arbitrarily accept as death, the destruction of one part of the body; but it is the supreme part, the brain..."[9]

How much of the brain? Current tests only look at selective parts of the brain, whether it be brain stem or higher cognitive function, and thus, by definition, these tests can not confirm the death of the whole brain.

In a recent issue of a leading Canadian medical journal the authors concluded: "the current evidence base for existing NDD (neurologic determination of death) guidelines is inadequate ... . We recommend that after NDD, the patient be declared dead."[11] Father John Breck, an Orthodox author on bioethics, clearly outlines the problem in regard to the state of organ donation throughout the world today:

"Using brain-stem criteria to determine death, we are left with the gruesome fact that vital organs can only be harvested from patients who are technically still alive... Human personhood is determined not by medical diagnosis but by divine Providence."[12]

The acceptance of brain death whether legally or morally is not equal or universal among countries. In India, organ transplants are largely limited to live or cadaveric donations due to religious and cultural rejection of NDD. In Japan, heart transplants were not done until 1997 when government legislation finally permit organ donation after neurologic or brain death. Despite these realities, and despite the growing challenge within the scientific community to acknowledge that biological death cannot be proven with certainty in brain death, information given to families and patients about organ procurement continues to falsely represent brain death as physical death. Furthermore, in some cases, religious and cultural consent to organ retrieval after neurologic death is misrepresented and misleading. John Gillman, pastor and ethicist in California, in his article titled Religious Prospectives on Organ Donation[10] attempts to outline the Christian prospective. The statement that the Greek Orthodox do not oppose organ donation was subsequently reinterpreted by the Trillium Gift of Life Network (an agency created in 2000 by the Government of Ontario, Canada) as the Greek Orthodox Churchs support organ donation. (see www.Giftoflife.on.ca)

For Orthodox Christians, the supreme part of the body is not the brain (which is an Aristotelian notion; c.f. De Anima) but the heart. "The heart is not just a physical organ or centre of his psychic life but something indefinable yet capable of being in contact with God, the Source of all being."[13] In the Book of the prophet Isaiah, we read, "make the heart of this people fat. Make their ears heavy, and shut their eyes; lest they see with their eyes, and hear with their ears, and understand with their heart, and turn again, and be healed."(Isaiah 6:10) Later, in another passage, "these people draw near to Me with their mouth, And honour Me with their lips, But their heart is far from Me. And in vain they worship Me, Teaching as doctrines the commandments of men." (Isaiah 29:13) Christ tells us, "Where your treasure is, there will your heart be also." (Matthew 6:21).

The reality that the noetic heart is located within the physical heart has always been the teaching of the Orthodox Church. St. Gregory Palamas (1296-1359), a champion of the Orthodox understanding of the knowledge of God, writes:

"Since our soul is a single entity possessing many powers, it utilizes as an organ the body that nature lives in conjunction with it. What organs, then, does the power of the soul that we call 'intellect' make use of when it is active?... For some locate it in the head, as though in a sort of acropolis; others consider that its vehicle is the centremost part of the heart, that aspect of the heart that intelligence is neither within us as in a container - for it is incorporeal - nor yet outside us, for it is united to us; but it is located in the heart as in its own organ."[1]

St. Nicodemos the Hagiorite (1749-1808) on instruction for stillness in prayer writes:

"You must free the energy (energeia) of your mind, whose organ is the brain, form all the external things of the world, through the guarding of the senses and of the imagination. Then you must bring the energy into the heart, which is the organ of the essence (ousia) of the mind. This return is customarily brought about in the case of beginners - as the Divine Wakeful Fathers teach - by turning the head down and resting the chin on the chest."[20]

Secular man, having lost the quietness and gentleness of heart, can not know God. "Blessed are the pure in heart, For they shall see God."(Matthew 5:8) As a consequence, he finds incredulous the Truth of self knowledge, the essence of the soul is located within the physical heart. Thus, ignorant of the mystery of life, how can he define the mystery of death and more specifically, how can the definition of death be measured by some grotesque notion of cessation of some part of the brain?

It is sad but not surprising that, for the most part, the medical community does not truly understand the nature of death. Acknowledging this limitation, Zameretti et al. advocate the substitution of the word (and thus concept of) death with the term irreversible coma or more precisely, irreversible apnoeic coma, understood not as equivalent to death, but as describing a particular condition in which life support should be legitimately forgone and organs can be retrieved from consenting patients.[9] Even more pathetic is the disregard, at best, and denial at worst that the human person is a creation of body and soul. So long as the medical community is ignorant of the soul of an individual, the medical definition of death will never be complete. Organ retrieval will remain an act of taking life, since it concentrates only on questions of physiology, ignoring the relationship between the soul and the body. Saint Paul cautions, that "those who live according to the flesh set their minds on the things of the flesh." (Romans 8:5) For Orthodox Christians, death is simply an impermanent separation of body and soul which afflicts mankind until the final judgement.[14] Saint John of Damascus reminds us, that "truly most terrible is the mystery of death, how the soul is violently parted from the body, from the harmony, and most natural bond of kinship is cut off by the divine will."[8]

[5] Vladimir Moss, The Saints of Anglo-Saxon England (9th and 10th Centuries) Volume II. St. Nectarios Press, Washington, 1993.

[6] St. Herman of Alaska Brotherhood, ed. St. Alexander of Svir and his Holy Relics. The Orthodox Word 2004; 40 (3-4) 119-145.

[7] Protopresbyter Michael Pomazansky. Orthodox Dogmatic Theology. Translated by Father Seraphim Rose, Third Edition. St. Herman of Alaska Brotherhood, California, 2005.

[8] Fr. Seraphim Rose, The Soul After Death, Forth Edition. St. Herman of Alaska Brotherhood, Alaska, 2004.

[9] Nereo Zamperetti et. al. Irreversible apnoeic coma 35 years later: Towards a more rigorous definition of brain death? Intensive Care Med 2004; 30(9):1715-22.

[10] John Gillman. Death and organ procurement: public beliefs and attitudes. Kennedy Institute Ethics J 2004; 14(3):217-34.

[11] Brain arrest: the neurological determination of death and organ donor management in Canada. CMAJ 2006; 174(6): Supplemental S1-30.


Linda Korz is an M.D., specializing in anaesthesiology.
(Pascha, 2008)

© All Saints of North America Orthodox Church
Orthodox Church in America, 2008.