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ss nucleus - winter 1994,  Transplantation - What Does the Bible Have to Say?

Transplantation - What Does the Bible Have to Say?

In the last issue of Nucleus, eminent surgeons from Oxbridge discussed transplantation. With their article as a background, this article discusses some biblical principles concerning the subject. It seems that there has been very little written from a strictly Christian viewpoint on this subject and so this article aims to stimulate further debate.

The body of Christ and transplantation

The vocabulary and to some extent the very concept of transplantation finds its origin in horticulture. It is very interesting to note the way in which the Bible uses metaphors from this area. Romans 11 is an important piece of Paul's discussion of the Church in relation to Jews and Gentiles. In it he describes Gentiles as being grafted into a tree which represents Israel. Here the emphasis is not on the transplant saving the life of the recipient, but the recipient providing the life for the transplant which would otherwise die.

Jesus talks of himself as the vine and Christians as branches, but mentions the necessity of us producing fruit.[1] Paul also talks of Christ as the head of the body, enabling each part to do its work.[2] If one part of the body is diseased the whole suffers.[3]

As Christ's body is formed by spiritual transplantation, is it not possible that we can view physical transplantation in the light of this? As biblical writers can conceive of Christ giving life to us as we are transplanted into his body, can we not also see that physical transplants can legitimately grant life to their hosts. That is not to say that this argument is sufficient to justify transplantation, but there are similarities.

While we are on this track it is interesting to note that in Christ's body there is the perfect antidote to rejection, each transplant must first receive the nature of its host![4]

Jesus gave his life for us. The Communion we share is described as being the blood and body of Christ[5]. Because of Jesus' death God spiritually transplants our hearts.[6] Some might say since only Jesus' death can give life it is wrong for us to say that the pointless death of a young person can be given meaning by providing life for another. Jesus' death is the only thing that can give spiritual life, and transplantation in no way lessens the importance of that. Paul considered that there was good obtained for the Church through suffering. The complete, permanent good was achieved through the Lord Jesus' death. Surely we can in a small way imitate Christ's actions by allowing the use of a relative's organs to prolong another's life.

The concept of unity and transplantation

The concept of unity is vital to the body of Christ. This is no doubt why the Bible uses the picture of transplantation as a picture of the church. The joining together of previously separate people is described as happening at marriage[7] and also at sexual intercourse.[8] Joining with someone of a different nature (ie a non-Christian) is considered wrong.[9] It might be possible to base an argument against transplantation as a whole because it produces 'one flesh' from two unmarried people. Surely however it is somewhat untenable to use these arguments as reasons for transplantation being immoral. It is not merely the bodies which are seen to be merged in sexual relations; indeed they are clearly not physically and permanently merged. To join one part of someone else's body to another is not the same as having sex.

A similar argument could be more specifically used in opposition to transplantation from animal donors. Genes for certain human cell surface proteins would be injected into the nuclei of a pig embryo. All cells in the pig would then, almost as if they were infected by a virus, produce human markers. This would,it is hoped, prevent rejection of any organs transplanted into a human being. To use a pun on biblical language they would be hidden and covered by the protein from the wrath of the white cells. Is this violating a moral principle?

The cross-breeding of different species is condemned in the law.[10] God created animals after their kinds.[11] The creation of a whole new species by crossing two unrelated species would violate God's creation. Interestingly cross species generally tend to be infertile, but the case in point is not the crossing of two species, it is the insertion of a tiny fraction of DNA. The pig remains a pig, and there is no new species created when the pig's heart is transplanted into the human either.

It is difficult to be conclusive about this point, it can certainly be argued either way. If one regards this process as immoral, should we also condemn the alteration of bacteria to produce human insulin for example. Can we make a distinction between a fertilised pig ovum and a bacterium which although one cell is the complete organism?

It remains that the idea of harvesting organs from pigs appears unnatural to many. Is it so merely because it is new? Is there a difference between whole organ transplantation and the use of catgut stitching or pig valve prostheses? The issue needs further discussion. Artificial organs may be a way forward, there have been recent advances with left ventricular assisting devices. Artifical organs still seem a long way off in most fields, however. God's creation of organs in the human body takes a lot to match let alone beat.

The principle of unity can be used positively in the discussion of the morality of transplantation. In the Bible we are actively encouraged to do good to one another as the result of our unity in Christ. People who see someone in need and know they can help but don't are strongly reprimanded.[12] Can it be right therefore to refuse to offer transplantation if we have the resources necessary to do so?

Financial issues

There are difficult issues relating to the finances involved. The parable of the Good Samaritan[13] shows the necessity incumbent on a Christian show mercy to all. The Samaritan was willing to expend himself on behalf of the injured man. If when he came back he had not got the money necessary to pay for the care, it is unlikely that the innkeeper would have taken another patient from that particular Samaritan! The state does have limited resources and it is not unchristian to consider money, far from it.

There is a worrying climate regarding health expenditure in the world today. The application of strictly Utilitarian morality to the issue of transplantation (the greatest good for the greatest number) would probably eliminate transplantation altogether. It would also eliminate all treatment for elderly, and terminally ill patients. One perfectly logical outcome, although it is hoped as yet still unthinkable would be the involuntary euthanasia of all over 65s since about half of health service expenditure is spent on then with little supposed benefit by the modern health economist.

Health care should surely be apportioned on the basis of need. In fact as has been pointed out in the previous article much modern thought on the subject of finances is exceedingly shortsighted. The opportunity cost of not doing a transplantation in terms of both necessary care and indeed the lost taxes from the individual who dies never seem to be considered. Just what is the value of a life, anyway? By most accounts expenditure on health is low in this country compared to other developed countries, and it seems we could afford to spend more.

The issue of high-tech health care in the light of global problems is a difficult one. The Samaritan in the story was helping someone of another race. When we consider the world scene with babies dying for want of a salt and glucose solution for rehydration after diarrhoea a whole different factor comes into our equation. Who deserves our help more; many babies in Africa, one young adult in need of a heart-lung transplant, or several old people disabled because of the need of a hip replacement? The gift of life is very precious. It is surely wrong to deny the needs of patients needing transplants but equally wrong not to weigh them against the needs of others. We have to face the fact that there will always be people who might benefit from a transplant who will have to be turned away.

Indeed, even if limitless money was made available to transplantation services, there is still a great shortage of potential donors whether living or dead. Those with two cloaks are encouraged to share with those who have none.[14] Would it be possible to extend this to 'let he who has two kidneys share with him who has none'? If there is only little risk to the live donor, then perhaps a willing unpressurised donor should be praised for his putting the needs of others before himself.[15]

The act of self-sacrifice must be a voluntary one. As we have seen in recent years there is much scope for exploitation of live donors. The strain that is placed on relatives of a recently killed son or daughter by the idea of transplantation should not be forgotten. Our compassion for them must be a high consideration. The situation needs to be handled with great sensitivity.

The body after death

As Christians we believe in the physical resurrection of the body. A question that might be raised is how could God raise a body from death which had been cut up and scattered? This is a real concern to some but let us first consider what else is at stake here. If we hold this view, cremation is of course unallowable, as is dissection by medical students and indeed the gathering of specimens for pathology museums and postmortems. This problem also would apply to people who have amputations or who die in particularly gruesome ways.

Firstly, God is powerful and able to gather the scattered pieces if that were necessary.[16] Secondly, much of our bodies decompose anyway. Thirdly it is surely irrelevant to God's act of recreation whether the actual atoms remain together. Even in life it is the structure of our bodies which is important, individual atoms are being replaced continually as we live.

The view also reveals a somewhat simplistic understanding of the resurrection. The Apostle Paul describes the body we will receive as being a heavenly body born from the seed of our present bodies. We surely do not need to worry about our resurrection bodies. If our present body is destroyed, we have a heavenly body already prepared by God.[17] Our earthly body is discarded at death and we will have no further use for it with all its failings.

The fact is that the Bible isn't especially concerned with the body as such. It is the actions we carry out with our bodies that are important. Our Lord Jesus Christ advocated amputation of parts of the body which cause sin.[18] If this was applied literally most of us would end up with little of our bodies left. It seems likely that Jesus is using a deliberate overstatement as a figure of speech to make the point of the very real seriousness of sin. That he could say such a thing surely says something in itself. Eternity is more important than our physical bodies, and the prospect of either before or after death losing part of our body to do good to someone else is surely not immoral.

There are those who would argue that transplantation is unnatural, and interfering with God's plans. The same could be said of any medicine. Once we accept that medicine is in fact part of the general grace of God with the skills of doctors and surgeons being his gift, it is surely legitimate to extend this to cover transplantation.

It is important also to keep a check on transplantation. The use of foetal tissue, except perhaps in the case of a spontaneous abortion is surely wrong. The act of abortion is the wilful termination of an innocent human life and allowing the use of foetal tissue could lead to the barbaric practice of farming human beings for the use of others. The life of a human being should under no circumstance be deliberately taken to extend that of another, any analogy here with a sacrificial laying down of life is incorrect because the foetus has no choice in the matter.

Tranplantation of organs mentioned in the Bible

With the background of all these arguments, perhaps the most conclusive text in favour of transplantation is found in the mention of transplantation in Galatians 4. Paul is reminding the Galatians of the zeal and love they once had for the message of the Gospel and him as God's messenger. He reminds them of his illness which brought him there, thought by many to be a painful and repulsing condition of the eyes, and their response 'if possible you would have plucked out your own eyes and given them to me'.[19] Not even the keenest advocate of transplantation would advocate the donation of eyes by a living donor. It is indeed unlikely that Paul would have accepted their offer if it had been possible. He does, however, actively commend them for this attitude and uses the memory of it as a spur to them not to be won over by a different gospel.

The transplantation of eyes is not as yet possible; the transplantation of corneas and other organs is. Should we not encourage transplantation within proper limits and see transplant surgeons like other medics as agents of healing, which is God's work. In the coming Kingdom of God all believers will have bodies which will never get sick or become worn out and our profession will no longer be necessary.

References
  1. Jn 15
  2. Eph 4:16
  3. 1 Cor 12
  4. Jn 1:12-13, Jn 3:3, 1 Cor 6:17
  5. Jn 6:54-6
  6. Ezk 36:26
  7. Gn 2:24
  8. 1 Cor 6:15-16
  9. 2 Cor 6:14
  10. Lv 19:19
  11. Gn 1:25
  12. Jas 2:14-16
  13. Lk 10:25-37
  14. Lk 3:11
  15. Phil 2:3-4
  16. Ezk 37
  17. Gal 4:15 (NKJ)
  18. Mt 5:29-30
  19. Gal 4:15
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