Organ Transplants & Catholic Teaching
Fr. Giuseppe Rottoli
In Rome, on August 29, 2000, John Paul II participated in the International Congress on Transplants, and delivered an address for the occasion. The press and mass media took the occasion to laud the speech as favorable to transplantation "science."
But is this really the case? The truth is that the text of the Pope's speech contained contradictory material that on the one hand boded well for advocates of transplantation, and on the other hand gave quarter to those opposed to it. In fact, the Pope affirmed that:
[V]ital organs which occur singly in the body can be removed only after death, that is from the body of someone who is certainly dead. This requirement is self-evident, since to act otherwise would mean intentionally to cause the death of the donor in disposing of his organs.
He also noted that death is the separation of the soul from the body and that:
This gives rise to one of the most debated issues in contemporary bioethics, as well as to serious concerns in the minds of ordinary people. I refer to the problem of ascer­taining the fact of death. When can a person be considered dead with complete certainty?
In this regard, it is helpful to recall that the death of the person is a single event, consisting in the total disintegration of that unitary and integrated whole that is the personal self. It results from the separation of the life-principle (or soul) from the corporal reality of the person. The death of the person, understood in this primary sense, is an event which no scientific technique or empirical method can identify directly.
Yet human experience shows that once death occurs certain biological signs inevitably follow, which medicine has learned to recognize with increasing precision. In this sense, the "criteria" for ascertaining death used by medicine today should not be understood as the technical-scientific determination of the exact moment of a person's death, but as a scientifically secure means of identifying the biological signs that a person has indeed died.
Up to this point in the address, we have no objection, but if we read further, we find some contradictions and imprecisions in the scientific data to the extent that it seems that the Pope has put too much faith in some contemporary scientists:
It is a well-known fact that for some time certain scientif­ic approaches to ascertaining death have shifted the emphasis from the traditional cardio-respiratory signs to the so-called "neurological" criterion. Specifically, this consists in establishing, according to clearly determined parameters com­monly held by the international scientific community, the complete and irreversible cessation of all brain activity (in the cerebrum, cerebellum and brain stem). This is then considered the sign that the individual organism has lost its integrative capacity.
With regard to the parameters used today for ascertaining death-whether the "encephalic" signs or the more tradition­al cardio-respiratory signs-the Church does not make technical decisions. She limits herself to the Gospel duty of comparing the data offered by medical science with the Christian understanding of the unity of the person, bringing out the similarities and the possible conflicts capable of endangering respect for human dignity.
Here it can be said that the criterion adopted in more recent times for ascertaining the fact of death, namely the complete and irreversible cessation of all brain activity, if rigorously applied, does not seem to conflict with the essential elements of a sound anthropology.
Therefore a health worker professionally responsible for ascertaining death can use these criteria in each individual case as the basis for arriving at that degree of assurance in ethical judgment which moral teaching describes as "moral certainty." This moral certainty is considered the necessary and sufficient basis for an ethically correct course of action. Only where such certainty exists, and where informed consent has already been given by the donor or the donor's legitimate representatives, is it morally right to initiate the tech­nical procedures required for the removal of organs for transplant.1
It is not true that the international scientific community is unanimously favorable to the current "neurological" criteria which results in a conclusion of "brain death." In fact, this recent concept was introduced to make possible the removal of organs from those finding themselves in a cerebral coma. But, as we shall cite, many scientists and professors have published their research and reported their results in authoritative scientific and medical journals. In these reports, they have stated their disapproval of the "brain death" concept because it does not coincide with total and irreversible cessation of brain activity; for these workers, it is not scientific and is not verifiable as true death. [See "'Brain Death' Is False," TheAngelus, March, 2000, pp.38-40-.Ed.]
Moreover, the Pope said that organ removal ought to be carried out on cadavers, and that only some tissues can be harvested from the truly dead, such as corneas, while living organs such as the heart, lungs, liver, kidneys, etc., in order to be transplantable must be taken from persons proclaimed "brain dead," who still breathe (and who also can be proclaimed "brain dead" while on artificial respiration), who have beating hearts, blood circulation, who are warm and have color, who when stimulated move (called "the Lazarus sign"), and, if female, can be lead through a pregnancy to give birth to a healthy child, etc. (It is quite anomalous to consider these persons dead, when no one would have the courage to put someone who is breathing into a coffin, and who has a beating heart and a pulse!)
It is evident that such persons are not cadavers, and that it is possible to remove organs only from real corpses who are already in a state of decomposition, and that such corpses are unable to be used for organ harvesting for transplant.
The History of the New Terminology
As quoted in the Pope's speech, there has been a shift from the traditional definition of death as the cessation of circulatory and respiratory function to that of "brain death," defined as the cessation of the functioning of the entire brain, including the brain stem. This neurological criteria of brain death was introduced following the first official heart transplant in 1967 by Dr. Christian Barnard in Cape Town, South Africa. Various professors and scientists opposed this new technology because of the fact that the persons whose organs were harvested were certainly not dead. In Italy, Professor Stefanini attacked Barnard on television, asserting that if the person is not dead, the transplant can't be performed, and if the person is not a corpse, it is homicide. Among others Italian professors who were opposed to these transplants were Professor Dieguardi of Milan, and Professors Gasbarrini and Puddu of Bologna. A month after the Cape Town transplant, 200 medical investigators in the United States organized an ad hoc Commission at Harvard University in Boston, their task being to define death in the neurological sense so that transplantation teams could evade legal and moral charges.
The Harvard Commission published its report, titled, "A Definition of Irreversible Coma," in the August 4, 1968 issue of the Journal of the American Medical Association (JAMA). The Report did not explain if coma is the same as death, but rather only asserted:
Our primary purpose is to define irreversible coma as a new criterion for death. There are two reasons why there is a need for a definition: (1) Improvements in resuscitative and sup­portive measures have led to increased efforts to save those who are desperately injured. Sometimes these efforts have only partial success so that the result is an individual whose heart continues to beat but whose brain is irreversibly damaged. The burden is great on patients who suffer permanent loss of intel­lect, on their families, on the hospitals and on those in need of hospital beds already occupied by these comatose patients. (2) Obsolete criteria for the definition of death can lead to controversy in obtaining organs for transplantation.
In 1979, two "Catholic" philosophers from the pro-life movement, Grisez and Boyle, invented a new definition of brain death, introducing the concept of integrative functional unity, as if the brain constitutes the only organ responsible for functional integrative unity. Thus, they contributed to supplanting the ethic which says that life is sacred by introducing the ethic of the quality of life. In 1981, brain death became defined in medico-legal terms, and became accepted without opposition in nearly the entire industrialized world, except in Northern Europe and Japan.2
But in 1992, two American scientists, also from Harvard, Dr. Robert D. Truog and Dr. James Fackler, would publish another report significantly titled, "Rethinking Brain Death."3 It is more than significant from a medico-legal perspective, that, strangely, this report was never published in Italy, perhaps because its title, and 87 bibliographical references were inconvenient! Following, is an excerpt from the data and analysis of Truog's and Fackler's study:
We advance four arguments to support the view that patients who meet the current clinical criteria for brain death do not necessarily have the irreversible loss of all brain function. First, many clinically brain-dead patients maintain hypo-thalamic-endocrine function. Second, many maintain cerebral electrical activity. Third, some retain evidence of environ­mental responsiveness. Fourth, the brain is physiologically defined as the central nervous system, and many clinically brain dead patients retain central nervous system activity in the form of spinal reflexes. These factors are in stark contrast with the requirement of an irreversible cessation of all brain function.
This study's conclusion is that there is no halfway, middle course instrumentation able to demonstrate the irreversible cessation of all brain function, not even, therefore, electroencephalogram (EEG); nor are other tests able to assert the cessation of all brain activity as being irreversible. Also noteworthy is that at the worldwide level, there is no agreement on criteria among scientists and clinicians, or on the proofs offered for adopting a declaration of "brain death." For example, the EEG is not used in the United Kingdom.
In Italy, the August 5, 1993 law, which repeats the 1968 Harvard definition, states: "Death is identified with the irreversible cessation of all brain function." The law provides four categories which must be established with certainty for being able to proclaim a person as being brain dead. All of these must be simultaneously present, and are: 1) the absence of consciousness; 2) the absence of spontaneous respiration; 3) the absence of reflexes; and 4) the absence of electrical brain response.
To satisfy the last condition, an EEG is used. The EEG graphically traces electrical brain response at the superficial brain level; the results are obtained by an apparatus attached to electrodes placed on the scalp, with a pen recording the results on a paper roll. In sum, the Italian law states that electrical activity above 2 microvolts is life, while a lesser activity is death. This immediately brings to mind the point that two microvolts represents an arbitrary threshold and is only a turn away from saying that a person is dead.
Scientifically, it is not exact. In fact, already at that time, Professor Bergamini4 wrote:
An EEG tracing can be normal as well as flat, that is, show­ing no visible rhythm: for example, an anxious adult subject or a neonatal subject can have a flat tracing that is absolutely unable to be defined as pathological.
(In fact, science does not know why, in the latter case, the EEG is flat, but other signs would indicate a pathological state.)
Professor Bondi5 also wrote that the presence of especially dense inter-cranial hemorrhage (typical in traumas induced by accidents)...
...can eliminate the signal from the tracing apparatus; or greatly diminish the strength of the signal picked up by the machine operating with electrodes attached over the bone layer. Given that the paucity of the tracing is always prob­lematical and gross, the objective appraisal of this vital sign, whose importance is overriding, can subject a patient to a medico-legal death sentence and to the irreversible emptying of his body via the removal [of organs]; in this case, the electrode ought to be placed under the bone layer. Thus, the EEG does not completely demonstrate the presence of brain life, as does the verification of the presence or not of cerebral circulation, yet it is a fundamental test employed in order to declare an unfavorable prognosis. In fact, a person can be declared dead although residual intercranial function persists. The isolation of residual intercranial circulation can represent brain function and persistent life, and I ask myself, and I ask you: are such isolated signs conscientiously and scrupulously sought? The answer is no, because the tests such as angiography, PET, SPECT, ECOPLANAR, RMI are not required by law and therefore are not going to be conducted.
Also, on the question of whether the absence of blood delivery to the brain constitutes a more reliable index of cessation of all intercranial function with respect to electro-brain silence, the 1992 report, "Rethinking Brain Death," stated:
[Two other options for modification of either the operational criteria or the conceptual definition of brain death are] whether electrocerebral silence or the absence of cerebral blood flow are indicative of the irreversible cessation of all functions of the entire brain. Many clinically brain-dead patients retain EEG activity. If electro-cerebral silence were added to the operational criteria for brain death, would this approach guar­antee the permanent loss of all brain function? Unfortunately, the EEG only detects electrical activity arising from the surface of the brain.6
To put it briefly, persons who find themselves in such conditions as these are not dead. However, no valid criteria exist to establish that there is irreversible cessation of function in other important areas of the brain such as the cerebellum, basal ganglia and the thalamus.7
As we have already discussed, the British negate that there is any value in EEG, and are in favor of a concept of brain death based exclusively on the absence of reflex in the brain stem, without reverting to the brain test. On this point, the already quoted 1992 "Rethinking Brain Death" report stated:
However, we have demonstrated that other cerebral func­tions (for example, endocrine function and temperature control) can persist despite the absence of all of the brain stem reflexes used to diagnose brain death... .Brain-dead patients frequently maintain hypothalamic endocrine function....In one study, 23% of 31 brain dead adults did not have diabetes insipidus, implying the presence of hypothalamic function (with the secretion of anti-diuretic hormone)....[A] reading in this sense at least means that documenting the presence of diabetes insipidus should be a more fundamental feature of our brain death criteria than the presence of nonreactive pupils. The British reject any role for the EEG and advance a conception of brain death based entirely on the absence of brain stem functioning. In this view, there is no need to test for cortical function or consciousness, since death of the brainstem necessarily implies the death of the reticular activating system, a critical component of consciousness. This position assumes that function of the reticular activating system is lost in parallel with function of the lower brain stem reflexes. However, we showed that other brain functions (e.g., endocrine function and temperature control) can persist despite the absence of all of the brain stem reflexes used to diagnose brain death. For these (and other) reasons, the British viewpoint has been strongly criticized.8 In contrast, the American conception of brain death explicitly refuses to distinguish between different types of brain function, strict­ly demanding the absence of all brain function. EEG activity is inconsistent with this definition. In fact, even after having ascertained the absence of reflexes in the brain stem, cases of regained consciousness have been verified.9
As well, "Rethinking Brain Death" states:
Third, there is evidence of some environmental responsiveness in brain-dead patients. A review of the anesthetic records often brain-dead organ donors showed a clear hemodynamic response to surgical incision at the time of organ removal, with an average increase of 31 min. Hg in the patients' systolic blood pressure and an increased heart rate of 23 beats/min. These reactions are inconsistent with the cessation of all brain functions.
The British scientists Evans and Hill examined the clinical record of data published by Wetzel on recent "brain dead" organ donors. Following is what happened to a 33-year old donor. Before going into the operating room, the patient was not diagnosed with hypertension. Then in the operating room, he was "treated" because his body did not move or respond to the incision. Before the intervention, his heartbeat was 90/min., and his blood pressure was 90/50. After a few seconds, with the jugulo-pelvic incision, his heartbeat increased to 104/min., and his blood pressure went to 120/70 (if he had been a corpse, these values couldn't have increased). Three minutes from the procedure's start, the heartbeat was 118/min. and the pressure rose to 150/75. After 11 minutes, he underwent anesthesia and the pressure returned to and remained at the pre-operative measurement. All of these donors were paralyzed and ventilated only with oxygen and manifested similar dramatic increases in blood pressure and cardiac rhythm after the incision was made for the organ removal process. Such responses matching the norm, rather than are the exception, are identical to the indirect cardiovascular responses mediated by the brain stem as observed in normal patients undergoing therapeutic surgical intervention when the anesthesia is found to be too weak.10
If the brain stem were truly dead, there would have to be an absence not only of central respiratory response but also of the central nervous system.11 Such reactions are in contradiction to the cessation of all brain function.
The 1992 "Rethinking Brain Death" report states:
Fourth, from a physiologic point of view, the brain is defined as the central nervous system. Early brain-death for­mulations, such as the Harvard criteria, recognized this fact and defined brain death as the death of the entire nervous system, including the spinal cord. However, clinicians soon realized that many patients who were otherwise brain dead retained spinal cord function in the form of spinal reflexes. These reflexes occasionally resulted in dramatic and disturbing limb movements, which came to be known as the Lazarus sign.12
The invention and adoption of the brain death criteria is based on the presumption that the observation of a certain series of similar, clinical cases which historically all had similar outcomes guarantees that all subsequent similar cases will all have the same outcomes,13 whereas the reality demonstrates that if intensive care were continued, the person would have been able to survive.
Only an autopsy of the donor's brain would be able to ascertain, case by case, if the cerebral lesions were really of an irreversible nature. Don't forget that in the case of a possible human error involving the valuation and appraisal of the reading, the donor is irrevocably and legally condemned to death. More suspect is the fact that hospitals do not provide autopsy of the brain of persons whose organs are taken in order to verify if this organ [the brain] was really destroyed. In fact in actual deaths, as Professor Baldissera affirmed, there is the destruction of the hemispheres, the brain stem, and the cells.14 The 1992 "Rethinking Brain Death" report, states:
Can the operational criteria be modified so as to ensure the irreversible cessation of all functions of the entire brain? The most reliable standard for meeting this conceptual definition would be to insist on pathologic evidence of total brain destruction. This standard would indicate the permanent absence of all brain function, but it would be impossible from a practical point of view, since this condition can only be con­firmed at autopsy. Nevertheless, if a particular constellation of clinical signs could be identified dial invariably correlated with total brain destruction at autopsy, then this set of criteria could be used as reliable evidence of brain death. Unfortunately, in a study of 503 patients, Molinari15 found that "it was not possible to verify that a diagnosis made prior to cardiac arrest by any set or subset of criteria would invariably correlate with a diffusely destroyed brain."
Also, Professor Hill16 reported that autopsy observations revealed a discrete conservation of the cerebral cortex. This increasing body of proof continues to cast doubt on the certainty of diagnosis of death in the presence of a beating heart, and leaves open the question as to how long, after the cessation of circulation, all brain function ceases.
The Therapeutic Possibility
In fact, everything goes toward exploding the false dogma that patients in a state of "brain death" are always and absolutely incurable, and that they will all suffer imminent cardiac arrest.
In the international scientific community, a recent statistically based investigation was conducted by a prominent American scientist, Dr. Alan Shewmon.17 He analyzed a statistically significant number of patients diagnosed as brain dead. He collected cases of prolonged survival and estimated the factors in degrees of determining the ability to survive in subjects given up for dead. The capacity for survival was inversely proportional to age (the younger, the greater the possibility of survival). Hemodynamic instability tended to progressively resolve itself to the extent that some patients were removed from ventilators and were able to go home.
So, here then is another false lay dogma that asserts that a brain grown to maturity is absolutely unable to produce new neurons, with the consequence being that brain damage is said to be irreversible. Recent research in the neurological field has reached a consensus affirming that human beings have the capacity of generating brain neurons throughout their lives, old age included. This was demonstrated by P.S. Eriksson, who had previously discovered that in mammals, the hippocampus maintained intact its neurogenic activity.18
In January, 1999, C.B. Johansson and other researchers succeeded in going further in the animal field by demonstrating the existence of an actual process of response to degenerative lesions of the central nervous system. They stated that there is a burst of growth of migratory neural stem cells that act to participate in scarring and repair. According to the latest scientific results, if the prospective ability of the damaged human brain cannot always be that of spontaneously repairing itself, at least in some cases involving specific areas of the brain, this is the actual patrimony of the destroyed neural cells. And the strongest statements, such as those of the Italian centenarian, Bizzozzero, supported by a vast scientific literature, confirm that elemental perennial tissues removed from the mammalian brain in research studies in the last ten years, have led to discoveries concerning the neuroplasticity of adult mammals, and that these findings can be extrapolated to man. Thanks to these results, supported by burgeoning biotechnological advances aimed at repairing the central adult nervous system, it seems that the goal of controlled therapeutic stimulation of neuronal regeneration in a lesioned adult brain, especially in an area such as the hippocampus, with its most delicate and primary importance in cognitive processes and memory, cannot be far off.19
And read what is being said regarding current progress in advanced intensive care therapy in resuscitation centers: "According to recent data, with aggressive assistance for relatively long periods of time, some patients clinically in brain death can advance to somatic survival for relatively long periods-36 days20; 63 days21; 68 days22; 112 days23, 201 days."24 It is, then, fallacious reasoning to construe that all patients who satisfy current criteria for being brain dead would be considered brain dead because they invariably have a cardiac arrest and briefly expire, and who are considered brain dead for at least three reasons: a) confusing the prognosis of "dying" with a diagnosis of "dead"; b) The "certainty" of impending cardiac arrest is debatable, given the progress in intensive care therapy; c) This reasoning, emphasizing only prognosis, does not mean that something in the brain is essential to our understanding of death.25 According to established scientific data, the damaged human brain's patrimony of regenerating destroyed nervous system cells is ever more realistically indicated.26
Controlled Hypothermia Therapy
Optimum results have been obtained with controlled cerebral hypothermia, a method applied by a team of Japanese researchers led by N. Hayashi.27 (Japan, by the way, has always refused to uncritically accept the Western imposition of brain death in place of real death.) These researchers treated 20 cases of acute subdural hematoma associated with diffuse cerebral damage, and 12 cases of global cerebral ischema caused by cardiac arrest for a duration of 30 to 47 minutes with controlled cerebral hypothermia (this is maintained by an adequate intercranial pressure). All of the patients were in a state of coma valued between 3 and 4 degrees GCS, Glasgow Coma Scale (the value of 3 corresponds to the most critical situations, commensurate with the total absence of response to ocular, motor, and verbal stimuli. These patients declared to be brain dead were classified GCS 3). They presented with bilateral dilation of the pupils and loss of reflex to light. Nevertheless 14 of the 20 patients in the first group, and 6 of the 12 in the second group were able to return to a normal daily life, all but one having the possibility of regaining verbal communication.
Striking cases which have been reported in the newspapers demonstrate that many times those who are about to be harvested for organs, but weren't, have gone on to a normal life. Here we report only two such cases.
Martin Banach,28 a young 18-year-old German, in 1996, was on vacation in Italy on the Island of Flowers, in Ischia. After renting a motor bike, the next evening he was hit by a car, and passed out. He was taken to a hospital where he was judged to be an organ donor. They telephoned his father: "Hello. This is the Cardarelli Hospital in Naples....Does your son have an organ donor card?...Your son is gravely wounded...He is in a coma....We are sorry to say that there is nothing more to do." The boy's father said: "Leave him as he is! I am coming right away. Don't touch him!" The parents arrived by plane, but were not permitted to see their son. After struggling for three days, by luck, he was successful in flying in a determined young German doctor who argued for two hours with the hospital personnel. Finally, they opened the steel door, and there was their son, on only a ventilator. The German doctor ordered: "Talk to him!" The mother cradled her son's head, and his eyelids fluttered. The young German doctor said: "Let's get him out of here." The boy was taken to Germany, and already on the first day opened his eyes. Today, Martin has finished his studies and plays basketball, and has no permanent lesions.
"Carlino's Rest of the Story," on September 12, 1999, reported on a young girl, Luca Sarra, from Aquila, who came out of a coma after having been pronounced dead and who had been prepared as an organ donor. Just before they were about to harvest her, she asked for a cigarette...and the headline said: "They Said She Was Brain Dead!"
The Magisterium of the Church
Formerly, Pope John Paul II, on December 15, 1989,29was moved to renounce transplants because the moment of death is not certain. And Cardinal Ratzinger, when speaking to Extraordinary Consistory in 1991, asserted:
We are witnesses to a real war of the powerful against the weak, a war which intends to eliminate the handicapped, those who have annoying or bothersome damage, and even those who are poor and "useless." With the complicity of states, huge numbers of methods are employed against persons at the beginning of life, as well as when life becomes vulnerable due to sickness or an accident and when such persons are near death.... Those who through sickness or an accident fall into an irreversible coma are quickly put to death in order to respond to the need for transplantable organs, or they shall serve medical experimentation [i.e., "warm corpses"].
As we have already stated, the press profited from the Pope's August 29, 2000, speech, because it contained imprudent phrases and was not exactly scientific, causing him to say that he is in agreement with transplants. We note that in that speech, the Pope did not wish to invoke his infallibility. In any case, when concepts are not clear and are contradictory, we must refer to the Magisterium and to immutable Catholic principles. On this point, it is necessary to recall that Pius XII30 already treated the theme of organ transplantation. At that time, he proclaimed the necessity of the certainty of the donor's death. In fact, he wrote:
In case of insoluble doubt, one can resort to presumptions of law and of fact. In general, it will be necessary to presume that life remains, because here a fundamental right received from the Creator is involved, and it is necessary to prove with certainty that it has been lost....Considerations of a general nature allow us to believe that human life continues for as long as its vital functions—distinguished from the simple life of organs—spontaneously manifest themselves, even with the help of artificial processes.
A good number of cases meet the definition of "insoluble doubt," and these ought to be treated according to the quoted "presumptions of law and of fact."
The new definition of "brain death" introduces a way to evade the legal and moral consequences of the removal of vital organs from the dying before they are dead as based on the concept that there must be permanent loss of the capacity for consciousness and of spontaneous respiration and that the death of man coincides with the death of his brain. This recently imposed criteria, and the pretense of identifying death with one part of the body, as well-intentioned as it may be, with the death of the whole, are absolutely unable to be demonstrated, and are arbitrary, nor are they founded on any true scientific justification.
Now, at the end of this article, we wish to report that in the US an international initiative has been begun, promoted by the movement, CURE31 and titled, "International Declaration of Opposition to "Brain Death-Inimical to Life and to Truth-and of Opposition to Organ Harvesting/ Transplantation."
This document affirms that:
None of the changeable protocols for alleged "neurolgical criteria" used to determine death satisfy the conditions described by the Pope for a "rigorous application" of the cer­tainty of "complete and irreversible cessation of all functions of the brain." In sum, cerebral death is not death, and death should never be declared if the destruction of the entire brain is not present, and concomitantly, the destruction of the res­piratory and circulatory systems.... Vital organs used for trans­plantation must be living organs removed from living human beings. Otherwise, as emphasized above, persons condemned to death via a declaration of "brain death" are not "really dead" but, on the contrary, are certainly alive...and to har­vest them means to violate the Fifth Commandment of the Decalogue, "Thou shalt not kill" (Deut. 5:17).
This international declaration has already been undersigned by more than 120 people, and is supported in 19 nations. Among the signatories are Catholic bishops, religious, priests and other ecclesiastics, members of the Pontifical Academy of Life, among them its ex-Secretary; doctors, professors, judges, lawyers, other professionals and defenders of the rights of the disabled and of life. Among the signatories we see strong critics of "brain death" such as Dr. Paul Byrne, Dr. Cicero Coimbra (Brazil), Dr. David W. Evans (England), Professor Josef Seifert (Lichtenstein), Dr. Yoshio Wanatabe (japan), Professor Massimo Bondi, Dr. Giuseppe Bartolini, Dr. Maria Luisa Robbiati and others from Italy.
Translated for Angelus Press by Suzanne Rini from the Society's Italian District magazine, La Tradizione Cattolica, (Vol.12, No.l, 2001). The author, Fr. Giuseppe Rottoli, is a native Italian who was ordained in 1985 for the Society of Saint Pius X. He was first stationed as a prior in Nice, France, and has been since assigned to Italy.
1. L 'Osservatore Romano, 8/3/2000. [Translator's Note: The official English language text has been used here. Contextual quotations from the Pope's speech have been added to Fr. Rittoli's more limited quotations for the sake of clarity.]
2. Ugo Tozzini, Mors tua vita mea [Your life, My Death}, published by Grafite,p.l08.
3. Dr. Robert Truog and Dr. James Fackler, "Rethinking Brain Death," Critical Care Medicine, vol.20, no. 12 (1992). (Dr. Truog was at the time at the Department of Anesthesia, Children's Hospital, Harvard Medical School, Boston, MA.) [Translator's Note: The English language version has been quoted here throughout, with some words added to Fr. Rittoli's quotations for the sake of clarity.]
4. Mors tua, vita mea, op. cit., p. 16.
5. Dr. Massimo Bondi, Professor of Surgery and Professor of General Clinical Pathology-Surgeon M.D., Sydney. Testimony presented at a hearing of the Select Committee of the Commission on Social Affairs of the Italian Parliament.
6. Grigg, M.M., Kelly, M.A., Celesia, G.G., et al,"Electroencephalographic Activity after Brain Death," in Archives of Neurology, 1987, no. 44(9), pp.948-954.
7. Prof. M. Bondi, ibid.
8. Shewmon, D.A., "Anencephaly, Selected Medical Aspects," Hastings Center Report, 1988, no. 10, pp. 11-19.
9. Dr. David J. Hill, M.A., FFARCS, Consultant Anesthetist, Addenbrooke's Hospital, Cambridge. Hearing on Sept. 29,1992, testimony presented to the Select Committee of Social Affairs of the Italian Parliament.
10. Mors sua vita mea, op. cit., pp.34-36.
11. Rethinking..." note 22 - Wetzel, R.C., Setzer, N., Stiff, J.L., et al, "Hemodynamic Responses in Brain Dead Organ Donor Patients," Anesth. Analg., 1985, no.64 (2), pp. 125-128.
12. Ropper, A.H., "Unusual Spontaneous Movements in Brain Dead Patients," Neurology, 1984, no.34, pp. 1089-1092.
13. Mors sua vita mea, op. cit., p.28.
14. Prof. Fausto Baldisero, Department of Human Physiology, University of Milan, Hearing Sept. 29,1992, Report delivered to the Select Committee of the Commission of Social Affairs of the Italian Parliament.
15. "Rethinking..." note 45 - Molinari, The GF NINDDS Collaborative Study of Brain Death: A Historical Perspective, in NINDDS, monograph no.24, publication no. 81-2286, Bethesda, Maryland, National Institute of Health, 1980, pp. 1-72.
16. Dr. Hill, ibid.
17. Dr. Alan Shewmon, Professor of Pediatric Neurology, UCLA Medical School, Los Angeles, CA, "Chronic 'Brain Death': Meta-Analysis and Conceptual Consequences," Neurology, 1998, no.51, pp.1538-1545.
18. P.S. Eriksson, of Gotenborg University, Institute of Clinical
Neuroscience, and F.H. Gage of the San Diego Salk Institute. Cf., Mors sua vita mea, op. cit., p.7.
19. C.B. Johansson et al., "Identification of Neural Stem Cell in the Adult Mammalian Central Nervous System," Cell, 1989, January 8, no.96 (1), pp.25-34.
20. A. Grenvik, D.J. Powner, J.V. Snyder, et al, "Cessation of Therapy in Terminal Illness and Brain Death," Critical Care Medicine, 1978, no.6, pp.284-291.
21. D.R. Field, E.A. Gates, R.K. Creasy, et al, "Maternal Brain Death During Pregnancy: Medical and Ethical Issues," in JAMA, 1988, no.260, pp.816-822.
22. J.E. Parisi, R.C. Kirn, G.H. Collins, et al, "Brain Death with Prolonged Somatic Survival," New England Journal of Medicine, 1982, no.306, pp. 14-16.
23. R.C. Klein, "Brain Death with Prolonged Somatic Survival," New England Journal of Medicine, 1992, no.306, p. 1362.
24. T.W. Rowland, J.H. Donnelly, A.H. Jackson, et al, "Brain Death in the Pediatric Intensive Care Unit: A Clinical Definition," American Journal of the Disabled Child, 1983, no. 137, pp.547-550.
25."Rethinking..." op. cit.
26. Luca Poli, "Abortion and genetic manipulation: biotechnology, euthanasia and organ harvesting of a beating heart," Supplement to la Tradizione Cattolica, p.89.
27. N. Hayashi, Department of Emergency Surgery at Nibon University Hospital.
28. Neue Revue Exklusiv, "Another Voice," May-June 1997, translation by The National League Against Organ Predation and Heart-Beating Cadavers.
29. John Paul II, "Speech to the members of the Pontifical Academy of the Sciences," Dec. 14, 1989.
30. Pius XII, Speech, "Dr. Bruno Haid, and several scientists, in response to some important questions on resuscitation," Nov. 24, 1957, in Insegnamenti Pontifici, published by Paolini (The Paulists). [Translator's Note: The official English language text has been quoted, with contextual material included for clarity.]
31. Mors sua vita mea, op. cit., p.38.