The issue of organ donation is serious and should be placed within the essential framework of theological thought and dialogue, so that the Orthodox Church can give its decisive opinion, at the universal level and not just the local one.

The focus to date has been on brain death as a criterion. Is the information about this criterion really correct, as Harvard claims? Why are there two types of death according to the new data, namely brain death and clinical death? Why are the donor’s organs removed before clinical death and after brain death? Most people know that organs, with a few special exceptions, cannot be taken from a dead donor, since in most cases, organs are useless after the heart stops. We know for sure that they are taken from a living being whose brain has stopped working, according to the Harvard data, which is in doubt.

Who can determine precisely when the soul separates from the body? Who can determine the mystery of death? Can the Church support the removal of an organ before the connection between soul and body is unambiguously dissolved? Shouldn’t the Church take into account the reaction of many scientists, around the world, who oppose the Harvard criteria and the idea of a double death, cerebral and clinical?

All of the above relates to data that are not yet established. We cannot accept any intervention to remove organs before final death, since this constitutes the removal of life, regardless of whether its goal is to heal another patient. This end does not justify the means. The mystery of death will forever remain a mystery. No one has the right to analyze and redefine it according to his medical or theological concepts. While this research as a whole is still in motion within the framework of the ideas referred to, a book has been published that will change the level of research as a whole and will inevitably stumble upon the mystery of death. The title of the book is “Free from the Genome” (in Greek) by Archimandrite Nikolaos Khazinikolai, published by the Center for Bioethics and Ethics. In the chapter “The Spiritual Ethics and Pathology of Transplantation” (pp. 315-345), we find positions that go beyond the problem in its current form. We raise these questions here, anticipating answers to the questions we raise in this text.

On page 328, it says: “Life is indeed a gift of God, but it is not a gift that belongs to the giver alone. It also belongs to the recipient. It is mine. It is the only field in which we exercise self-government. It is not given to us for the fulfillment of our selfishness and possession, but to become ours so that we can give it to others. That is why we love it and protect it more than anything else, with prudence, because it belongs to God and at the same time it belongs to us. The best way to return it to God is to give it to our brother man. <ما من طريقة للخلاص إلا عبر القريبين منا> (Saint Macarius the Egyptian)

Question 1: Our life is naturally a field for the exercise of self-governance. But if this self-governance does not lead to God, is this gift not merely horizontal and human?

Question 2: Is the phrase <الحياة تخصّنا أيضاً> Are we theologically justified in doing what we want with our lives?

Question 3: What does the liturgical phrase mean? <وكل حياتنا للمسيح الإله>?

Question 4: Is it possible that the author of the book mixes up the two phrases? <الخدمة للقديسين> (2 Corinthians 4:8) and<في يديك استودع روحي> (Luke 23:46), or even: <وَاسْتَوْدَعَاهُمْ لِلرَّبِّ>, or <فَلْيَسْتَوْدِعُوا أَنْفُسَهُمْ، كَمَا لِخَالِق أَمِينٍ> (1 Peter 4:19)?

Question 5: How can the words of Saint Macarius be used in this arbitrary way, for purposes that were not in his perspective during his life?

Question 6: Does not the arbitrary and fragmentary use of St. Macarius’ words threaten to open the way for considering human offerings as a practical means of salvation, and to make the ascetic life within the Church a surplus? Does not the balance in the verse provide <فَلْيَسْتَوْدِعُوا أَنْفُسَهُمْ، كَمَا لِخَالِق أَمِينٍ> From the Apostle Peter, a definitive answer free of all dangerous polarizing positions?

Question 7: Is it possible that the text, in its reference to giving and loving, assumes that the removal of organs is from a living person, because the (brain-dead) person lacks the autonomy required to exercise giving and loving?

Question 8: Could it be that, by using flowery phrases, we are trying to persuade God's people to make an incorrect gift, or, if the giver is alive, are we taking the event of death out of the hands of God, who is the Master of life and death?
On page 329 we find a full recognition that the removal of organs must be from a living person: “How can the value of life be respected and recognized? Towards the donor who is inevitably dead, or towards the recipient who is allowed to live?”

Question 9: How can the writer be so certain that the Giver’s departure is “inevitably departed”? Can’t God intervene in things that we believe to be final?

Question 10: Why does the writer ask whether the respect given to the giver is greater than that given to the recipient? Does the Church make such differences in the standards of respect for the individual?

Question 11: The writer again acknowledges the fact that the donor is alive when he speaks of an “inevitable departure.” Does this mean that he accepts the taking of life from someone? Can the Church cooperate in the taking of life? On the same page (319), the writer speaks of the “improbable miracle.”

Question 12: Is it possible to deny the possibility of a miracle? Aren’t all miracles “improbable” events by nature? How can a writer predetermine God’s free intervention in the performance of a miracle? How can God be excluded from a miracle, once and for all?

I fear that Lazarus, or the son of the widow of Nain, or the daughter of Jairus, if they had lived in our time, would have missed the opportunity for resurrection because their organs would have been removed (with the blessing of the church pastors) on the pretext that they were “gifts.”
On page 320, we find the phrase: “Medicine confirms the dilemma, and is called upon to dare to prove the love of those who are dying. For there are two people: one will be able to rebuild his life on the wreckage and remains of the other’s life.”

Question 13: What kind of love is this, to kill one person so that another can live? Is killing allowed in the name of love?

Question 14: With all of the above, wouldn’t the way be open to a “theology” of euthanasia, or even suicide at the time determined by man?

On page 323 we read: “Conscious consent to donate the body after death constitutes, in an exceptional way, a sacred act of self-denial and love, because it means that the donor has the opportunity… finally, during moments of blessed stillness, to give up his right to benefit from the doctors and those around him and thus to give up his trust in them, so that they may stop the heart when they see fit, instead of waiting for the heart to stop working of its own accord, assuring him that they want exactly what is best for him.”

Question 15: Isn't the text somewhat in an awkward intellectual conflict, because at first it emphasizes "after death", and later it refers to love? The question is raised again: How does one love after death?

Question 16: Doesn't the writer contradict himself when he talks about Mubarak's later stillness? Does the dead have stillness?

Question 17: What is the definition, thought, or Orthodox tradition that gives a person the right to demand that his heart be stopped? “Instead of waiting for the heart to stop working by itself,” the text is clear. The Church is asked to bless the forced intervention in a living being. Who bears this responsibility? What “theology” will accommodate this non-theological nonsense?

On page 331, the text is absolutely clear: “Therefore, respecting a person does not only mean allowing him to die, but also making it easy for him.”

Question 18: Where exactly in the Orthodox Church did the writer learn about the subject of facilitating human death?

In his attempt to present an Orthodox light film of his unprecedented and unacceptable “theology,” the writer resorts to a prayer for the soul in agony, from the Little Euchologion, stating: “Save this servant of yours from this unbearable affliction, from the severe illness that has seized him, and give him rest where the souls of the righteous are.”

Question 19: What comparison is possible between the prayer that begs for “deliverance from distress” and the actual process of removing organs, which, if the being is alive according to the writer’s previous ideas, will cause unbearable pain to the body and will make the event of death even more painful?

Question 20: Isn’t the violent intervention of removing organs from a living donor a violation of the prayer that asks for “peaceful endings”? How can the Church pray for peaceful endings and at the same time condone violent endings?

The contradictions of this text are evident, even in its moments of excellence. On page 330 it says: “We intervene in the body only therapeutically. Any movement that contributes to its deterioration is offensive to the soul and sinful. For this reason, the process of corruption must be natural and never forced.” On page 329 we read: “Death must not be hastened in any way. We have no right to take anything from the body, nor to interrupt the bond between soul and body, nor even to shorten a single moment of the time of psycho-physical unity.”

Question 21: The writer needs to clarify the purpose of these phrases “hasten death” and “the process of corruption is natural and never forced,” because a moment ago he was talking about “facilitating death.” The writer has taken clear positions that contradict themselves in these last words. Is it possible that there are attempts to confuse people by using correct theological ideas?

Question 22: Does the writer reject the donation of organs by living donors to living recipients in the statement “We have no right to take anything from the body”? And finally, does he reject blood transfusions as well?

He points out on page 325: “The donation of organs does not have the same value for the recipient (since he gives him only biological life) as for the donor who, by giving organs, receives the essence of spiritual life.”

Question 23: If organ donation is not of great value to the recipient, why do we keep talking about love and giving? Is it because we want the donor to benefit spiritually?

Question 24: What does the phrase “receive the essence of spiritual life” mean? Are we dealing with a new type of ascetic teaching in the Church? We usually attain spiritual life through asceticism, within the framework of the grace of the Holy Spirit. Are we to understand that from now on a person attains spiritual life when he gives his members while he is still alive? Does he become a spiritual person at the moment of his death?

On page 335 we read: “At the Last Supper, the Lord offered his apostles to lay down their lives for their fellow men, considering this the ultimate expression of love: ‘Greater love has no one than this, that a man lay down his life for his friends’ (John 15:13). But the apostle John says more forcefully in his first epistle: ‘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).

Question 25: Is it permissible to use these passages to serve our theological demands?

Commenting on the verse “I lay down my life for the sheep” (John 10:15), St. John Chrysostom writes: “He repeats this saying to show that he is not a deceiver” (EPE 14, 121). Concerning the Gospel of John (10:17-18): “For I lay down my life that I may take it again. No one takes it from me, but I lay it down of myself. I have power to lay it down, and I have power to take it again” (John 10:17-18), Chrysostom writes: “Let us pay close attention, then, to the phrase <لِي سُلْطَانٌ أَنْ أَضَعَهَا> Which he says. And who has no power to sacrifice his life? For every man is able to bring death upon himself whenever he wants. But that is not what he says. Well, how? I have the power to sacrifice myself so that no other man can do it if I do not want to, which man cannot do, because the only way we can give our lives is by killing ourselves. If we happen to meet people who plot against us and may kill us, we lose the power to sacrifice our lives or not, and they may take our lives without our wishing it. But things are different for the master, for although they were plotting against him, he still has the control to give himself. So after he said <لَيْسَ أَحَدٌ يَأْخُذُهَا مِنِّي> he added <لِي سُلْطَانٌ أَنْ أَضَعَهَا> any <أنا الوحيد صاحب السلطان لتقديمها لأنكم أنتم (الناس) لا تملكون هذا السلطان إذ إن كثيرين قد يتسلّطون عليكم ويأخذون حياتكم>However, he did not say these things from the beginning, otherwise his words would not have been convincing, but only after he had obtained testimony from the events themselves, and after they repeatedly conspired against him and he was escaping from their hands, then he said: <لَيْسَ أَحَدٌ يَأْخُذُهَا مِنِّي>“If this is true, then it is equally true to think that when he wants, he can take back his life. If his death is so superior to that of other people, we do not doubt that he can take back his life as well. For as the only one who has the power to sacrifice his life, he shows that he is the master by his power to sacrifice it. You see how, from the first point, he proves the second, and how from death he makes the resurrection indubitable” (EPE 14, 125-127).

Saint John comments on the phrase <أَنْ يَضَعَ أَحَدٌ نَفْسَهُ لأَجْلِ أَحِبَّائِهِ>“I say this to you so that you may love one another; in other words, I do not say this to accuse you, as if I were the only one offering my life or as if I wanted first to be close to you, but to lead you to friendship. Then, since persecutions and accusations were terrible and cruel things, capable of humiliating the most noble souls, for this reason, after telling them many things, he comes to them and shows them with generosity that these things were said for their sake” (EPE 14, 481).

We cannot convince the faithful with theological acrobatics or skirmishes. The responsibility is great and one should not stir things up by conflicting positions or by accepting a truth that, if not treated with theological wisdom, can lead the Orthodox mental attitude of respect for individuals and the mystery of death to a difficult moment.

Proto-Priest Constantine Strategopoulos
Translated into Arabic by Father Antoine Melki
Quoted from Orthodox Heritage Magazine