Concerning Transplantation (Original title: Zur Frage der Qrgantransplantation. Rundbrief fwr die Mitarbeiter der Medizinischen Sektion am Goetheanum in aller Welt Michaeli 1994 No. 7, S. 251-4. English by U. O'Callaghan and A. R. Meuss, FIL, MTA.)

Hinrich Baumgart

Referring to the question raised in the Michaelmas 1993 issue of the Circular Letter (No. 1), an attempt is made to consider, first of all, the general medical thinking and then Rudolf Steiner's statements based on the science of the spirit to help us gain a deeper understanding of the problems involved.

Before addressing the implications of transplantation for both donor and recipient, we need to consider what lies behind the term "organ donation."

Terms used in transplantation medicine such as 'cadaver kidney' suggest that the organ in question comes from a dead body. Yet organs taken from dead bodies as we know them in the world of medicine are not at all suitable as donor organs, for they are biologically dead and cannot resume their functions.

Concepts such as 'cadaver' or 'dead body' clearly have different meanings in different fields of medicine. If we follow this up, we find that the organs are removed from someone who is not biologically dead but brain dead, for the organs must still be vital if they are to be of any use to the recipient. This is absolutely essential for transplantation but needs ethical justification if the dignity of the human being and the right to physical integrity are to be preserved.

In 1968, a conference was held at Harvard University at which physi- cians, legal experts and ethicists sought to solve the problem by equating brain death with the death of the individual. Transplantation was thus legi- timized, but the actual issue has not been dealt with, as Johannes Hoff and Juergen in den Schnitten have shown in reports published in a German paper.(1)

Defining the moment of brain death as the time of death of the individual means that people are declared dead when still in the process of dying. Most organ systems are still vital at the time. They only die off gradually, growth of nails and hair being the last to cease. Only then is a person biologically dead, i.e. a corpse. A large part of the dying process is therefore considered to lie outside me sphere of life and occur in the 'corpse'. It thus appears to be ethically and morally justifiable to remove an organ from someone who, in fact, is still alive simply by considering the person to be dead once brain death has occurred. Death is a condition, however, never a process.

After these introductory considerations concerning die legal and moral situation in transplantation medicine, I shall now turn to the potential implications of organ removal for the donor. As we have seen, the organs are taken not from a corpse but from human beings on their irreversible journey into death. It is important to hold onto this distinction in view of what follows. If the organs were really taken from corpses, it might well be that organ removal holds no significance for the donors. The corpse is subject only to physical laws, which cause the inevitable decomposition. Post mortems and organ removal merely accelerate this natural process (see also(2)).

Organs are, however, removed from the dying, with the four aspects of the human being still active in their vital processes. We have to ask how much is also removed of the vital forces that create and maintain the organ. One possible consequence would be that the individual loses part of the ether body which is responsible for creating the panorama of life during the first days after death.(3) If we assume the process to take place, organ removal would signify a loss or sacrifice made by the donor. But do people know they are making a sacrifice when signing a donor card, for example, especially as the circumstances of organ removal are wrongly represented by terms such as 'cadaver kidney?' If the sacrifice is made in full awareness of the implications, it assumes a totally different meaning. It is evidently our duty as physicians to make people aware of the situation so that a free choice may be made.

This is no longer possible when someone is brain dead. The fact that a donor card has been signed merely solves the legal problem, for at me time in question we do not know the circumstances under which the card was signed.

The situation is completely different if a living person - a relative, for instance - donates the organ. We then have the opportunity and, indeed, the duty to put the donor fully in the picture, enabling him or her to make an independent decision. People who will have only one kidney after making the donation will be fully aware of what they are doing in this case and will be reminded of this for the rest of their lives. Another advantage is that the physician gets to know donor and recipient before the transplantation and will be responsible for their postoperative care.

What can be said about the situation of the recipient? The first question to ask oneself is what would be the significance of the destructive restructuring of an organ to the point where it is no longer able to perform its function in the medical sense and has to be replaced if the patient is to go on living? Aspects of this are discussed in two lectures by Rudolf Steiner(4,5) where he speaks of organs being destroyed for karmic reasons 'by the benevolent powers', giving me person concerned a chance to deal with the causes of the disease and thus creating an opportunity for further development. Trans- plantation intervenes in this process of interaction between the human being and the hierarchies.Transplantation does not discover and deal with the cause of pathologic organ destruction as is evident, for instance, from the fact that the renal disease may also manifest in the transplant.(6)

Patients must of necessity be immunosuppressed. The immune system enables us to maintain our boundaries against the environment and exist as individual entities. It may thus be seen as a function of the ego organization. Medication prevents the ego organization from intervening at this level. The question as to how far this also disrupts or inhibits the ego organization in other areas will be left open for the moment.

A transplanted organ is also a denervated organ. The body-bound astral body is no longer able to perform its regulatory function via the autonomic nervous system.

Massive intervention clearly occurs in the biography, and we have to ask ourselves if this serves the individual's higher purpose in life. To what extent do transplantation and postoperative medication interfere with karma? What are the consequences for all involved? In spite of this, all of us no doubt find it difficult if not impossible to let a patient die in terminal renal failure without doing everything possible. A tentative idea may prove helpful in this situation.

Would it not be possible for someone to make a deliberate sacrifice in the Christian and Michaelic sense by donating an organ to another person whose corresponding organ has been destroyed for karmic reasons? This would give recipients another opportunity to work on their mission in the present life. It would then be the physician's responsibility to ensure that the sacrifice is freely made and genuinely appreciated and used by the recipient to deal with karma. The physician would be a mercurial mediator between donor and recipient- a tremendous responsibility.

These thoughts were written down after a conversation with Dr. T. Schietzel, nephrologist, at Herdecke Community Hospital.

Hinrich Baumgart, med. student Harkortstr. 15 D-58313 Herdecke Germany

References

1 Hoff J, in den Schnitten J. Tot? (dead?). Die Zeit 47,13 November 1992, and Organspende - nur
ueber meine Leiche (organ donation - over my dead body). Die Zeit, 7,12 February 1993.

2 Steiner R. Eight Lectures to Doctors (in GA 316). Lecture of 8 Jan. 1924. Tr. not known. MS
translation R 96 at Rudolf Steiner House Library, London.

3 Steiner R. Occult Science - An Outline (GA 13). Tr. G. & M. Adams. London; Rudolf Steiner
Press 1962.

4 Steiner R. The Being of Man and his Future Evolution (in GA 107). Lecture of 26 Jan . 1909. Tr. P. Wehrie. London: Rudolf Steiner Press 1981.

5 Steiner R. Manifestations of Karma (GA 120). Lecture of 22 May 1910. Tr. unknown . New York: Anthroposophic Press 1983.

6 Herold G. Innere Median 1991, S. 477.