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"TRANSPLANTS AND MAN: The view of the Church"


Address to the Hellenic Association of Transplants

Recently there has been much talk about the issue of transplants and sufficient reference has been made to the part that the Church could play in promoting them in our country.

Transplants have come to the foreground as a source of hope for the survival of many of our fellow-men who are gravely ill and would otherwise be doomed to death. They constitute a revolutionary method of surgery and, from an ethical point of view, are marked by two features: firstly, they bring two men together —since organs are transferred from one person to the body of the other— and secondly, they bring them so closely — since the death of one offers life to the other. The Church approaches everything related to man’s health and to his struggle with death very sympathetically, with understanding and with a sense of responsibility and seriousness. Moreover, she views everything related to the offer and the mutual rapprochement of men, as is the case with transplants, with particular respect and a sense of sanctity. However, she approaches it with fear and attention both because it can be easily abused and because its abuse constitutes sacrilege and unforgivable disrespect.

As She expresses Her position on the matter of transplants, She comprehends the size of the problem, the possibilities transplants provide and Her great duty towards society, medical practice, beneficiaries and potential donors. She wishes to help the transplantee but She must also respect the donor.

The ecclesiastic treatment of transplants, as of every problem, is of a spiritual order; if something is detrimental to the soul or downgrades spiritual values, She rejects it unreservedly. On the contrary, if in some aspect She discerns that medical boldness is compatible with the spiritual life and tradition of our Church, She blesses it. As is stated in the official position of the Holy Synod on transplants, “the criterion of Her ethics is spiritual. It is not to do with rational scholasticism nor does it give in to political purposes nor does it take sides with secularisation”(1).


Acknowledging the immediacy and the size of the whole problem, the Holy Synod of the Church of Greece assigned Her Committee on Bioethics to study and elaborate an Ethics of transplants. On the basis of the proposals of the Committee, the Synod came to the following conclusions:

1. General Principles

The first principle, from which the thinking of the Church about transplants begins, is Her love towards humanity. The fact that transplants transform the transplantee’s tragedy into hope for life is cherished by the Church with particular sympathy and respect. This is why She could consider blessing them, provided, however, that during the transplant process the donor’s conscience is protected and spiritual values are not violated. The spiritual character of the Church does not preclude Her love towards humanity.

Her second principle is that man possesses of a psychosomatic nature, a mortal body with an eternal and immortal soul. His destination is to become “after the image”, something that is achieved with God’s Grace and the right activation of free will. Accordingly, anything related to the soul has eternal implications and anything related to the body is also related to the soul. Anything that neglects or offends free will disrespects his salvation.

On the basis of these two principles, any rationale for the acceptance of transplants by the Church has three axes:

1.1. Although the Church feels Her philanthropic duty to the transplantee —who needs to live—, She also perceives Her part by the side of the donor — who is free to offer. Under no circumstances and in no way does She sacrifice the respect for the donor to the transplantee’s need of survival. Her philanthropic purpose is that the transplantee may live; her spiritual purpose is that the donor may give.

The notion of transplants is based on the biblical passage: “it is blessed rather to give than to receive” (Acts 20:35). According to the Orthodox Christian perception and experience, charity and offer are carried out mainly for the spiritual benefit of the one who gives and secondarily for their social effect. According to Saint John the Chrysostom, “the wealth of beneficence is great: in the giving it is received and in the scattering it is amassed”.

1.2. The Church could accept transplants only in a spirit of love, solidarity, sometimes of a self-sacrificial frame of mind, of our personal need to come out of the cluster of our selfishness and love of life — and never in a spirit of a utilitarian logic or of profit, which alienates the donor from his or her own offer.

1.3. The donation of an organ must involve the “conscious consent” of the donor; in other terms, the donor must have consented in full awareness and freedom and without coercion to his or her organs being removed, in case he or she dies cerebrally for some reason. The donor must act as donor, not as a soulless deposit of organs.

In this manner, the issue of transplants is also approached not only as an occasion for the transfer of life to some people, but mainly as an occasion for the transfusion of a spiritual ethos to society.

2. The part of Medicine

Medicine sees to the recovery or the amelioration of man’s health. By so doing, she also sees to the prolongation of his life. The fact that the Church lives in the atmosphere of eternal life and of the kingdom of God does not necessarily entail a degradation of the value of biological life. “Without overseeing the relative power of medicine, Theology not only does not prevent it, but also supports it. Nonetheless, at the same time, it sets certain preconditions for the right development and practice of Medicine. And there are two such preconditions: (a) the respect for the human person and (b) the benefit of one’s neighbour”(2).

This is the reason why “medical science and research as well as clinical practice must be conducted within the framework of medical and bioethical and more broadly ethical rules, which protect man as a personality, while doctors must work in humility and with the deepest sense that they are instruments of God for the service of man”(3).


In view of all the above, the problematics of the Church regarding the matter of transplants is focused on three questions, namely:

(a) if one has the right to offer one’s organ or to become a body donor and, if yes, under what preconditions;

(b) the issue of “cerebral death”, i.e. whether and to what extent one brain dead person is dead indeed; and

(c) the part of free will in the process of authorising the use of organs and the so-called “presumed consent”.

At the same time, the Church must contribute to the protection of the donor and of transplants from financial exploitation, from the disrespectful and reckless removal of organs, from instances of injustice in the process of the allocation of transplants, etc.

1. The possibility of offering organs

The frame of mind and the disposition of offering oneself constitute the spiritual axis of the Ethics of the Church in the matter of transplants. The Church constantly urges the faithful to give indiscriminately: “give to every man that asketh of you” (Luke 6:30) and indeed “not grudgingly or of necessity: for God loveth a cheerful giver” (Cor. II, 9:7). On the contrary, if one remains entrenched, keeping what one has to oneself, one is then condemned by the Evangelical spirit (Matt. 5:44, Luke 6:27-36). The gifts of God are best used if offered to one’s brethren out of love. Indeed, the highest gift is life itself and the greatest offering is the sacrifice of life for one’s brother; “greater love hath no man than this, that a man lay down his life for his friends” (John 15:13). These words of the Lord, according to the tradition of the last legacy to His disciples, dispels every doubt about the fact that one’s offering one’s life and consequently the donation of one’s body constitute not acts of suicide or instances of euthanasia but, when performed in a Christian ethos, namely disinterestedly and by a free, conscious and Evangelical use of one’s autonomous will, expressions of that “greater love”.

When the Church lives in this manner, then the ethical problem becomes a spiritual one and is transposed from the scholastic determination of cerebral death to the respect for and the free expression of the human will.

As Prof. Gheorghios Mantzaridis notes, “freely putting one’s own life at stake or even sacrificing it out of love for one’s neighbour certainly has a positive character and is the very antipodes of suicide or euthanasia”(4). Therefore, in case someone would like to offer his or her organs even if cerebral death did not signify the definitive separation of the soul from the body, by the same act he or she would have offered his or her life, together with his or her organs. This act would bear not only the element of offering but also that of self-sacrifice.

On these grounds, the Church could unreservedly encourage the offering of one of our twin organs (e.g. kidneys) or tissues (of skin, bone brain, blood) from a living donor and further, under certain essential preconditions, accept also the offering of organs of Her faithful after death.

2. Regarding cerebral death

The greatest obstacle to the Church’s consent to transplants from deceased donors is the problem of cerebral death. This problem is not a product of Her own conception but a purely medical problem, the seriousness of which She herself realises and follows with great respect the debate and research related to it. The Church respects and trusts both medical research and clinical practice, but at the same time She also respects the facts of life and death of each man. When, according to the European, and mainly British, approach, “cerebral death” is defined as the death of the cerebral stem, whereas the criteria of Harvard, Minnesota or Stanford include the death of the cortex as well, is it not reasonable that the Church, which lives the burden of the responsibility deriving from Her respect for the donor, should reserve judgment, on the one hand, and, on the other hand, feel more comfortable with the strictest of criteria?

Generally, however, even though the Church is not competent to pass judgment on this matter, She could accept the global consensus that “cerebral death” is identified with the irrevocable biological end of man, while waiting for a unanimity to be formed on a global scale in the medical world. This is so in the understanding that “cerebral death” constitutes a sign of definitive and irrevocable destruction of the brain and a situation in which the loss of senses and consciousness is complete. The respiratory function is maintained only artificially, and the interruption of artificial support leads to an almost immediate arrest of the cardiac function as well.

We fully comprehend that what is essentially achieved by the artificial support of respiration is the temporary halt of the process of the body’s decomposition and not of course the halt of the soul’s departure. Therefore, we confidently accept the medical view, believing that “cerebral death” is not an invention for the promotion of the interests of some small groups but a reasonable scientific conclusion that renders transplants a medical achievement and a unique possibility.

Nonetheless, and because there is always the danger —fortunately in isolated cases— of inadvertence, mistake or disrespect for the fact of death, the Church, together with the majority of the medical and paramedical world and the relevant social agents, demands that the observance of the internationally accepted criteria for the diagnosis of cerebral death and the appropriate procedure for it as described in the Memorandum of the Committee of the Church on Bioethics(5) be accurately safeguarded.

On the basis of all this, both the donation of organs from brain dead donors and the lucid and conscious decision on the part of a healthy person to offer one of his or her organs to a suffering fellow-man, as acts of love of one another, are in accordance with the teaching of our Church that is fully disposed to endorse them.

3. Of conscious and presumed consent

As becomes clear from what we have said, the main precondition for the Church’s approval of the idea of transplants is the donor’s “conscious consent” to what he or she does. Anything that “presumes” his or her will constitutes an intervention in its freedom and cannot possibly be accepted.

The offering of organs must be a fruit of the donor’s respect and love and not a result of sophistries on the part of the legislator. The donor cannot be anything but a “gift-giver”. The grafts will be found, when all of us shall cultivate ourselves in giving from our selves. The view that the organs of our bodies are part of public wealth and property of the state or society finds us categorically opposed.

We are convinced that anything that substitutes the conscious will by impersonal presumptions will secure much fewer grafts than the Church’s written and wholehearted consent to transplants.

The “conscious consent” constitutes a sacred act of self-abnegation and love par excellence, because it links the donor to the fact of his or her death, and indeed in the understanding that this latter will occur in a tragic manner (car accident, crime or serious cerebral damage) and at a relatively young age. It also involves the virtues of disinterestedness, relinquishment of one’s natural rights, trust in the competent doctors and the relatives, interest in the fellow-man, self-offering and liberation from the spirit of the love of life.

All this is sought by the Church in every man, as proof of his departure from the strait of selfishness.

As a result, through the exercise of Her transplant pastoral work, the Church may be able to secure a number of grafts annually and thus contribute to the survival of a number of persons, respectively (depending on the percentage of success of transplant operations). Nonetheless, under the condition of conscious consent, those who cultivate themselves spiritually are more numerous — those, in other terms, who have maturely expressed their consent and from whom donors, certainly the fewest, will appear. The Church turns Herself not only to actual but to the potential donors as well. Only conscious consent does achieve its purpose at the level of man’s cultivated disposition.

The donor may do good to others through his or her offer, but he or she also benefits mainly from the act of his or her act of consent. He or she saves not only the transplantee biologically but, by the same token, himself or herself spiritually.

For all the above reasons, the Church considers free consent such a sacred act that society should treat it with particular respect and never elicit it. Consent is not something secondary that could be overshadowed by any other act (e.g. census, issuing of identity cards). The statement of consent should be uncoerced and absolutely conscious, a fruit of mature thought. This is why it would be advisable that the statement of consent be made in complete independence of any other act of social nature and under the condition of accurate and unbiased information.

4. Of the consent of relatives

Under certain conditions, from the point of view of the sanctity of the ties of kinship and of the cultivation of relationships of communion, the Church could also accept the substitution of the donor’s will by that of relatives, provided of course that this latter does not counter his or her own. Providing for one’s own constitutes an expression of faith (Tim. I, 5:8), while the inherent obligations to them are the proof of sacred kinship rights.

Our country is the only one in Europe where kidney transplants from living donors are proportionally higher in number than those involving grafts from deceased donors, a fact that indicates how, in this blessed country, we find it easier to offer our body to our relatives than to donate organs of our relatives after death.

To relatives, the donor’s life and the honour due to his or her body may be of greater worth than to himself or herself. Given their love, the decision to donate the body of another may indeed be more difficult than the decision to donate our own body. In this sense, the real donor is the relatives.

However, the law should provide for the exclusion of any suspicion or possibility of commercialisation of grafts by relatives, precisely because, in our society and our time, interests of all kinds, and mainly financial ones, often creep into even the most sacred of relationships in a sacrilegious manner.

Needless to add, in any process of consent in writing, it would be desirable that the donor be in position to cede in advance to his or her relatives the right to bestow his or her body.

5. The reservations of the Church

The development of the sciences of communication and information (Internet, keeping digital records with a vast range of data and a limited possibility of control, etc.), on the one hand, and the spiritual poverty of modern societies, on the other, can lead to the abuse, commercialisation, exploitation or even sacrifice of transplants on the altar of significant financial interests. For this reason, the duty of the Church is to protect the institution, the practice and the persons involved from any eventual act of profanation (such as hasty diagnosis or offhandedness in the observance of the criteria of cerebral death, commercialization or transaction of any kind in relation to the offering of organs, selection of transplantees on racist criteria, violations of waiting lists, etc.).

At this point, it should be made clear that, whereas international and Greek legislation imposes the anonymity of both donor and recipient and forbids the donation of an organ to a person predetermined by the donor by virtue of ties of friendship or kinship (with the exception of kidney transplants from living donors), in order to protect transplants from the threat of commercial transaction, this is not necessarily incompatible with the ethics of the Orthodox Christian Church.

It is true that the Church views all these modern discoveries and applications with great attention and caution. This is due not to suspiciousness but to considerations dictated by prudence. She feels that She must protect Herself from any event of unpredictable malpractice or unjustifiable inadvertence. Thus for instance, in the immediate future, because of the looseness of the Ethics globally vis-à-vis euthanasia and because of the tendency legally to recognise it, there is the danger of the combination of transplants with euthanasia. As a result, persons who will choose this way to put en end to their lives may also be allowed to become organ donors. This is one more reason why the legislation on transplants must indispensably be founded upon sound and high ideological premises(6).


Even though the Church can accept the notion of transplants, She finds it impossible to agree either with their recent legal recognition in our country or with the utilitarian logic and a narrow-minded rationalism that seems to prevail in such legal acts. The only way to protect the morality and the practice of transplants from the event of their being abused is the clarity, the thorough study and the ideological —and not utilitarian— nature of the foundations of the relevant legislation.

The main reservations of the Church as regards the particulars are the following:

a) In the law that was recently passed, the “non-refusal” of relatives is interpreted as consent of the donor (Art. 12, para. 4). Organs may be removed not when relatives consent to it but when they are “not opposed”. However, transplants cannot possibly be founded upon a mere “non-refusal”, and indeed of relatives, at the moment when we all of us strive to secure consent, and indeed of the donor.

Otherwise, how could this matter be settled in the case of lack of relatives or when it is not possible to trace them? What could happen, if the potential donor were to be found in hospital on his or her own, for instance after a road accident about which his or her relatives would not have been notified immediately? What could happen in the cases of groups of people (such as foreigners, illegal immigrants, unknown and abandoned, tziganes), whose number is not negligible at all, and whose relatives either would not be in Greece or would not be easy to be found? Would the lack of relatives not risk to be taken as “non-refusal”? Given that our country has the lowest percentage of relatives’ consent in Europe (lower than 40%), the law on “non-refusal” constitutes a violation of conscience.

As is stated in the aforementioned Memorandum of the Committee of the Holy Synod of our Church on Bioethics, “consent is nothing to do with “non-refusal”. It is one thing to “give something that is mine” and quite another to “be stripped of something that belongs to me”. In the latter case, the will of the state and society substitutes in the sphere of goods the expression of personal freedom”(7).

The private realm of citizens’ lives is sacred and inviolable, and the state has no right to intervene in it. This goes against Articles 2 para. 1 (On the respect and protection of human dignity) and 5 para. 1 (On the free development of the personality of the individual) of the Constitution.

b) The legally binding termination of artificial support of he respiratory function in the case of a brain dead person who is not a donor (Article 12, para. 6) is spiritually and ethically unacceptable. It is the only medical practice that is imposed by law and indeed by a particularly strict law. The law, however, ought to protect the doctor who, out of reasons of conscience, does not wish to terminate mechanical respiration, and not to punish him (Article 12, para. 6). Besides, cardiac death is something that is apparent to the eyes of relatives, whereas cerebral death needs to be determined. In the latter case, the visual indications may allow hope to relatives, who often operate with the logic of “just another while yet”.


1) The Church wishes to help with this notion of transplants for reasons not only social but also spiritual. She could create a spiritual tradition in transplants oriented to the donor’s spiritual needs and sense of offering. In this manner, finding grafts and furthering transplants would not constitute a goal sought for but a natural result.

2) This does not mean that the Church imposes one view on Her flock, because She neither sacrifices truth nor makes the human person subservient.

According to the suggestion of the Most Rev. Ierotheos, Metropolitan of Nafpaktos and Saint Vlassios, submitted to the recent Synod of the Hierarchy of the Church of Greece, the Church “respects the freedom both of whoever wishes to become a donor and of whoever has difficulty consenting to it. At the same time, She respects and fully understands the natural desire of those patients who, by receiving grafts, wish to prolong the time of their biological life, because She believes that this fact may contribute to their spiritual fulfilment and to the attainment of the purpose of their existence”(8).

3) Nonetheless, given that transplants can easily lead to abuses and violations of fundamental moral principles and values, and there is a great discrepancy in the ethos and the approach between the secular and the ecclesiastic perception of the matter, the Church is very careful in Her acts and sparing in Her words. Without spiritual values, transplants may be abused, and indeed cruelly. Only the perennial values of respect for life, death, the soul and the body can preserve them.

For these reasons, in Her co-operation with the state, the Church sets clear terms, so that She may not be held responsible for secular decisions and acts that may be carried out in a totally different spirit and to totally different purposes. She will consider the possibilities of organising Donors’ Days or of proceeding to the raising of the highest possible number of grafts only if and when there will be clear guarantees of respect for Her principles and terms.

4) Regarding the new law, the Church ought to separate Her position at all costs, and so She did, dispassionately but prudently and clearly, so as neither to damage the cause of transplants nor to devalue the gravity of Her views. At the same time, She made these views public on the points where She maintains Her reservations and objections. Moreover, She is ready to proceed to immediate legal interventions and apply for those amendments and legislative ameliorations that will safeguard the premises of Her reasoning and will allow Her essential assistance.

An indispensable term for the co-operation of the Church with the state is that the latter may realise that it is the bearer of the tremendous responsibility to protect transplants, both on the legislative and on the practical level, from any form of unscrupulousness, utilitarianism or financial exploitation, and to guarantee the scientific integrity, information and training of the relevant doctors and agencies. In this manner, the donor will not fall victim to debased interests, disrespect or scientific superficiality and ignorance.

Furthermore, the medical community and the state should help with the imposition and the legal safeguarding of the most accurate possible criteria for “cerebral death”, the observance of which should be strictly controlled.

5) For the rest, it is necessary to establish serious and reliable transplant centres, which must possess the appropriate scientific and technological infrastructure, so that the reception of the donor’s organs and their subsequent transfer into the right transplantee be effected with the highest rates of success and the lowest numbers of losses.

6) In view of the dire need for grafts, advocates of transplants often speak of the necessity to undertake information campaigns. The purpose of the Church is not only to find grafts but also to awaken love; and this is not achieved solely through information but mainly through inspiration. Her part and possibilities in this realm are incalculable, as are also the difficulties and the obstacles.

7) The Church will see to Her representation in scientific medical fora regarding transplants, so as to renew Her knowledge and to promote Her principles. Her part and representation in the Greek National Organisation of Transplants (“E.O.M.” in Greek) will be of the highest level and activity and not virtual or secondary. Her aim is for transplants centres to operate as much as possible on the basis of spiritual principles of respect for, freedom and love of the human person.

It is a common conviction that the discourse and the part of our Church in the course of transplants in Greece are of the highest significance. Transplants are perhaps one of those matters for which the state needs the direct assistance of the Church. For her part, the Church is fully and most sincerely disposed to co-operate and offer, and realises that She can help decisively with the cause of transplants and with the donor’s need to live. At the same time, however, She is also conscious of Her great responsibility to defend both the donor —whom She embrace with the utmost sensitivity both as a person and as a notion— and the moral values that are the prerequisites implied and served by transplants. This generates essential rights for Her —such as the right to speak up— and great obligations — such as the obligation to protect Her ethos and authority, given that transplants do not only solve the problem of survival of our fellow men that are gravely ill but can easily lead to abuses or violations of fundamental freedoms and values.

The Church can say “yes” to transplants, if the state and society say “yes” to perennial spiritual values and the respect for the human person.

[Translation from Greek :
Dr Nikolaos C. Petropoulos, M.St., D.Phil. {Oxon.}]


1. Holy Synod of the Church of Greece, Main Positions on the Ethics of Transplants, October 1999, p. 1.

2. Mantzaridis, Gheorghios, “Theological Problematics of Transplants”, in Ethical View of Transplants, July 1999, p. 100.

3. Most Rev. Ierotheos, Metropolitan of Nafpaktos and Saint Vlassios, Transplants from an Orthodox Ecclesiastic Point of View, Suggestion to the Holy Synod of the Hierarchy of the Church of Greece, October 1999, p. 13.

4. Op. cit., p. 108.

5. According to the Memorandum in question: a) the documented and clear identification of the causes of cerebral death is indispensable; b) the certification of cerebral death must be conducted by a committee of experts completely independent of transplant groups and on the basis of existing clinical and laboratorial criteria; c) the criteria of cerebral death are not sufficient if they are merely clinical. To these the laboratorial ones must be added (tomography, electroencephalogram, angiography), so that the arrest not only of the functions of the cerebral stem but of the cortex be confirmed as positively as possible. Where there is no apparent cause of cerebral damage, tests must be repeated for greater certainty, even if this could conceivably result in a loss of organs. d) for the tests of cerebral death to be applicable, biochemical tests yielding normal values (neither urea nor electrolytic anomalies) must have preceded, on the one hand, and on the other hand at least 24 hours must have transpired since the initial crisis. e) the verification whether someone is a donor (in other terms, if there is consent) must be conducted after the definitive diagnosis of cerebral death, so that it be impartial as much as possible. (Committee of the Holy Synod of the Church of Greece on Bioethics, Ethics of Transplants. Conclusions – Suggestions, July 1999, p. 4.)

6. As regards the use of artificial organs and/or genetically modified grafts from animals as well as of products of cloning, given that research has not produced any clear results as yet and its course is not readily discernible, the Church maintains a stand-by status so as to be able to present Her positions and views at the appropriate time.

7. Op. cit., Suggestion no. 29, p. 8.

8. Op. cit., p. 14.

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