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POSITION STATEMENT OF THE BULGARIAN ORTHODOX CHURCH – BULGARIAN PATRIARCHATE REGARDNG THE NATIONAL LEGISLATION OF ORGAN, TISSUE AND CELL TRANSPLANTATION

25 декември 2018 17:03, Българска Патриаршия

The Holy Church treats transplantations, altogether with everything else concerning man’s health and his battle with death, with particular interest, comprehension and indispensable seriousness. The Church is thoroughly aware of the dimensions of the problem, as well as of the opportunities opened up by the transplantations, and respectively of the Church’s enormous duty in this matter towards society, the medical sphere, the recipients, and the potential donors. The Church supports the help that is to be rendered to the recipient, and in the same time, the respect that the donor is due and his interests, which should not be adversely affected.

Man’s desire to extend the bounds of his terrestrial life is blessed by the Orthodox Church and She sees in that an opportunity for repentance, good deeds, and spiritual progress - a fulfillment of the divine call “be holy, because I /the Lord, your God/ Am Holy” (Lev. 11:44).

The wisdom of the Sacred Scripture tells us, that man is “the crown of creation” – “the image and likeness” of God - and that in implementation of his assigned goal, he is the link between the Creator and the Creature. Man is the reflection of what is divine, because the created world tells about its Creator. The most transcendent gift, which has been given to man by the timeless and infinite Being /God/ is freedom. Man’s freedom is an independent act of man’s will, which has been given to man as a spiritual entity. The human personality possesses the right given by God Himself, to independently direct his will toward approving or rejecting considerations. Everything that affects life, death and one’s spiritual being, presupposes a voluntary expression of an individual position.

Without freedom love does not exist, and “God is love” (1 Jn 4:8).

The Orthodox Church of Bulgaria perceives donorship and its sequel – transplantation – as an expression of love, as a kind of altruism. To love means to self-give in a selfless and unreserved way, the same way as the Almighty in His unfathomable grace, has fulfilled the world with graciousness for all – “The Lord is sweet to all: and his tender mercies are over all his works!” (Ps 144:9). The word “donor” means “one that gives”, a fellow-man that does not simply donates an organ, but gives life and hope. Donation denotes a conscious decision, not a forcible one, but a free will. To donate means to show love and empathy.

In the human love, there speaks the Most High of all

Outside the free will, one’s decision is never authentic. Consent is an inviolable act of a person, an expression of an individual choice. That is why, imposing a domination of a foreign will, a will that is “implied” as personal will, is inadmissible. In that case “the implication” proclaims interest and the Church dismisses it, as morally unacceptable and discrediting consent. No act of donation is valid unless it is a result of a conscious consent.

The Church stands by Her doctrine that the man is a unique and inimitable identity: a psychosomatic unity of eternal soul and physical body, and not a plain biological unit. Man is not a “precondition” of himself, his existence is a gift from God. And in spite of the fact, that life has been given to man in such a way that he has even the right to donate it to his fellowman as a

self-sacrifice before the all merciful God, the human soul and the human body belong to the very human being and to God.

The Orthodox Church of Bulgaria does not recognize the assumption, that a non-declared refusal should be treated as a consent for donation, as if the lack of declared refusal, alongside a potential consent, might also be due to many other reasons, such as: insufficient information, lack of opportunity to declare one’s will, and least but not last - to a lack of a decision.

The acceptance of the transplantation practices by the Orthodox Church, lies on three key aspects:

1. The Church is aware of her humane duty towards the recipient, who desires to live, but She rather sees Herself in the position of protecting the donor, who should be given the open choice opportunity and he should be free to choose whether to become a donor and give something from himself.

For no reason or circumstance, shall the Church sacrifice the respect that the donor is due, for the sake of the recipient’s survival. Because here, the goal should be the voluntary donation by the donor and not the prolongation of the recipient’s life at any costs. The recipient receives only a perishable organ from a dead body, while the donor donates driven by his soul, which is immortal. The degree to which the soul stands above the body is the same, as the degree at which the spiritual benefit for the donor stands higher than the degree of the biological benefit for the recipient, because “it is more blessed to give than to receive” (Acts 20:35).

2.When an organ is donated, it is an obligatory requirement for those in charge of the procedure to take a “conscious consent” by the donor, i.e. the donor should be aware of what he is doing, or, if being in a brain dead state, there should be an evidence that he has expressed freely and not under coercion his consent for his organs to be taken away. The donor should always be a person that donates.

3.The Church can accept transplantation practices only as an expression of love, of mutuality, or of an urge to make a sacrifice, of freeing oneself from the nets of egoism. But She will never accept such practices if they are an expression of greed and cupidity, depriving the donor from his donation.

With regards to the brain death, it is required that the procedure should guarantee an exact adherence to the internationally recognized criteria for diagnosing brain death.

That is why it is necessary:

1.A reliable and clear manner of establishing the causes of the brain death;

2.The confirmation of the brain death to lie upon the grounds of existing clinical, instrumental, and laboratory criteria, confirmed by an expert commission which should not be linked in any way to the transplantation teams;

On the basis of all of the above, the act of organ donation by donors in a state of brain death, alongside the conscious consent by a healthy person to give an organ to a suffering fellowman is an act of altruism and love and is in agreement with the doctrine and the opinion of our Church.

The Reservations of the Church

The Church is duty-bound to defend the donor institution, its practice and the parties connected to it against any possible desecration, a diagnosis given under the conditions of coercion, hastiness with regard to the adherence to the criteria of brain death determination, commercialization or a sale of any kind concerning the donation of organs, the choosing of recipients on the basis of racist criteria, the violation of the waiting list order for a suitable donor, etc.

Conclusion

The Orthodox Church of Bulgaria – Patriarchate of Bulgaria gives Her blessing for transplantation under the following criteria:

1.A strict and law-governed adherence to the fundamental principles of bioethics;

2.Brain death should be determined on the basis of strictly defined clinical criteria, through highly specialized instrumental investigations (angiography, nuclear magnetic resonance, etc.) by an absolutely independent (external) commission. At present the law and the regulations in the Republic of Bulgaria allow the diagnostic process of a brain death to take place without the proof of instrumental investigations, which the Church could not accept;

3.Informed consent in writing (statement) by the donor and next of kin (which organs, cells, or tissues to be taken in case of potential brain death) and not a presumption for total agreement with the act of donation;

4.It is necessary for the entire clinical process of transplantation to be coordinated and implemented by approved national transplantation hospital centers that are trusted by the society and that could guarantee in the best possible way the accomplishment of the brain death determination procedure and the protection of the entire integral rights of the donor, together with achieving the highest success rate levels of the transplantation process, in the best interest of the recipient;

5.The Orthodox Church of Bulgaria – Patriarchate of Bulgaria reserves the right to change Her position in case of a change in legislation and the transplantation law.

 

 

 

 

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