Last week I went to renew my Pennsylvania Driver’s License. Things went better than I had hoped. For one thing, I didn’t have to take any tests, which was a big relief, because the last time I had to take the written test I came within one question of failing. For another thing, the Department of Motor Vehicles gave me a chance to change my photo if I didn’t like it. When my smiling face came up on the computer screen, the technician asked if I was satisfied or if I wanted a retake. Actually, the photo looked all right to me, but having to choose does take some of the adventure out of getting a new license.

My reason for mentioning this domestic errand is that it made me start thinking about organ donation. A few months ago, when I received my temporary license in the mail, I also received a pamphlet from the Pennsylvania Department of Health called “The Greatest Gift.” It began like this: “Please take a moment to consider giving the greatest gift that one human being can give to another. That gift is the gift of life. You may give someone else life by donating an organ or other tissues after death to those who are critically ill and in need of a transplant. The need is urgent.”

The pamphlet went on to explain that far more organs are needed than are donated. It also said that when I went to renew my Pennsylvania Driver’s License, I would be asked if I was willing to become a donor. If I had any questions, I should talk things over with my family, my doctor, and my local clergy. That part about the clergy made me wonder if any of you are counting on my help. And, in fact, I am sometimes asked if I am in favor of organ donation.

Organ donation is probably the kind of thing Christians are free to disagree about, but there are some good reasons to be a donor. To spare you any further suspense, I should tell you that I signed up to be one myself, although I was a little alarmed when I first saw my license. Underneath my picture, in capital letters, it says, “ORGAN DONOR.” Not “potential organ donor,” or “future organ donor,” just “ORGAN DONOR.” It made me wonder if I had signed up for more than I had bargained.

There are several different kinds of organ donation. Sometimes family members have the opportunity to donate an organ like a kidney to someone else within the family. Provided the surgery does not unnecessarily threaten the life of the donor, and provided the donation is genuinely voluntary (i.e. the donor is not pressured in any way), this is a permissible, an admirable, indeed sometimes a life-saving thing to do.

Many other organs are donated at death (hearts, lungs, kidneys, livers, etc.)–and this is where the Department of Motor Vehicles comes in. At any given time, some 40,000 Americans are waiting for a vital organ. Patients who die from disease or old age generally are unable to make a healthy donation, so the best organs usually come from the 10,000 or so annual victims of massive head trauma, the kind produced by a bad traffic accident.

Donating such an organ is one way to show love for your neighbor. It demonstrates in the most tangible possible way that we are all made of one blood (Acts 17:16). It may also be good stewardship. After all, where you are going, you will not need the organ anyway. No matter what happens, eventually your body will return to the dust (Gen. 3:19), and God will have to perform a miracle of supernatural power to raise you from the dead. Giving up an organ or two will make no difference at the resurrection.

Still, some Christians may feel uncomfortable about parceling out their organs, and their reluctance should be honored. There is a great deal of pressure in our culture to treat persons as things. Whenever the body becomes a commodity to be bought and sold, Christians are right to insist that God has made us whole persons, body, soul, and spirit. One of the reasons Christians have always taken care to bury their dead is because we believe in the sanctity of the body, dead as well as living. (Incidentally, the bodies of organ donors are generally returned to their families for burial).

Depending on how it is done, transplanting an organ runs the risk of violating that sanctity. The Pennsylvania pamphlet asks, “Could there be any conflict between saving your life and using your organs/tissues for transplantation?” The answer the state gives is, “Absolutely not! Donation is considered only after all efforts to save your life have been exhausted and does not occur until death is certified.”

That is true, as far as it goes, but there is still the question as to what is meant by the phrase “death is certified.” Obviously, the longer a body has been dead, the less viable its organs are, so physicians want to transplant them before they have a chance to deteriorate. Since 1968, American doctors have generally pronounced a patient dead when all brain activity ceases. This allows some organs to be taken from a body that is still on life-support, with a breathing lung and a beating heart. On occasion, doctors will even restart a heart after a patient has been declared legally dead.

There is always something artificial about the life of someone on life-support, of course, but it still means that some donors are not quite dead when they give up their organs, or at least there is some doubt as to whether they are dead or not. To put it in a provocative way, doctors are sometimes willing to remove organs from a body that undertakers would be unwilling to bury. As a result, I am not certain that the safeguards the medical community has established for organ donation are altogether adequate. I shudder at the possibility that one day physician-assisted suicide will produce organ donors who are not dead at all.

Although I have reservations about the way transplantation is sometimes practiced, I am not opposed to it in principle. The Pennsylvania “Voluntary Uniform Anatomical Donor Card” helpfully provides space for “limitations or special wishes.” On my own card I have added the following notation: “organs not to be removed while body is still on life support.” This is my way of practicing the sanctity of the body in death as well as in life. The sanctity of the body is something all Christians–whether they plan to become organ donors or not–should seek to preserve.

[There is a helpful chapter on organ donation in Gilbert Meilander’s Bioethics: A Primer for Christians (Grand Rapids, MI: Eerdmans, 1996), pp. 88-103]