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Just a Pump. For the surgeon who would transplant a heart, the problems are manifold and more difficult, with moral and ethical as well as medical considerations involved. Since ancient times, the heart has been apostrophized as the throne of the soul, the seat of man's noblest qualities and emotions—as it still is in poetry and love songs. But even the Vatican newspaper L'Osservatore Romano noted last week that "the heart is a physiological organ and its function is purely mechanical." In fact, the heart is nothing more than a pump. There is no more soul or personality in a heart than in a slice of calf's liver.
But on one score the ancients were right. The heart is essential to life in a more immediate, temporal sense than any other organ, even the brain. The human body can survive for years in a coma, with no conscious brain function —but only for minutes without a beating heart. So the presence of a heartbeat, along with breathing, has long been the basic criterion for distinguishing life from death. It still is, in the vast majority of cases, despite some special situations in which the brain's electrical activity is a more reliable index. (So far, no surgeon has seriously considered transplanting a brain, because, beyond the forbidding technical difficulties, this would be akin to transplanting a person. Similarly, transplantation of entire gonads—ovaries or testicles—might carry with it a change in hereditary material.)
The real moral and ethical difficulty in heart transplants arises from medical uncertainty. Even when the heart has "stopped cold" and there is no more respiration, the condition is often reversible—as is proved countless times every day by first-aid squads and lifeguards as well as doctors. The surgeon wants the donor's heart as fresh as possible, before lack of oxygen causes deterioration or damage—that is, within minutes of death. This has raised the specter of surgeons' becoming not only corpse snatchers but, even worse, of encouraging people to become corpses. The question remains: Where should the line be drawn between those to be resuscitated and those not to be?
Equally acute is the ethical problem regarding the proposed recipient of the heart. Obviously he is close to death, or such drastic surgery would not be contemplated. Yet his own heart must be cut out, which is tantamount to killing him, while he still retains vitality enough to withstand the most Draconian of operations. If the transplant should fail, he will certainly die. Thus the surgeons will, in effect, have killed him (as they might in any major operation), no matter how lofty their motive in trying to prolong his life and make it more satisfying.