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What Does Halachah Say About Organ Donation?

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What Does Halachah Say About Organ Donation? HealthandMedicine Fifteen people die each day waiting for What Does a donated organ. can be declared dead if neurological cated and the stakes are high. If brain lung and kidney transplants (although Halachah Say About tests confirm total cessation of brain death is not halachic death, removal of not for heart transplants). function (including a brain-stem func- the organs is murder. If brain death is At first glance, the use of NHBDs seems tion such as respiration) even if, as a halachic death, failure to remove the to avoid all the halachic issues associated with result of mechanically supplied oxygen, organs could indirectly condemn peo- brain death. After all, if there is no heartbeat the heart continues to beat and blood ple who could otherwise be saved to or circulation, there will be no respiratory continues to circulate. (It must, of activity (neither the brain nor the lungs ORGAN DONATION? course, be emphasized that even under die. This is the single most difficult By Yitzchok A. Breitowitz can function unless they are supplied with the brain-death criteria, persons who problem in the organ donation blood). And, in the absence of both lack higher mental functioning, such as process, and it is essential that one those in a coma or in a persistent vege- consult with his posek before making a heartbeat and respiration, the donor tative state, are unequivocally alive and decision to donate one’s organs. would be deemed dead even under the Transplant surgery is one of the afraid their organs will be harvested Organs and tissues can be removed therefore, their organs cannot be used.) Fortunately, in the long term this strictest of halachic criteria. wonders of modern medicine. Persons prior to their deaths. There is also a at any one of four points—and each Whether halachah allows a determi- may be a diminishing problem. As In reality, however, the use of who, in the past, would have died fear that organ donors who have not point has its own problems: 1. Removal nation of death to be made based on superior methods of preserving organs NHBDs raises ethical and halachic because of the failure of their hearts, yet died will not receive full medical of organs from persons clinically diag- clinical brain-death criteria is a matter are developed, removal could be issues of the first magnitude and essen- livers or kidneys can now have years treatment since there may be a greater nosed as being brain dead but whose of sharp debate among posekim. Some deferred until cardiac death as well as tially involves a prearranged death. added to their lives. Persons who benefit in their passing away. Still oth- hearts are still beating; 2. Removal of analogize brain death to anatomical cessation of brain function is estab- Donors who are not brain dead would have been condemned to blind- ers find the disfigurement and mutila- organs from donors whose hearts have decapitation, which is unequivocally lished. Moreover, the increased utiliza- (although they may be in a coma or a ness can now have the gift of sight. tion of their bodies or those of their stopped beating; 3. Removal of organs deemed “death”; others assert that tion of artificial organs, possibilities of vegetative state) are disconnected from Horribly disfigured burn victims can loved ones repugnant. Whatever the and tissues from cadavers; 4. Removal while true destruction of the brain transgenic transplants (i.e., from ani- life-support (pursuant to the terms of a begin the return to a normal and pro- reason, there is an acute shortage of of organs or organ parts from live would be equivalent to death, clinical mals) as well as stem cell research and living will or the family’s consent or ductive life with the aid of skin grafts. organs; the demand far outstrips the donors. tests do not unequivocally establish therapeutic cloning may eliminate the both). In some cases, the physicians 4 The tragic death of one person can supply. Around fifteen people die This article is designed solely to such destruction; still others rule that need to rely on human donors and wait no more than two minutes, deter- give life and hope to as many as eight each day waiting for a donated organ. familiarize the reader with the general as long as the heart is beating, the per- would not only resolve the brain-death mine there is no spontaneous heartbeat people. At one time, heart transplant Because of the great value Judaism concepts that are relevant to the prob- son is alive irrespective of the brain, quandary but would also greatly or respiration, declare the patient dead and proceed to remove organs. Because surgery had such a low probability of places on the saving of a life—“He lem. In determining what to do in any and a final group asserts that a brain- enhance the organ supply. success that Rav Moshe Feinstein ruled who saves a single [Jewish] life is as if of these situations one should consult dead patient may have the status of a of warm ischemia, typically no more that removal of the diseased heart con- he saved an entire world”5—it would his posek for halachic guidance. safek met—safek goses (possibly dead than two to five minutes can elapse stituted murder of the recipient;1 it was appear that organ donation ought to but possibly alive, though death is II. Donation from from the time life-support is discontin- more likely that the recipient would be encouraged, provided the procedure I. Donations from deemed certain and relatively immi- Non-Heart Beating ued until the organs are harvested. live longer with the bad heart than does not otherwise entail violations of Brain-Dead Donors nent). Although there may be no mitz- Donors There are two distinct halachic prob- with its replacement! Today, with the halachah. To the extent such donation vah to prolong the life of a goses, such lems with this procedure. First, the development of improved surgical is halachically permissible, the unease a life cannot be terminated by affirma- From a medical standpoint, brain- withdrawal of life-support from a non- techniques and anti-rejection drugs, and discomfort the family might feel he traditional legal definition of tive action such as the removal of a dead donors whose hearts are beating brain-dead patient may in itself be an the prospects of at least some degree of at the dissection of their loved one’s “death”T was irreversible cessation of res- vital organ.8 Moreover, the brain-death due to mechanically supplied oxygen act of murder or at least a violation of success are quite high.2 body should be overridden by the piratory and circulatory functions, i.e., standard itself has recently been ques- are optimal sources of organs because the commandment, “Lo ta’amod al dam In spite of the tremendous good that value of pikuach nefesh (saving a life) a person could not be declared dead tioned by some neurologists.9 the organs are supplied with oxygenat- rayecha,” “Do not stand idly by while organ donation can accomplish, rela- and by contemplating the great spiri- until there was both cessation of Both the Israeli Chief Rabbinate and ed blood, and thus they do not deteri- your neighbor’s blood is shed” (Lev. tively few people—Jews or non-Jews— tual merit that would accrue to the breathing and circulation of blood as the Rabbinical Council of America orate even after the patient is declared 19:16), and therefore neither a living “dead.” The vast majority of heart, sign up to be potential donors.3 A niftar (the deceased) whose generosity evidenced by the absence of a heartbeat have accepted brain-death criteria in will nor family consent could authorize and pulse.7 This definition would liver and lung transplants are taken variety of reasons are given for their has enabled others to live.6 Conversely, allowing organ donation.10 Rabbi Dr. such discontinuation.13 Second, even if make transplants extremely difficult from clinically brain-dead donors. to the extent halachah prohibits the reluctance. Some do not want to con- since organs deteriorate rapidly once Moshe D. Tendler, in particular, has However, in order to partially alleviate one concedes that withdrawal or dis- template their mortality. Others are choice, our feelings of sympathy for they are cut off from a blood supply argued that this is also the position of the severe shortage of donors, some continuation of life-support may be those in need of a transplant would (warm ischemia). Accordingly, his revered father-in-law, Rav Moshe.11 hospitals have developed protocols halachically sanctioned as an “omission” Rabbi Breitowitz is the rabbi of the simply be immaterial. The commands American law in all fifty states now rec- Many posekim, however, differ.12 enabling organ removal from persons rather than an affirmative act of mur- Woodside Synagogue in Silver Spring, of God cannot be set aside because ognizes the concept of “brain death” Jewish Action is not the forum to whose hearts have stopped beating. To der, the removal of organs within two Maryland, and an associate professor of others or we perceive them as inhu- (called “brain-stem death” or “whole- fully explore the intricacies of this date, NHBDs (non-heart beating minutes of disconnection would in law at the University of Maryland. mane or politically incorrect. brain death”), which means a person halachic debate. The issues are compli- donors) have been utilized for liver, itself be an act of murder.14 Cessation Fall 5764/2003 JEWISH ACTION Fall 5764/2003 JEWISH ACTION One is not obligated to put oneself in potential sakkanah to save another but to do so is laudable and meritorious.
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