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Vaad Halacha Teshuvah on Brain Death and Organ Transplantation

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Vaad Halacha Teshuvah on Brain Death and Organ Transplantation Halachic Issues in the Determination of Death and in Organ Transplantation Including an Evaluation of the Neurological ”Brain Death“ Standard Sivan 5770 –June 2010 A Study by the Vaad Halacha of the Rabbinical Council of America of the Halachic and Medical Issues Relating to Organ Transplantation from both Live & Cadaver Donors, and the Determination of Death in Halacha. This Study is Designed to Assist Members of the RCA in the Process of Psak Halacha and is itself not Intended as a Formal Ruling. 1 Members of the Vaad Halacha (in alphabetical order) Rav Asher Bush (Chairman) Rav Kenneth Auman Rav Daniel Feldman Rav Tzvi Flaum Rav Dovid Gottlieb Rav Chaim Jachter Rav Zvi Sobolofsky Author: Rav Asher Bush Contributors: Rav Kenneth Auman Rav Daniel Feldman Rav Tzvi Flaum Rav Dovid Gottlieb Rav Chaim Jachter Rav Zvi Sobolofsky 2 Table of Content Section I: Introduction ........................................................................................................................ 6 Methodology .................................................................................................................................... 9 The Question of Death and Organ Transplantation at the Rabbinical Council of America...... 10 Definition of Terms ....................................................................................................................... 11 A Note about Terminology ........................................................................................................... 12 Sec. II: Medical Introduction ........................................................................................................... 13 The Clinical Presentation and Pathophysiology of Total Brain Failure ..................................... 13 1. The ―Vital Functions‖ in Health and After Brain Injury................................................... 13 A. Oxygen In, Carbon Dioxide Out .................................................................................... 13 B. The Role of the Central Nervous System and Ventilator Support ............................... 14 C. Circulation of Blood ....................................................................................................... 16 D. Ventilator Support and Determination of Death ........................................................... 16 2. Total Brain Failure: Pathophysiology ................................................................................ 16 Continuing Brain and Other Functions after the Onset of ―Brain Death‖.................................. 18 Other Medical Conditions that Result in Permanent Cessation of Spontaneous Respiration ... 20 Additional Concerns with the Implementation of the ―Brain Stem‖ Standard .......................... 20 Yoma 85a ....................................................................................... 24/ .יומא פה Sec. III: Analysis of Conclusions .................................................................................................................................... 29 Ohalos 1:6, Chulin 21a .אהלות א:ו , חולין כא :Sec. IV Decapitation, Virtual Decapitation & ―Brain Death‖ ....................................................................... 30 32 ........................................................................... פירוש המשניות להרמב"ם לאהלות פ"א משנה ו' 34 ....................................................................................................... נשברה מפרקת ורוב בשר עמה 36 ................................................................................ יומא פה in light of חולין כא Understanding for the ―Brain Death‖ Standard ................................................... 38 הותז ראשו The Relevance on Rav Shlomo Zalman Auerbach ..................................................................................................... 40 Rav Moshe Feinstein ..................................................................................................................... 41 Sec. V: Responses of Leading American Poskim to Questions posed by the Vaad Halacha ....... 43 Brain Death .................................................................................................................................... 43 Post Mortem Organ Transplantation ............................................................................................ 46 Live Organ Donation ..................................................................................................................... 47 Sec. VI: The Opinion of Rav Moshe Feinstein on Organ Transplantation & Brain Death ......... 48 The Written Rulings ...................................................................................................................... 48 48 ................................................................ אגרות משה )יו"ד ח"ב סי' קע"ד( Responsum of .1 48 ................................................................. אגרות משה )יו"ד ח"ב סי' קמ"ו( Responsum of .2 49 .................................................................. אגרות משה )יו"ד ח"ג סי' קל"ב( Responsum of .3 54 ................................................................. אגרות משה )חו"מ ח"ב סי' ע"ב( Responsum of .4 55 ....................... )יו''ד ח''ד סי' נ''ד labeled) ,"אגרות משה Letter printed in the "8th Vol. of .5 The ―Oral‖ Record ......................................................................................................................... 56 3 1) Rav Dovid Feinstein.............................................................................................................. 56 2) Rav Moshe Tendler .…………………………………………………………………….57 59.…………………………….……………………… נרקב המוח לגמרי The Meaning of 3) Rav Moshe Sherer …………………………………………………………………...…60 4) Rav Shlomo Zalman Auerbach ……………………………………………………...…61 5) Rav Aharon Felder…………………………………………………………………...…61 6) Rav Shmuel Fuerst…………………………………………………………………...…62 Conclusion ...................................................................................................................................... 62 Sec. VII: The Rulings of Other Leading Poskim ............................................................................. 63 Rav Shlomo Zalman Auerbach ..................................................................................................... 63 Rav Eliezer Yehuda Waldenberg .................................................................................................. 69 Rav Yitzchak Yaakov Weiss ......................................................................................................... 69 Rav Ahron Soloveichik ................................................................................................................. 70 Rav Shmuel Wozner ...................................................................................................................... 70 Rav Yosef Shalom Elyashiv.......................................................................................................... 71 Rav Yosef Dov Soloveitchik on the matter of brain מרן הגריד''ס זצ''ל Sec. VIII: The opinion of death and organ transplantation ......................................................................................................... 75 Conclusion ...................................................................................................................................... 76 Sec. IX: The ruling of the Rabbanut HaRashit on the matter of brain death and organ transplantation ..................................................................................................................................... 77 Rav Shaul Yisraeli ......................................................................................................................... 77 Rav Mordechai Eliyahu ................................................................................................................. 79 Rav Zalman Nechemia Goldberg.................................................................................................. 82 Rav Avraham Shapira .................................................................................................................... 83 Rav Dr. Avraham Steinberg .......................................................................................................... 85 85 ................................................................................................................................. יומא פה .1 87 ........................................................................................................... הותז ראשו )חולין כא( .2 3. Our Ability to Establish a New Standard to Determine Death ......................................... 88 91 ...................................................................................... שו"ת חתם סופר )יו"ד סימן של"ח( .4 5. The Position of Rav Moshe Feinstein ................................................................................ 91 6. The Onset of ―Halachically Valid Brain Death‖ ............................................................... 93 7. The Position of Rav Shlomo Zalman Auerbach ................................................................ 94 8. Elaborating on Rav Shaul Yisraeli's Published Position ................................................... 94 95 ..............................................................טריפה The Relevance of the Patient's Status as a .9 10. Reliance on the Medical Establishment ........................................................................... 95 11. The Schneller Law and the Legal Force of the Rabbanut's Ruling
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