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The
article “Sanctity or Desecration?” on religious belief and organ donations,
which originally appeared in the Los Angeles
Times, was re-printed in the Jerusalem
Post (November 8, 2002) with a sidebar that featured the halakhic opinions
of Rabbi David Golinkin. The
following article appeared in the Los Angeles
Times. Sanctity or Desecration?
By TERESA WATANABE
For Los Angeles screenwriter
Robert Avrech, it was a wrenching choice between two of his greatest loves: his
Orthodox Jewish faith and the life of his only son. His son, Ariel, is in critical
need of a lung transplant. Avrech knew of a man who had just collapsed on a softball
field and was in a coma. But Avrech, guided by his religious and moral compass,
would not approach the family about a possible organ donation. It seemed ghoulish,
he said. He saw a slippery slope that would turn the desire for life into a morbid
wish for death in order to harvest organs. Wouldn¹t
that make him no better than a Nazi? Even after the man died, Avrech declined
to approach the family, for he says his Jewish values, particularly the need to
show reverence to the body and respect for mourners, overrode even his desperate
desire to save his son. “It¹s a difficult situation for me, because
I want to save Ariel¹s life,” Avrech said slowly, his voice weighted
with emotion. “But there are worse things than death, like leading an immoral
life.” Avrech¹s
case underscores the sometimes wrenching dilemmas and the vast divergence
of belief that occur in the religious world over the issue of organ donations.
All religions cherish the value of saving lives, but questions of when death begins
and when donated organs may be used have raised a thicket of moral issues.
In Japan, for instance,
an ancient religious belief that cutting a corpse defiles the individual¹s
spirit has severely hampered organ donations. Not until 1997 did the nation recognize
brain death as legal death, becoming the last advanced industrial nation to move
away from the idea that death occurs only when the heart and lungs cease working.
In part, the hesitation stemmed from Buddhist beliefs that transplants from the
brain-dead would deprive a soul of reincarnation. The
Roman Catholic Church, by contrast, has an “upbeat, positive attitude”
toward organ donation, said James Walter, the O¹Malley professor of bioethics
at Loyola Marymount University in Los Angeles. The positive Catholic tradition
stems from the 1940s, when theologians began promoting organ donations as an act
of charity “a willingness to sacrifice for the sake of other people,”
Walter said. Officials turned to the concept of charity because the church until
then had frowned on mutilating a body except for the purpose of benefiting the
greater whole amputating a gangrenous limb, for instance. That “principle
of totality,” sacrificing a part for the whole, could not be used to justify
donations lest it open the door for totalitarian societies, for instance, to claim
ownership of people¹s organs. So a new principle personal acts of voluntary
charity had to be established, Walter said. WITHIN
ISLAM, organ donations are encouraged under the Koranic exhortation that “whoever
gives life, it is like giving life to all human beings,” said Maher Hathout,
a retired Muslim physician and member of the Kuwait-based Islamic Medical Conference.
The group affirmed organ donations as an act of charity several years ago, he
said, stipulating that organs were not to be bought or sold, and that living donors
could not endanger themselves by offering organs. He added that Muslim scholars
have also affirmed the use of organs from pigs a growing supply source
despite prohibitions against eating pork. In
the Jewish world, debate rages between religious movements, and even within them.
“To many people, the issue of organ donations is very emotion-laden,”
said Rabbi Yitzchok Adlerstein, a professor of Jewish law at Loyola Law School
in Los Angeles. “Unless you have a very, very definite cause, and usually
an immediate need, Judaism attaches a high value on keeping the body intact.”
Those attitudes, however,
appear to be changing in at least some sectors of Judaism. In 1995, legal scholars
from the Conservative movement approved a rabbinical ruling that not only declared
organ donations permissible, but said they are an obligation under Jewish law.
“Saving a life
takes precedence over the general principle that honor is due to a dead body,”
said Rabbi Elliot Dorff, an expert in bioethics at the University of Judaism in
Los Angeles and author of Matter of Life and Death: A Jewish Approach to Modern
Medical Ethics. He added that organ donations in fact honor a dead body and give
meaning to the death of loved ones. Since the 1995 decision to deem organ donations
a religious obligation, many Conservative synagogues have promoted them through
sermons, fliers and donor cards, said Rabbi Bradley Shavit Artson, dean of the
Zeigler School of Rabbinic Studies at the University of Judaism.
The issue, however,
remains highly controversial within Orthodox Judaism. Rabbis from opposing camps
continue to debate when death begins at the cessation of neurological functions,
known as brain death, or when the heart and respiratory systems fail. The definition
is key to organ donations, because doctors using heart-lung machines can keep
those systems working for a long time even without a living brain.
Rabbis also disagree
about whether there is consensus on the issue within Orthodoxy, and about the
scope of a late 1980s decision by the Chief Rabbinate of Israel that accepted
brain death as the standard and paved the way for heart and liver transplants.
Rabbi David Bleich, a professor of Talmud at Yeshiva University in New York, said
the vast majority of Orthodox scholars reject the brain-death standard. Traditional
Jews cannot be party to pulling the plug on a patient before the heart and respiratory
functions stop, he explained. He added, however, that Orthodox Jews could receive
organs extracted from brain-dead patients as long as they had nothing to do with
obtaining them. That position provokes a withering rebuttal from Rabbi Moshe David
Tendler, professor of medical ethics and chairman of the biology department at
Yeshiva University. He said Jews who reject brain death should not then be able
to harvest organs from brain-dead patients, or they would be akin to “hit
men” waiting for others to kill someone so they can benefit.
AS THE debate rages,
Ariel Avrech needs donations of at least two lung lobes, which can be extracted
in what medical experts regard as a relatively safe procedure. The 21-year-old
rabbinical student suffers from pulmonary fibrosis, a severe scarring of the lungs
caused by massive chemotherapy he has undergone since being diagnosed with a brain
tumor at age 14. In May, his breathing functions deteriorated so rapidly that
he was forced to return to Los Angeles from his rabbinical studies in Baltimore.
Most of the time, Avrech is attached to an oxygen machine. He tires easily, and
can no longer devote his customary nine hours a day to his beloved Talmud study,
managing only an hour at most these days. Avrech
and his father spend hours watching DVDs together most recently howling
with laughter over a documentary on a Thai Elvis impersonator. Robert Avrech says
his son, who has endured his illnesses without complaint, has become his hero.
“I don¹t know if this is God¹s intention, but Ariel and I know
each other better and love each other more than ever before,” said the elder
Avrech, eyes filling with tears, “I wish Ariel weren¹t ill, but I¹m
going to take advantage of it.” The
family¹s Orthodox community has rallied around. Members of Avrech¹s
synagogue, Young Israel of Century City, in Los Angeles, have brought food, gifts
and even daily services to his home during the High Holy Days. The Jewish Healthcare
Foundation has distributed an e-mail about Avrech¹s plight throughout the
Americas, Europe, Brazil and Israel. The appeal, a “Life-Saving Search for
a Living Lobar Lung Transplant Donor,” says the suitable donor would be an
adult male, age 18 to 50, 5¹8” [173 cm.] or taller, blood type A or
O, a nonsmoker and non-asthmatic in good health. So
far, more than 20 potential donors have come forward, but few if any appear to
meet the qualifications. As time ticks by, the family is reaching out to the broader
community. For his part, Ariel says his ordeal is an example of the unique challenges
God presents everyone, challenges that have helped him grow. He focuses not on
his pain, but on the beauty and godliness his illness has elicited. “People
have displayed tremendous courage, bravery and generosity, and they wouldn¹t
do this if I weren¹t sick,” he said. “I see all the beautiful things
coming out in this world because of me.”
reprinted with permission from the Los Angeles Times The
following article appeared in the Jerusalem
Post.  | Rabbi
David Golinkin with a representative from the Israeli Association for Organ Donors
after a lecture he gave at SIJS on Jewish Law and organ donations. |
Sanctity
or Desecration? -- In Israel
by
Elliot Jager Would
the Avrech family have faced the same halachic quandary if they lived in Israel
and not California? Perhaps, and yet transplants no longer pose insurmountable
halachic complications for most Israelis. When a potential donor is confirmed
brain dead, meaning the brain-stem has ceased to function, the practice
in Israel, using procedures established by the Health Ministry, is to allow organs
(with the approval of close relatives) to be removed for transplant. The crux
of the issue is the precise definition of when life ends. In an earlier era, when
a brain¹s electrical activity could not be measured, Jewish law held that
death was synonymous with a cessation of breathing. But now machines can “breathe”
for a person, allowing the heart to keep functioning even when there is no brain
function. Most organs are recovered from donors who are kept breathing artificially
but are brain-stem dead. There
is no consensus among the ultra-Orthodox on transplants. For some, the decision
comes down to how the responsa of the late Rabbi Moshe Feinstein is interpreted.
Feinstein, founder of Mesifta Tifereth Jerusalem on the Lower East Side of Manhattan,
was considered one of the main poskim (halachic arbiters) of the 20th century.
His son-in-law, Yeshiva University medical ethics expert Rabbi Moshe Tendler,
says Feinstein eventually came to accept the criteria for brain-stem death, but
other poskim say Feinstein never wavered from the traditional “no heart function”
definition of death. Other haredi camps generally concur that transplants from
brain-dead donors are prohibited if the heart is still beating.
But among the modern
Orthodox, the brain-stem criteria (even if the heart and lungs are kept pumping)
is acceptable. This distinction is significant because in some types of transplants,
the chances for success are greater if the heart and lungs are kept functioning
by machine. Despite
opposition from haredi elements, the first heart transplant in Israel was conducted
at Beilinson Hospital in December 1968. That year, Chief Rabbi Issar Yehuda Unterman
gave his qualified halachic approval for heart transplants, conditioning his approval
on the cessation of heart activity. Ten
years later, in response to the second heart transplant, a haredi group, the Public
Committee for Human Dignity, unsuccessfully applied to the attorney-general demanding
that the chief of the operating team be tried for murder. The national religious
camp grappled with the issue, trying to find a way to harmonize halacha with medical
advances. Then minister of religious affairs, Zerah Warhaftig of the religious
Zionist Mizrachi movement, said: “The decision as to when it is permissible
to remove the heart of a donor in a transplant operation cannot be left to doctors
alone.” Since then, several Orthodox physicians who are also talmudic scholars
and experts on medical ethics, such as Rabbi Doctor Mordechai Halpern, have helped
develop Israel¹s transplant policies. BESIDES
definitions of cessation of life, other halachaic issues that make transplants
problematic for observant Jews involve prohibitions on the mutilation of a corpse,
delaying burial, and obtaining benefits from a dead body. Still, most halachic
authorities agree that these concerns areoverridden by the cardinal principle
of pikuah nefesh, saving a life. For haredim, however, these difficulties remain
unresolved if the recipient is a non-Jew. Robert
Berman, founder of the Halachic Organ Donor Society, says: “Even though most
Jews in America and in Israel are secular, when it comes to death and dying they
tend to adopt what they perceive to be a “more religious” approach.
And therefore since they think traditional Jewish law is against organ donation,
they don¹t donate.” Berman¹s
group distributes organ donor cards that allow individuals to select either brain-stem
death or irreversible cessation of heartbeat as the basis of their donations.
He says that “what most people do not know is that in certain situations
it is now medically possible to recover kidneys for up to 40 minutes after the
heart has stopped beating. So those people who believe brain-stem death must be
followed by cessation of heartbeat can now be donors. The society¹s Web site
is www.hods.org. Noting
that there is a severe shortage of organ donors in Israel, Rabbi David Golinkin,
a foremost halachic authority in Israel¹s Masorti movement, has also ruled
that “organ donation after death falls under the category of pikuah nefesh
and should be encouraged, providing it has been established without a shadow of
a doubt that the donor is halachically dead.” Heart and liver transplants,”
says Golinkin, “are the most halachically problematic.” His halachic
ruling embraces the position of Israel¹s Orthodox Chief Rabbinate, which
lists five conditions for allowing heart transplants: -
clear knowledge of the cause of injury
- absolute
cessation of natural breathing
-
clinical proof that the brain stem is indeed dead
-
objective proof such as the BAER test that the brain stem is dead
-
proof that numbers two and three continue for at least 12 hours under full and
normal treatment. These
criteria, says Golinkin, have been in use for heart transplants at Hadassah Hospital
at Ein Kerem since August 1987. The official position of the Masorti movement
is that ‘it is a mitzva [positive commandment] to donate organs after death
because “whoever saves one life is considered as if he had saved the entire
world¹ (Mishnah Sanhedrin 4:6).”
For
Rabbi Michael Boyden, director of the Rabbinic Court (Beit Din) of the Israel
Council of Progressive Rabbis, halacha alone is never the determining factor.
He says: “We all know that the talmudic definition of death is no longer
valid, and that medical research has provided us with updated criteria.²”
Israel¹s Reform movement, says Boyden, examines the classical sources “to
see if they can still speak to us today, but we recognize that the world has moved
on and that the traditional sources cannot be the sole reference from which we
seek guidance today. Traditional Halacha is given a vote but not a veto.”
Boyden says: “Judaism considers one of the greatest mizvot to be the preservation
of life, pikuah nefesh, a mitzva which overrides almost all the mitzvot
of the Torah. I myself carry the Adi Organization donor¹s card, and would
encourage all Jews to do so.” For
their part, Ariel¹s parents, Robert and Karen Avrech, emphasize that they
“see no problem with harvesting organs when doctors declare brain-stem death.
We are seeking two living lobar [partial lung] donors in case there is no time
to wait” for a donation from a cadaver. 
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