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Nov. 23, 2007
Kosher organ donation
The issue raises medical and religious debates.
DENA DAWSON
If you're a person of a mature age, people have probably already suggested that you make a will, fill out a representative agreement form and do the rest of the end-of-life clearing up. But, has anyone mentioned the organ donation form? Probably not. Jews from Orthodox to Reform are in favor of organ donation – as long as it's the only way in which a life can be saved. The essence of Judaism is respect for life, pikuah nefesh. If you can donate an organ to save a life, then you have once more "saved the world." This mitzvah, of saving a human life, overrides any taboo associated with mutilation of the body after death or of the requirement that a Jewish body be buried whole.
On Nov. 7, at Schara Tzedeck Synagogue, Dr. David Landsberg and Rabbi Moshe Kletenik, spoke about organ donation.
Landsberg is a clinical associate professor of medicine at the University of British Columbia, in the division of nephrology (the study of the kidney). Landsberg moved to Vancouver from Toronto and established the renal transplant program at St. Paul's Hospital, where he is currently director. His research interests include clinical transplantation, transplant immunology and living donation.
Kletenik, a highly respected scholar and authority in Jewish law, has been rabbi of Bikur Cholim-Machzikay Hadat Congregation in Seattle since 1994. Kletenik has been involved in medical ethics for a number of years and, in 2005, was a lecturer and faculty member at the international conference Ethical Challenges in Stem Cell Research and In-Vitro Fertilization, co-sponsored by Columbia and Bar Ilan University in Israel. Kletenik has served as program chairman at several medical ethics conferences.
Landsberg has performed multiple transplants of kidneys, from both living and deceased donors, and he offered some alarming statistics. Canada is one of the countries with the lowest number of donations and British Columbia has the lowest rate in Canada – because there are fewer traffic accidents. The best kidney donors are young, healthy people and very few of them sign donation cards. Without that signature, it is illegal to take an organ, unless the doctor is able to get the family to agree that the potential donor would have wanted to donate.
Although there are many donations from living donors, there are not enough to meet the demand. Therefore, the transplant society is accepting more and more donations from older people, as long as their health permits. Many people will make a living donation of a kidney to a family member or friend, but don't think of making a donation to a person on the waiting list. In fact, 85 per cent of B.C. residents approve of transplantation, but only 15 per cent have registered on a donor card. The B.C. waiting list for transplantation has 362 people on it, although the actual number of people in need is higher. Some people on the B.C. list wait seven years before receiving a kidney transplant and many die before an organ is available.
Although Orthodox, Conservative, Reform and Reconstructionist organizations all support organ donation, there is serious disagreement among them as to when the donor has halachically (according to Jewish law) died. The major debate concerns brain death or, more correctly, brain-stem death, according to Kletenik. In the medical community as well, there is discussion of how death is determined.
Kletenik, who represents an Orthodox view, spoke on this subject at the synagogue. He noted that the rabbinate of Israel and the Rabbinate Council of America allow heart transplants under some conditions. As Kletenik explained, employing a respirator and a pacemaker to maintain the organs of a clinically and halachically dead person is not hastening death, but preserving viable organs for transplantation.
According to Kletenik, this is the central issue of discussion in the Orthodox world. Some rabbinic authorities accept the medical definition of brain-stem death and others require that the heart irreversibly stop beating. Dr. Robert Daum, a professor of Jewish law and ethics at UBC, points out that, in 1994, Moshe Tendler and Fred Rosner proposed an influential resolution of the continuing halachic impasse: "Brain death is a criterion for confirming death in a patient who already has irreversible absence of spontaneous respiration."
Landsberg cautioned that organ recovery must take place very soon after cessation of the heartbeat because, without a continuing blood flow to the organs, they too die. The Rabbinate Council of America approves organ donation from brain-stem dead patients – this sets them in conflict with other Orthodox views.
This debate is likely to continue for a long time. One solution, offered by the U.S. Halachic Organ Donation Society, is a donation card on which you can specify your choice – you agree to donate organs for transplant only after either irreversible cessation of autonomous breathing (as confirmed by brain-stem death) or irreversible cessation of heartbeat.
Another issue that arose in the discussion was whether a Jew could donate an organ for research purposes. The answer given was no, because it doesn't directly save a life. The long-term goals of research, to save many lives, do not fit into the historic Jewish viewpoint, according to the speakers.
But Kletenik showed how flexible Jewish views can be. For example, he said, one may donate a cornea to a blind person, even a one-eyed person, because that person is in danger of being harmed. A woman can donate a uterus (if there is no harm to her) to someone who isn't fertile, because that woman is suffering, he added.
Dena Dawson is a Vancouver freelance writer.
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