Ultra-Orthodoxy and Organ Donation

After learning the results of an experiment involving a decapitated sheep, Rabbi Shlomo Zalman Auerbach decided to permit organ donations.

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Reprinted with permission from The Jerusalem Post, August 2, 1992.

When a revered haredi [ultra-orthodox] rabbi reverses his position and rules that organ transplantation is permissible and not--as he previously stated--“bloodshed,” will his followers change their views as well?

As first reported by The Jerusalem Post, Rabbi Shlomo Zalman Auerbach--regarded as one of the foremost halakhic arbiters of the age and influential among many modern Orthodox Jews--now regards organ transplantation as allowable under Jewish law.

Auerbach recently accepted the definition of “death” as being cessation of function by the brain stem, which controls breathing and other vital bodily functions. If brain-stem function is proven by various tests to have ceased, doctors may turn off the respirator. If the person’s heart is asystolic (shows “heart silence”) for 30 seconds, vital organs may be removed for transplant, the rabbi stated.

Despite his ruling, Auerbach has not issued a public call for organ donation.

Health Minister Haim Ramon responded to the rabbi’s ruling by saying that he “welcomes all efforts to increase the number of organ donors.” He added that the matter of the 30-second delay would be studied by the ministry. Prof. Joseph Borman, head of the cardiothoracic surgery department at Hadassah-University Hospital, which has performed most of the country’s heart transplants, said he was “willing to meet with anyone, anywhere and at any time to increase the pool of available organs.”

Rabbi Yehoshua Scheinberger, “health minister” of the ultra-Orthodox Eda Haredit, is the haredi community’s coordinator with the medical world here and abroad. He told the Post that he was aware of Rabbi Auerbach’s new position on transplants. “The haredi community in Israel is so emotionally opposed to the idea of transplants, that a ruling that they are permissible, even by someone with the stature of Rabbi Auerbach, is not enough to overcome basic beliefs and fears about this.”

Scheinberger arranges organ transplants abroad for haredim who need them, since accepting organs removed from non-Jews is regarded as less objectionable, he said. “Unfortunately, most haredim don’t trust the doctors to follow halakhic procedures exactly as delineated by the great rabbis. They just don’t believe they can rely on them.” He was pessimistic that the gap between the haredi and medical communities could be bridged in the short run. “I am ready to sit down with the doctors and discuss the matter, and then go to the top rabbis of the Eda Haredit’s [haredi community’s] rabbinical court (Badatz [which stands for beit din tzedek, or court of justice]), even though this would arouse great opposition. The doctors would have to initiate talks, but I would be ready to be a go-between,” Scheinberger said.

If given no alternative, some transplant surgeons would accept Auerbach’s requirement for a 30-second waiting period after removal from the respirator. Others insist that it is irrelevant in determining brain death and significantly reduces the chances of a donor heart functioning well in the recipient.

Some years ago, the Chief Rabbinate approved the principle of brain-stem death. The chief rabbis have formally approved heart transplants under rabbinical supervision at Jerusalem’s Hadassah-University Hospital, and more than a dozen Israelis owe their lives to such surgery. But the Chief Rabbinate has not issued a halakhic ruling on liver transplants because doctors here have less experience with that surgery. Nevertheless, half a dozen such transplants have been performed successfully in the past year without the chief rabbis objecting.

Rabbi Dr. Moshe Tendler, a biologist at New York’s Yeshiva University and chairman of the bioethics commission of the (Orthodox) Rabbinical Council of America, said he helped persuade Auerbach to recognize the validity of brain- stem death and the permissibility of organ transplants.

Since decapitation is regarded by the Talmud as the only applicable model for brain death, Tendler and Hadassah-University Hospital medical ethicist Rabbi Yigal Shafran arranged for an $8,000 experiment a few months ago. A pregnant sheep, close to giving birth, was decapitated and organ viability was maintained with a respirator. The decapitated sheep was kept on a respirator for several hours with heart action and blood pressure remaining within normal limits. A live lamb was delivered by cesarean section.

That, Tendler said, proves that neither a beating heart nor a live fetus is a sign of life when an animal is on respiratory support. Auerbach modified his view after being notified of the results of this experiment. But a potential donor’s heart must not continue beating on its own after being taken off a respirator for 30 seconds, he ruled. “I had thought that this was impossible. I had thought that a heart cannot beat in a dead person, but the experiment proved that it can beat,” Auerbach decided.

Tendler said that waiting 30 seconds does not affect the success of a lung or liver transplant, but most doctors believe it lowers the chances of success in a heart transplant. The heart must be removed from the brain-stem-dead donor while it is still beating via the respirator.

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Judy Siegel-Itzkovich is health and science correspondent of The Jerusalem Post in Israel. She is also Israel correspondent of the British Medical Journal. In 1997, she received the Women of Distinction Award (in the field of journalism) from the 350,000-member Hadassah Women's Zionist Organization of America.