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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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.