Are Transplants Permitted
The life of many ill people depends on whether or not organs for transplant can be found for them. Today, hearts and livers can be taken from people who have been seriously injured and their brains, including their brainstems, have died, but their heart continues to beat by the use of a respirator. If the heart stopped beating, the blood and oxygen would cease to flow to the organs, and they would atrophy and deteriorate. But since the blood system continues to function, the organs remain active and suitable for transplant.
The essential question of Jewish law is: what is the status of a person who is brain-dead, however, his heart is still beating? If he is considered alive, taking his organs is murder; if he is considered dead, it is a mitzvah for the members of his family to donate his organs to save lives.
Difference of Opinion
In principle, it is agreed that death is decided according to breathing (Yoma 85a; Rambam, Shabbat 2:19; Shulchan Aruch 329:4). Since breathing is dependent on the brain, according to a number of prominent Jewish law arbiters, a person whose brain has been completely destroyed – including the brainstem, which is responsible for breathing – and cannot return to function and breath independently – is considered dead, and it is permissible to take the organs of someone who is brain-dead for the purpose of transplant (Rabbi Goren, Rabbi Yisraeli, and heard in the name of Rabbi Feinstein).
In opposition, other prominent arbiters believe that, as long as the heart is beating, a person is considered to be alive, and someone who takes his organs for transplant, is regarded as murdering him (Rabbi Waldenberg, Rabbi Wozner, Rabbi Eliyashiv).
Rabbi Shlomo Zalman Auerbach, of blessed memory, also forbid, and although, in principle, his opinion was that the brain determines death, nevertheless, he feared that all the doctor’s medical tools were not precise enough, and that according to their tests, they will conclude that the brain is completely dead, but in truth, parts of it is still alive.
Our Rabbi’s Decision
This question arose during the tenure of the Gaon Rabbi Avraham Shapira, and the Gaon Rabbi Mordechai Eliyahu, both of blessed memory, as Chief Rabbi’s. In conjunction with their colleagues, the Gaon Rabbi Shaul Yisraeli ztz”l and other members of the Rabbinical Council, they delved into this topic, and in 5747 (1987) decided that death is determined according to the brain, permitting the transplanting of organs from a person who is brain-dead.
One of the sources for this is in the Mishna (Ohalot 1:6), which states that a person whose head was decapitated is considered dead, even though his body convulses. It became evident that if an animal’s head was decapitated, but its’ body was connected to a respirator, the heart would continue to beat. This proved that the heart beating after brain death is not a sign of life, but similar to the convulsions of someone whose head has been decapitated.
In order to prevent any doubts, strict control conditions were set, via which it could be clearly confirmed that indeed the brain had died, including the brainstem. Along with other information, the rabbi’s made use of the research and development of Professor Chaim Sommer, a religious, internationally renowned neuroscientist. They also conditioned their approval, stipulating that one of the two doctors deciding brain-death must be a religious doctor whom they trusted.
It should be pointed out that our Rabbi’s standpoint requiring the inclusion of a religious doctor on the panel of those deciding when a person has died does not stem from stubbornness or a desire to interfere in the work of the doctors. The requirement comes from a well-founded concern, for there are doctors who feel that it is permissible to take organs also from someone defined as being a “vegetable” or about to die, even though he is not completely brain-dead, because, in any case, there is no chance for him to come back to life. And although this approach stems from good intentions, according to ‘halacha’ (Jewish law), it is considered murder.
The Ugly Side of the Medical Establishment
But then the ugly side of the medical establishment was revealed. For years, members of the medical establishment claimed that the rabbi’s didn’t care about saving lives. Without understanding the severity of the issue, and the difficulty of ruling in a question which deals with an action that is possibly murder, or possibly saving of a life, they accused the rabbi’s of being scared to decide ‘halacha’, and in the meantime, they claimed, people needing transplants were dying. But, behold, when the Chief Rabbinate did decide to be lenient in this issue, suddenly, it became clear that there is something more important than saving lives – the honor of the medical establishment. True, the issue of transplants is important, but not so important that one of the doctors deciding the moment of death should be decided by the Rabbinate. Let all those in need of transplants die – provided that the Rabbinate is not a partner in deciding the moment of death. Indeed, this is exactly what happened: tens of people died as a result of the medical establishment’s stubbornness.
In practice, the decision of the Chief Rabbinate went down the drain. Hospitals did not acknowledge the instructions of the Rabbinate, and the rabbi’s could not encourage their followers to donate organs. The percentage of those willing to donate remained low.
Over time, the medical establishment was forced to soften its position, kindly agreeing to include a clause on the ‘Edi’ donor’s card, allowing religious people to indicate that the donation is conditional on the consent of a “clergyman” acceptable to the family. It seemed for a while that the addition of this clause would solve the problem, and allow religious and traditional Jews to donate organs for transplants. In practice, however, the addition of this clause didn’t help much, because over 99% of “clergymen” are not familiar with the devices meant to check the situation of the brain, and consequently, cannot permit the disconnection of someone from a respirator. Thus, the possibility of taking organs for transplant was lost. Only when a way was found reach one of the doctors who are experts in this issue, were they able to permit organ transplants according to the decision of the Rabbinate.
Years ago, I wrote that the most desirable solution of the problem would be the establishment of an independent body which is not reliant on the medical establishment, that would join rabbi’s and religious doctors, who decide the moment of death according to the fundamental decision that brain-death is considered death.
Recently, we were informed that an organization called “Areivim” was established to solve the problem. At the head of the organization stand three of the foremost leaders in the field of ‘halacha’ and medicine: Rabbi, Doctor, and Professor Avraham Shteinberg, author of the exceptional series “Encyclopedia of Jewish Law and Medicine”, and the first editor of the series of books “Asiya”, the central platform for clarification of the Jewish laws of medicine; Rabbi, Doctor Mordechai Halperin, Director of the “Shlezinger Institute”, who, for over twenty years has edited “Asiya”; and Rabbi, Professor Yigal Shafran, head of the department of “Medicine and Halacha” in the Chief Rabbinate, and head of “Merchavim”, a teacher’s training institute which will manage the organization.
They have begun to train tens of religious doctors from all the hospitals in Israel, who can perform the tests required to decide the moment of death according to the ‘halachic’ decision of the Rabbi’s. And thus, without having to ask rabbi’s who are not experts in the field, to enter into all kinds of doubts, and usually, to avoid donating organs – even in cases where it is permitted and even a mitzvah – the family members can donate the organs of their dying loved one’s without worrying. Thus, together with the tremendous sadness, they can fulfill a great mitzvah of saving lives, and this will be the most wonderful mitzvah they can call fulfill for the elevation of the deceased soul.
Signing This Card is a Mitzvah
To this end, a new donor’s card called “B’levavi” has even been issued, confirming support for the position that believes it is a mitzvah to donate organs according to the tests required on behalf of “Areivim” – “The Committee of Rabbi’s and Doctors in the Matter of Transplants.” Indeed, on this type of card – it is a mitzvah to sign. May it be His will that in the merit of our readiness to save other’s lives, we will merit long life, and to be written and signed in the Book of Life for a good year.