Resistance to practice gradually lifting in Israel
WENDY ELLIMAN
Special to Jewish News
Too many Israelis in need of new kidneys, hearts, lungs and livers must go to Europe or North America to get them - or die waiting.
However, although organ donation has been slow to catch on among Israel's most observant Jewish and Muslim populations, the country's sluggish record for organ donation is, at last, on the upswing. Whereas two years ago, an average 300 healthy people were signing themselves up each month as potential donors, today that figure has increased tenfold. And at the Hadassah-Hebrew University Medical Center in Jerusalem, where no organs at all were donated through 1996 and most of 1997, there was a donor a month for the first three months of 1998 - and 10 people received a new lease on life from those organs.
The pace of donations has been steady since then, and several factors are contributing to this year's upsurge, according to Sari Gotthold, Hadassah's transplant coordinator since November 1997. One is the ongoing education/information effort conducted in Israel by individuals, groups and hospitals for some 20 years. Another is the recent centralization and coordination of this campaign.
"A few years ago, the Health Ministry looked around and saw that organ donation in this country was a disaster," says Gotthold. "Then they looked further afield and saw that the Spanish had developed a very successful system, which upped the number of organs donated there from seven for every million people to 27 for every million within a year. So they adopted the Spanish model: they provided for the appointment of a transplant coordinator in every hospital in Israel; they run ongoing seminars to help coordinators function effectively; and they computerize the details of all those waiting for organs so that they can be rapidly matched with donors."
Gotthold fails to mention that the successful securing of donors - at least at Hadassah - sprang to life with her own appointment. What she does say is that requiring all transplant coordinators to be experienced nurses makes good sense.
"At first, the thinking was that it's a job for social workers," she says. "But we've seen that that's mistaken. What I do as transplant coordinator is essentially a nurse's job, much as I've worked for the past 20 years."
And a nurse's job, she says, is supporting families through the ordeal. "Last month, nine potential donors were admitted to Hadassah," she says. "One fortunately recovered; one went into a vegetative state; and in another, brain death was never established - but that's not the point. I spent days with the families of each, introducing myself as a nurse who works with families of the severely ill. I went with them into the intensive care unit, stayed with them while they spoke to the doctors. I brought them drinks, showed the observant where to go for minyan.
"What I did was build a human connection," she adds. "Yes, I had an ulterior motive, but I also did it for its own sake. That's part of what a nurse's job is."
Family approval is key
One recent potential donor was a 19-year-old woman completing her Israel Defense Forces service. She had suffered a brain aneurysm, and had no chance for recovery.
"Her parents were Russian immigrants," says Gotthold. "I spent several days with them, trying to help them come to terms with the approaching loss of their daughter. Once the hospital committee formally declared this beautiful girl brain-dead, I brought up organ donation. The parents wept. I waited till they were calmer, and then said, 'You've told me so often these past few days how wonderful a girl she is, how all she ever wanted to do was help others. If you could ask her now, don't you think she'd take this last chance to help?' They agreed to donate her organs."
Another recent patient was a 70-year-old, ultra-Orthodox Hassidic Jew. "He'd been hit by a bus and was already brain-dead when he was brought to the hospital," says Gotthold. "His heart and lungs were too old to help anyone, but his kidneys were in good shape. I spent a lot of time with his wife and four grown children.
"With one son in particular, I connected very well, and it was with him that I first raised donating his father's organs," Gotthold continues. " 'What will happen if we agree?' he asked. I gave him the details, finishing with, 'And you'll have the mitzvah of saving a life.' He took the suggestion to his mother and siblings. Their reaction: 'How can you even think of it without asking the rebbe?'
"Well, their rebbe has never yet agreed to organ donation, and he didn't on this occasion either. His advice was to continue treatment and there would be a miracle."
There was no miracle. Two days later, the patient went into cardiac arrest, and his heart followed his brain into death. Gotthold, however, was encouraged nonetheless.
"That one son heard me, and understood - perhaps this is the start of a softening in the ultra-Orthodox community," she says.
Observant Muslims have been as implacably opposed to organ donation as ultra-Orthodox Jews. Two of Gotthold's successes, however, have been with Muslim families.
"One was Ahmad, a 6-year-old from Hebron," she says. "He and his father were injured in a car accident. The child never had a chance. Two of his uncles and several cousins agreed to give his organs.
" 'A human being is a human being,' they said. Perhaps they thought that if they helped others, Allah may help the father, who was still unconscious."
Desperate though the need for organs is, Gotthold wasn't satisfied with the agreement of the child's uncles and cousins alone.
"The boy had a mother at home in Hebron," she says. "It was problematic reaching her, because of the Israeli/Palestinian Authority areas of rule, so we contacted the army. They sent an officer and a car to take the two uncles to see the mother. Predictably enough, she said that whatever the men decided was all right with her."
Gotthold believes intensely in securing agreement from the widest family consensus as possible, to prevent recriminations later. "Even if the brain-dead patient has a signed organ donor card, I still seek the family's consent," she says. "This is my own personal ethic. I use the fact of the card. I say, 'Look, he wanted to give.' But if they refuse, we don't take the organs."
Gotthold, herself religiously observant, is one of only 130,000 Israelis with signed donor cards in their possession - as are her five grown children. "It's something I believe in passionately," she says. "I worked for 20 years in the open-heart surgery recovery room, and cared for many heart transplant patients. I've see with my own eyes what a new heart does for a desperately sick patient. I think that my total conviction helps me persuade others."
Wendy Elliman is a freelance writer living in Israel. This article was distributed by Hadassah, a women's Zionist organization that supports medical programs in Israel.
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