July 30, 1999/17 Av 5759, Vol. 51, No.43
It's a mitzvahNew technology ushers in redefinition of death - and way to give lifeABIGAIL PICKUS
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 When people donate the bodily organs of brain-dead loved ones, it often becomes possible for surgeons to save lives using transplant surgery. |
At the age of 12, Yomtoob, an Iranian Jew from Michigan, declined from robust health to hovering on the brink of death.
An extremely rare genetic disorder called Wilson's disease had contaminated his liver with so much copper that David practically disappeared, ravaged to the point where he dropped to 57 pounds and finally lapsed into a coma.
For a week, his family kept a bedside vigil, waiting for a liver to become available. Then, on Selihot, David was given the gift of life.
Selihot, the night when Jews traditionally ask God for forgiveness, occurs a week prior to Rosh Hashana, the Jewish New Year, which begins the High Holidays, during which the fate of who will live and who will die is sealed in the book of life.
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maintain Torah prohibits organ donation |
"David really was a breakthrough. No one thought he was going to make it; he was so sick," said his mother, Parichehr Yomtoob, who lives in Riverwoods, Ill., with her husband, Youssef. "It was a miracle."
Now David is 30 and his transplanted liver has failed him. Doctors think this may be due to complications with his bile duct and not necessarily because of the liver itself. Married, and with a little 2-year-old daughter, he awaits another transplant, too fatigued to work full-time, his life once again hanging in the balance. He has been waiting since April of last year for a liver to become available.
In a phone interview from his home in Michigan, he admitted he sometimes is frightened. "It's not easy not knowing what the future holds."
A question of Jewish law
David Yomtoob is one of 63,000 Americans waiting for a new organ. While the need is great, United Network for Organ Sharing (UNOS) estimates that a new person is added to the database every 16 minutes. Not nearly enough organs are donated to meet the need.
According to Jewish leaders from across the established movements and denominations, organ donation, far from being against Jewish law, is a Jewish obligation.
"Since we have a religious obligation to save human lives when in danger, and since that obligation overrides all other religious obligations, we are obligated to give (organs). To refuse to give consent is a violation of Jewish law," said Rabbi Joseph H. Prouser of Congregation B'nai Sholom in Newington, Conn.
Prouser's position statement on organ donation, "Chesed or Chiyuv? The obligation to preserve life and the question of post-mortem organ donation," was passed in 1995 by the Committee on Jewish Law and Standards of the Conservative movement's Rabbinical Assembly.
The applicable commandment is pekuach nefesh (the mitzvah of saving a life), which takes precedence over everything except prohibitions against murder, idol worship, and sexual perversion, say Jewish organ-donation supporters.
"What is the fundamental value among the Jewish community? The dignity and sanctity of human life. If we have evolved technology to make choices to save human lives, we have the divine commandment to do that," said Rabbi Richard Address, director of the Department of Jewish Family Concerns for the Reform movement's Union of American Hebrew Congregations, the first denominational movement to actively promote organ donation with its "Matan Chaim: the Gift of Life" program. This far-flung educational outreach program includes the distribution of organ donation cards and study guides that include sermons and rituals for donating and receiving organs.
Modern advancements
The concept of organ donation has brought the Jewish community to a modern turning point in interpreting halachah (Jewish law). The traditional definition of death - the only one at the time the Talmud was written - was cardio-respiratory failure, tested by placing a feather in front of a person's nose. If the feather failed to flutter, the person was pronounced dead.
But with the development of the respirator, a new concept emerged: brain death or brain-stem death. When a respirator artificially pumps oxygen into a person's lungs after the brain has died, blood and oxygen continue to circulate to the vital organs, keeping them functioning. Add to that the development of immuno-suppressive therapy - drugs that prevent the body from rejecting foreign tissue, such as someone else's organ - and a fully functioning organ from a "dead" person can be successfully transplanted into a living person.
"Brain death is the same as physiological decapitation - the brain is no longer connected to the body physiologically," according to Rabbi Moshe Tendler, biology professor at Yeshiva University in New York City, professor of Talmudic law at Yeshiva University's Theological School and chair of the Biomedical Ethics Commission of the Orthodox movement's Rabbinical Council of America.
"Brain death means you cannot breathe at all, cannot respond to stimuli, cannot process information. You're not alive," said Tendler, who appeared before the Chief Rabbinate of Israel to advocate accepting brain death as valid under halachah. The Chief Rabbinate allowed this neurological criterion of death in 1991, the same year that the Orthodox movement's Rabbinical Council of America approved organ donation as permissible and Jewishly obligatory.
But Rabbi David Bleich, rosh yeshiva (head of the yeshiva) at Yeshiva University, has emerged as Tendler's most vociferous opponent. For Bleich, there is only one definition of death: cardio-respiratory failure, which means that removing organs from a person whose heart is still beating, albeit because of a respirator, is akin to murder.
"Jewish law doesn't take cognizance of brain death. It must be a cardiac cessation. ... Death occurs only when all bodily functions cease. There is no such things as brain death because the heart is still beating, still regulating body temperature, and metabolic activity is still going on. The concept of brain death doesn't exist medically. It's a clever marketing device," he said.
Tendler, who has a doctorate in microbiology, said that Bleich "regrettably has little understanding of biology and medicine."
Resurrection of the dead?
Rabbi Elliot Dorff, rector and professor of philosophy at the University of Judaism in Los Angeles and vice chair of the Conservative Movement's Committee on Jewish Law and Standards, called the belief held by many Jews today that it's against halachah to donate organs "a folk belief that runs very deep." Dorff said that in his talks across the country on modern medical ethics, including organ donation, there is always someone who says that to be resurrected when the messiah comes, a person must be buried with his organs intact.
Never mind that after a person dies, the body disintegrates. And never mind that as the medieval Jewish philosopher Saadya Gaon pointed out, if God created man and the universe out of nothing, then God could certainly recreate a person from what remains.
Still, what Dorff describes as folk belief persists, and its magnitude is such that it impedes doctors working to save human lives, especially in Israel. Because Israel accepted so many more organs than it contributed, it no longer belongs to the international organ bank.
"There's nothing wrong with a folk belief except if it prevents us from achieving important purposes, like saving life and health," said Dorff, whose book "Matters of Life and Death: A Jewish Approach to Modern Medical Ethics" includes a chapter on organ donations.
Such beliefs are rooted in Judaism's strong position on respecting the body and honoring the dead. "This widespread misperception is based on a good intention. The important principle in Jewish law is reverence for the body, which extends even after death," said Prouser.
Confronting death
The one thing no one disputes is that organ donations save lives. A well-known case in the Jewish world is that of Alisa Flatow, the 20-year-old American college student killed by a terrorist bomb in Israel in 1995. Her parents, after consulting with their rabbi and Tendler, donated her organs to six people, including one who received her heart.
"Do we not have the obligation in the religious context if, God forbid, something happens, to (demonstrate that) there is a Jewish response to tragedy, (that) one can give the gift of life?" posed Address of UAHC.
Still, it's an unpleasant topic to broach, especially with parents of a young person who has died. "Do you want to talk about the fact that to give away your heart, you have to die? It's as brutal as that - it raises issues of death," said Address. "Tragically, (teenagers] do get into automobile accidents."
Worries persist
Because of moral and ethical principles, there are strict laws prohibiting the sale of organs, but because the number of donors is so low, Pennsylvania recently passed a controversial measure under which the state will pay funeral expenses for organ donors.
Some people, meanwhile, fear that if a potential consenting donor is in a perilous situation, the attending doctors will not provide all the medical care necessary and instead will hasten the death so that the organs can be removed. Doctors are quick to reassure people that such medical behavior is not only illegal, but anathema to the principles of medicine.
Finally, there are psychological effects connected to organ donations that linger long after a transplant has been done. "There is often a psychological transfer. The question of self-identity: I have someone else's heart, am I still I?" said Dorff.
Compounding these concerns is a system less than perfect. Given the sheer magnitude of the demand for available organs, UNOS - a national registry established in 1984, after the National Organ Transplant Act was passed - divides the country into regions. A resident of one region waiting for an organ can't receive a compatible organ from another region, unless no one in that region is compatible.
UNOS says the system makes sense because organs are too perishable to transport far away. "We really can't ship organs across the country, which is why they are offered locally first, then regionally, then nationally," said Bob Spieldenner, UNOS spokesman.
Still, the chief concern is "the desperate need for organs," said Dr. Alfred Soffer, a Chicago cardiologist and world-recognized medical editor, who regularly lectures to synagogues on Judaic bioethics. "We must establish an equitable system which would identify the patients most likely to experience successful transplantation. There has to be an impartial system structure. It doesn't exist today," said Soffer.
'In God's hands'
In the meantime, as rabbis and Jewish educators spread the word, and as medical scientists work on new technologies and advances, including the possible development of immuno-suppressors that would enable the successful transplant of animal organs into humans, people like David Yomtoob wait.
"What we went through we wouldn't want anyone else to have to go through," said Parichehr Yomtoob, who co-wrote "The Gift of Life," a book about David's ordeal 18 years ago.
Now the possibility of going through it all again is very real. "The first time (this happened), David said to me, 'How can I pray for myself when someone has to die for me to live?' And I said, 'It's not up to us; it's up to God who lives and who dies.'
"The older I get, the more I believe that. Every day outside of the hospital is a happy day. Every day we live our lives we are grateful for our health, because it's not in our hands, it's in God's hands."
Abigail Pickus is a staff writer at JUF News in Chicago.