The Onset of Death in Halakha III: Noteworthy Discussions

The paper published by the Vaad Halacha of the RCA (for my previous posts thereon, see here and here) has definitely achieved one of its unstated but obvious purposes: it has generated a flurry of activity. It is my sincere hope that this activity will not be restricted to blogs and newspapers, but will also lead to a reappraisal by today’s major posqim.

Here is are some of discussions I consider noteworthy, along with some editorial comments [UPDATED 2011-02-11 – split into two posts]:

  • As the press erroneously interpreted the Vaad Halacha‘s paper as an official position of the RCA, the RCA saw fit to issue a clarification. Some people subsequently misunderstood the clarification as a disavowal of the paper. This is as far as I know (and being a member of the RCA, I know quite some things about the organization) totally incorrect. I am neither authorized by the RCA to represent them in this matter, nor did I seek or desire to represent them, so the following comment is entirely mine, but I believe it accurately portrays the actual situation:The RCA does not need to issue any ruling in this matter, as it is not a hospital. As this is an area subject to great disputes, on which the membership is divided, the RCA does not want to issue any rulings in this matter. Neither does the Vaad Halacha. Rather, the idea was that the VH would conduct a thorough research and make their findings available to member rabbis (the paper was never officially presented to the public). So while it is true that the paper finds a preponderance of evidence against permitting reliance on “brain death,” it was never meant as any organizational policy, and the RCA seems to consistently want to allow its members to make up their own minds. What the RCA does do is to provide material to allow members to educate themselves. Over the years, many papers have been published through the RCA’s scholarly journal, Tradition, and now, another landmark paper was produced. But none of these papers should set the RCA’s policy. In fact, the RCA’s health care proxy does not prejudice users one way or another regarding this question, merely bringing people’s attention to the fact that this is a halakhic issue that the proxy issuer may have discussed with his or her rabbi. So there, too, the RCA tried to remain neutral.
  • R’ Aryeh Klapper analyzed both R’ Dov Linzer’s petition in support of relying on “brain death,” and the Agudath Israel’s statement against. R’ Gil Student commented with his own critique of that petition.
  • R’ Gil then organized an on line symposium, with eight contributors. The introduction and the first six posts are up: Gil’s inroduction, # 1: R’ Aaron Glatt MD, #2: Dr. Kenneth Prager, #3: R’ Moshe Dovid Tendler, #4: R’ Yaakov Weiner, #5: R’ Basil Herring, and #6: R’ Michael Broyde. The other two contributions, as well as some additional essays are eagerly awaited.I just noted that R’ Broyde, in his contribution, argues that R’ Shelomo Zalman Auerbach, a foremost 20th century halakhic authority, was of the opinion that, despite his utter conviction that a person remains alive as long as the heart beats, even past brain death, it is still possible to do a test that may show that the patient has already died, in which case i is even possible at that moment to remove vital organs for transplantation. (Obviously, the test will only be done after the recipients are matched, because there isn’t much time afterwards). As R’ Auerbach’s view evolved over time, it would be most interesting to compare R’Broyde’s and the Vaad Halacha‘s understanding of R’ Auerbach.N.B.: In case it wasn’t obvious yet from all my disclaimers, by now it should be glaringly obvious that not only was I not the author of the Vaad Halacha‘s paper, but I didn’t either conduct the interviews, nor the detailed reading of the halakhic and medical literature for them. I did read a number of key sources in this field, some quite profoundly, which allowed me to see how the VH convincingly read the sources, but I do not claim any independent expertise; I am just learning and sharing my understanding as per secondary sources. In my eight years since becoming a pulpit rabbi, I had never had to bear the burden of answering an organ transplant question. Other end of life issues are much more common, and still rare enough that I remain a student of this subject matter.
  • In my previous post, I articulated my unease with the position that disallows relying on the onset of “brain death” to donate organs, one may nonetheless receive organs without asking questions. I posited that the reason of those who adhere to this position is that the posqim have generally assumed that available organs will be harvested no matter what, and that a patent receiving an organ therefore bears no responsibility whatsoever for the possible murder of the transplant donor. I then proceeded to question the accuracy of the underlying medical assumption.This issue has now been directly addressed by Dr. Kenneth Prager, in his contribution to Hirhurim’s symposium (see above). However, a correspondent suggested the following defense of this position:

    … many who want to argue with this logic present the following claim: “These rabbis are not aware of the medical facts. No heart is harvested from a donor until the perfect match is found. As such, when a Jew receives a donor’s heart, that heart would not have been removed unless that Jew was on line for it & was a perfect match. Were it not for this Jewish recipient, that heart never would have been removed from the donor. As such, there is no hiding behind the many other Americans who also need a heart.”

    This argument, however, is false.

    The organization which oversees all organ transplants in the USA is called UNOS (see  http://www.unos.org/). Their FAQ page can be found here: http://www.transplantliving.org/beforethetransplant/qa.aspx#matchRight
    See these 3 Q & A’s:

    How long will I have to wait?
    There is no set amount of time, and there is no way to know how long, a patient must wait to receive a donor organ. Factors that affect waiting times are patient medical status, the availability of donors in the local area and the level of match between the donor and recipient.
    How will they find the right donor for me?
    When a transplant hospital adds you to the waiting list, it is placed in a pool of names. When an organ donor becomes available, all the patients in the pool are compared to that donor. Factors such as medical urgency, time spent on the waiting list, organ size, blood type and genetic makeup are considered. The organ is offered first to the candidate that is the best match.
    How are organs distributed?
    The organs are distributed locally first, and if no match is found they are then offered regionally, and then nationally, until a recipient is found. Every attempt is made to place donor organs.

    This fits with what I have been told by several cardiologists.
    There are far more potential recipients than there are donors of hearts. While the best case scenario is that donor’s heart be a 100% perfect fit for the recipient, that is rarely the case. The heart usually ends up being as close a fit as possible (thus, some patients will require more anti-rejection drugs than others). Within each blood type, there is a range of patients who could be potential candidates for that heart.

    UNOS decides who the organ goes to based on compatibility, illness, time accrued on the waiting list, location, etc. No donor heart will ever go to waste – as they are in such short supply VS. the potential recipients, and somewhere in the USA (if not the local UNOS region) a match can be found.

    As such, whether a Jewish name appears on a waiting list or not, the person who signed up to be a donor will have his/heart harvested (assuming they are still a candidate to donate when they are declared brain-dead). While UNOS will determine which patient on the waiting list will get the heart before it is removed, that heart would have been removed regardless of whether or not the Jewish recipient was on the list.

    What my correspondent is suggesting is that since the donor would anyway give his organs, since demand is so great, therefore, the recipient does not cause any additional people to become donors, and no additional people are killed. Dr. Prager deals with this argument implicitly in his symposium article, and I must say that the argument does not sit well with me, since at teh very least, by agreeing to receiving an organ, the donor will now be operated upon sooner, but I nonetheless faithfully report the defense my correspondent offered.

Obviously many more news items were published, along with countless blog posts. This is just a small, but in my opinion interesting selection of articles and posts.

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