Medical Halacha (Law) -  Transplantation - Non Living Donors

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By yael on December 2, 2012 -- 11:49pm

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Medical Halacha- Organ Transplantation- Non living donors AUDIO

problems of transplantation
questions relating to non living donors- organ is taking from one no longer alive.
transplanted surgery is an aspect of modern medicine. Its not experimental anymore its an everyday procedure.
Heart transplant is newer- 5 year survival rate
Lung/lobe of lung transplantation is not common from living donors bec the mobility and mortality to the donors is felt to be excessive. Non living lung donations is used.
Judaism recognizes psychological pain if u cud (measure for measure) measure these things are at least as great as physical pain.
Transplant surgery is a real active field of medicine particularly since development cyclosplorine major suppressive drugs which enables the body/recipient to tolerate many organs in conjunction with other aspects of drug regiments. People can live many years with transplant organs.

Non living donor- someone has died, now we seek permission to use their organ in order to transplant.
Kidney failure dialysis the classical scenario
Q) What are the issues when u try to get organs from a donor who has died and u want to use the organs to trans into a recipient?
• taking an organ from a dead body involves many torah prohibitions
• Mutilating a human body when u take parts of that body, u potentially transgress 3 torah prohibitions
• When the postmortem is complete before we even talk about transplantation.. Someone dies and permission is given for an autopsy, the pathologist is cutting up the body to find cause of death, they may remove certain parts of body for testing/transplant. This transgresses 3 torah prohibitions. Int his case the 3 prohibitions are:
1. Mutilating a body, called nivul h’mes when u actually cut up a body
2. Benefiting form the dead: The taking of organs because theirs a prohibition of benefiting form the dead. We are not allowed to benefit from the body so when u gonna use part of a body for a positive purpose thats called benefitin.
3. We have an obligation of burring a person and burring them whole with all their parts, all of them.
So when your taking an organ your transgressing all three
• How do we approach these three issues
general rule: if you looking to save a life in jewish law we will override virtually all other prohibitions.
• 3 things we DO NOT override/commit to save your own life: sexual morality, idolatry, murder

But when not talking about these three and talking about transgressing other torah prohibitions our priority is Saving a life.
Thus we will transgress virtually everything else non kosher, breaking shabbat In the torah to save a life.
Is (1)mutilating (2) benefiting (3) failing to burry, on of the three primary issues? No! Therefore, we will transgress all three of those in order to save a life.
The life we wish to save must be here now, not research that may save lives in future. Were talking about a real individual. Even if the individual is not CLEARLY in danger only, they MAY be in danger- thats good enough I jewish law we dont use the concept of majority when it comes to saving a life . If I have a life may be in danger and I I can take an organ to save their lives or anything else that saves their law that involves a torah prohibition. i dont even have to be certain ill save their life- they are in danger or certain it will save them. A vague possibility their in danger and a vague possibility I can save them is good enough in jewish law but they must be a real person. A real indiviudual who may/is in danger
Ill mutilate the body to the dead person in order to save their life

Mutilating body
we will override prohibition. The parameters involved in mutilating the body are: 2 opinion in halachah as to why u cant mutilate a body
• the body is formed in the divine image called Tzelem Elokim. Has Deeper/higehr meaning. One of the meaning The body itself is formed in tzelem elokim so u cant mutilate the human body. If u hold thats the reason u cant mutilate this would apply to non jewish bodies too. Because non jewish is formed in the same image so no distinction.

By yael on December 2, 2012 -- 11:51pm

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• 2nd opinion- mutilating is connected to kavod h’ames dignity of the dead himself is affronted by mutilating his body. These opinions dont hold that autopsy or mutilating applies to non jews. Were not obligated in non jewish societies to stop non jewss from dissection f non jewish bodies. Like med school dissect a human body..we dont rule that is a jewish problem. In israel its a problem cuz body may be jewish.
However, If u hold that mutilating a body is a transgressing to the dignity of the person (not a jewish/non jewish problem ) its another problem which is, if its ur dignity u can give it away. According to this opinin, If a person gave permission for his body to be used after death, its no problem. Bec its ur dignity and before you die u sign saying I dont mind to use my body for science, I dont mind about my own dignity there are opinion that says its allowed. - wide range argument

One position/opinion its not ur honor thats at stake, its mutilation of the body, in that case we will rule that jewish and non jewish bodies are equally involved. However to save a life we will take an organ even take it against ur permission, why? Because ur permission is not relevant. Weve got Saving a life and your opinion so we will deff override ur opinion to save a life.
Other opinion will say opposite. Mutilating a body is ur dignity and its ur possession, therefore we dare not take an organ without ur permission.
Interesting argument here. Some sources say like this: lets say u hold that its my dignity and I have to give permission and If I refuse permission, whats to stop u taking my organs anyway bec u wanna save a lofe , reason u cant take my organs because saving a life is a mitzvah and the dead have no mitzvahs. A dead person can theoretically say I wanna be buried with all my organs In tact I dont have to save a life, no longer my obligation. Bottom line permission is given by person of family than its good enough then were usong organs to save a life even when transgressing 3 prohibtions.

We spoke about prohibition 1..

• Prohibition 3- All Organs shud be buried- the real obligation is when its a limb of the body, meaning having bone, scineu, and flesh. Must have these 3 elements. Like a finger or hand. Not complete body parts (bone,scineu,flesh) aren’t really part of the obligation. That would be the problem of burring a person so we set that aside by taking an organ in order to save a life. Organ is left with recipiant even a Pace maker is buried with recipientit can be deamed as part of their body in certain ways.

By yael on December 2, 2012 -- 11:52pm

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The Major most contentious problem – taking a heart
When organs are taken, cant subject person to harm, killing them. you can take an organ when they have died already. BUT At which point are the deamed to have died?
Jewish law- The person is diagnosed as dead when heart and breathing is stopped AND then wait certain period time. Looking for irreversible sensation of cardio respire function. Heart and lungs stop working AND u have waited some time, then u can proceed to take organs in order to save life.
How log do u have to wait? Custom in most communitys is half hour (diff customs )but minimum that has eve been allowed is five mins.
Listen at 20 Mins into audio..We know five mins after a person is dead their organs without blood flow etc. their organs are unusable. Person is dead and and not obliged to resuscitate like brain damage your are free to wait a certain amount of time then proceed to touch body and if necessary to remove an organ.. listen to audio 20 mins
In Heart surgery a technique is the body is cooled temps because gives u longer period of time to operate without damage. (opposed to normal temperate) but im not talking about those situations im talking about normal conditions u waiting a normal amount of time under normal conditions then ur allowed to take body part. .
Problem- the heart is not susceptible, you cant wait 4/5 mins then take a heart. Bec certain tissues in the body are much more metabolically active than others and If you wait the period of time without circulation they become unusable. The heart is so metabolically active that if u wait even a short period if time after death the heart no longer functions the cells are damaged and when u take the heart and try to implant into someone else it will not function. The only way to preform as successful heart transplant is to open the chest of the donor while the heart is still beating, then u stop the heart urself with injecting preservative cardioplegic solution which perseveres the function of the cells and rapidly cool the heart in a bath of cardioplegic solution then transport the heart and transplant into the recipient and warm it up again the heart. If u follow Jewish law and take the heart after u have waited, it will not be useful- see the problem in heart transplant.

The cornea isnt a problem bec it doesnt need the blood supply but organs that are highly metabolically active like heart, its a problem.

The first heart transplant in 1968, the Heart was taken from a donor that was only brain dead. But the heart was still beating so u killed the donor. Moshe finstein ruled the first transplant was double murder because u killed the donor and recipient because who says he will live any longer than he would with his own heart. Later he revised this ruling to make it permissible for the recipient when it was demonstrated that you could save the recipient but he didnt change his mind about the donor giving the donor heart– this is the norm position in jewish law today. If u need a heart as a recipient u can receive the heart. If u wanna take the heart from the donor for that recipient, u cant take it because ude have to kill the donor to taking his heart.
Anesthesiologist- supports body functions during transplantation.
in 1968, shortly after transplantation began, Harvard convened a committee to decide on criteria of death. Issue was Could we now change the definition of death. Could we say the definition of death is brain stem function/death? Instead of saying life depends on heatbeat/ respiration. If you could prove there is no more brain function and the heart beats from a reflex point of view Because the heart can still beat outside the body in the correct environment it has its own intrinsic pace maker but breathing will not continue its under control of the brain. When brains stops the breathing stops but the heart doesnt eventually it stops cuz no breathing, no oxygen so heart doesn’t get oxygen so it stops. Can we possibly define death as brain stem function? The person stops breathing but we will keep the breathing going by a ventilator and the heart will beat automatically. If we define it as that there is no problem, the person is considered dead and we can remove the heart. The committee came up with set of criteria called irreversible coma, if u have all the requirements for brain stem death by testing apneia testing(detach all machines and if any effort to breathe the brain us still alive) if no attempt made to breathe considered Positive apnea testing- brain stem has died. Committee says if all these conditions are present, apnea testing etc and the brain stem has died, we can guarantee you that its an irreversible coma. Dont ask us about death, death is a spiritual question of ask the rabbi/priest. Medically the person will not recover.

By yael on December 2, 2012 -- 11:52pm

transcript (4/4)

Today its widely accepted today in modern medicine that if The brain stem death criteria is fulfilled, then that person will not recover. Not a single case where valid criteria for brain death was established and the person recovered. Its a good definition of an irreversible coma. The problem is, is irreversible coma, death? The normal scenario is, you diagnose brain stem death- the heart is beating by reflexive activity the ventilator machine is keep the breathing, absolutely no brain stem function . Their may be certain function of brain stem like temperature regulation issues some of those could continue but the brain stem the governs breathing is no longer functional and what happens is if u keep the ventilator going eventually the heart stops. Noone is sure why (not even neruosurgeons). If u make an effort to keep internal homeostasis (BP, nutrients, oxygen) so the heart has what it needs, usually the heart stops- the heart stops within 2/3 days. Only few recorded cases it continued for 27 days.
Question is- before the heart stopped, while it is beating by reflex activity, and you are keeping breathing going and brain stem dead, is this person called dead? Harvard says- we can’t define that, all we can say is this is set criteria that defines irreversible coma.
In 1980, Presidents commission in US decided to accept irreversible coma criteria as legal definition for death (tranplnat surgery advanced far enough to make a decision) (and not cessation of heart rate and respiration.) brain stem death (previously called irreversible coma)= diagnose death. Today this is what accepted in UK, south africa, US, Israel.
Therefore, once you can diagnose brain stem death accurately, can legally terminate ventilator, or perform organ transplant surgery. The fact that heart is beating is only reflex phenomenon and not diagnostic of life.
Question is in Jewish law, halacha, is that valid? Vast argument til today. Opinion in US, new york, judges in israeli chief rabbinate- brian stem death is valid criteria for death. But majority halachic authorities don’t agree, say not valid., say Jewish law requires irreversible cessation of cardiorespiratory activity (heart and breathing). Which is main one? Breathing or heart rate? Which one determines other. We learn this from buried alive on shabbos from gemara. We rule In practice its heart rate. Bottomline, We need to know no heart rate and not breathing, then wait some time.
Is there possibility of saying brain stem death is valid criterion for death in Judiasm? If hold old halachic definition, can’t take heart for tranplantation= killing donor (and no bigger averah). New def of brain stem death, can do heart transpl and save lives= mitzvah. Can take heart while beating bc brain stem is valid criteria. Logic—> Gemara makes clear that if head is not present, decapitated, then they are dead even if heart beating, twitching. (we learn from pregnant mother decapitated, save fetus). Even though heart beating from reflex. today we can be absolutely sure that there is no viable (time ~40 min).
Latter day authorities, brain stem death is modern day decapitation. Brain is not there. Brain is not functional. No blood flow to brain and no functionally.
But other side of argument- say that that is not decapitation, (BP maintained, other things still happen, physiologically not the same). BP drops instantanly when head is removed)
Present day- minority opinion- we ought to accept brain stem death, bc it’s a valid criterion and will save lives. Other side say, you are killing donor, spilling blood, not allowed to foreshorten life of a iretreivably irreversibly comatose individual, not even by a moment. Therefore, can’t heart transplant
=main issue about transplanting hearts.

In country that’s takes Kidney by same criteria. Today- Don’t wait until heart stops. Use same definition for that matter

When brain stem dead, whats point of keeping machine going, only keep ventilator to keep body functional for perfusion and transplantation. person by definition dead and keeping ventilator to keep organs profuse with ventialtor.
But Jewish law, majority says person is still alive we don’t switch machine off or take organs on basis of brain stem death criteria not for heart or for other organs.

=Jew should not sign blanket permission of organ donation card.

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