Avraham Steinberg & John Touhey

 

DEBORAH MOON/Jewish Review

Death’s definition rules organ donation

By DEBORAH MOON

article created on: 2009-01-01T00:00:00

“If you accept brain death, you should be an organ donor,” Rabbi Dr. Avraham Steinberg said after a medical ethics lecture that lured more than 100 people out in the midst of Portland’s worst snowstorm in 40 years.

Despite the weather conditions Dec. 16, the Maimonides Society of the Jewish Federation of Greater Portland and the Portland Kollel decided to go on with the inaugural Jewish Medical Ethics Lecture featuring Steinberg and the Rev. John Tuohey, Ph.D., since Steinberg was visiting from Israel and would not be available if the event were rescheduled. Additionally, a lull in the storm that day made it one of the few days of the storm that many Portlanders ventured out on the streets.

The two men reflected on “Defining the Moment of Death and the Transplantation of Organs from Jewish and Catholic Perspectives.” Both men said changing the definition of death to make it for the purpose of organ donation is a slippery slope that should be approached with caution.

“Death is not ‘for the purpose of,’” said Tuohey. “Death is the end of us in this world. It’s great if some good could come out of death. But dead ‘for the purpose of…’ Where does that lead?”

In an email interview after the lecture, Steinberg said the mitzvah of life-saving (pikuach nefesh) applies to organ donation provided the donor is dead by halachic criteria. Those in the Halachic community who oppose organ donation do so because the criteria for death are debatable, he said.

Steinberg, who won the Israel Prize for his definitive book, “The Encyclopedia of Halacha and Medicine,” led Israel’s Chief Rabbinate’s medical committee in 1986 when they unanimously accepted brain-stem death as halachic death and supported organ donation. He also helped draft Israeli legislation that in March 2008 defined the criteria for brain death.

While the legislation defines confirmed brain death as death, the law allows families who reject brain death on religious grounds to request to continue artificial respiration until cardiac arrest.

“One cannot die twice, therefore we say until cardiac arrest, not till dead,” said Steinberg.

Despite the legal definition of death, Steinberg said that there continues to be debate within the halachic community and among philosphers and physicians about the moment of death.

Steinberg said that biological death, when every cell in the body ceases to function, is the only true definition of death. Yet he said that definition is not halachically acceptable.

Steinberg said that rabbis were debating the definition of death 2,000 years ago. Even then moment of death was important for several reasons. First, a body was biblically required to be buried immediately after death and waiting for decay to set in when the final cells died three days after breathing stopped was not acceptable. Additionally, since one can break the laws of Shabbat to save a life, there must be a clear moment when life ends. In Talmudic times, that moment was considered the cessation of breathing and heartbeat.

Now there are also important medical aspects, he said. In addition to determining when organs may be obtained for donation, Steinberg said it is also important to know when a patient has died so that they can be removed from intensive care units. Maintaining a body on life support might cause others to die if there is no room in an ICU, he said.

Generally, he said, the halachic view in the United States and Israel is to accept brain death instead of the classical cardio-pulminary death.

Tuohey, director of the Providence Center for Health Care Ethics, said that as in Jewish tradition, Catholic tradition considers organ donation a highly charitable act … “as long as the one would not die as the result of the donation.”

Tuohey noted that living donors are permitted to donate a kidney because “kidney function is vital, but having two kidneys is not necessary.” (See related story previous page).

While the evening continued half an hour longer than expected, the audience remained attentive throughout.

For more information on the halacha of organ donation, Steinberg recommends visiting www.HODS.org.
Dr. Howard Lazarus, who is active with both the Kollel and Maimonides Society, said the two groups hope to host an annual medical ethics lecture.