Jerusalem – Israel is launching a potentially trailblazing experiment in organ donation: Sign a donor card, and you and your family move up in line for a transplant if one is needed.
Subscribe to our Daily Roundup Email
The new law is the first of its kind in the world, and international medical authorities are eager to see if it boosts organ supply. But it has also raised resistance from within Israel’s ultra-Orthodox Jewish minority.
These opponents say it discriminates against them because their religious convictions forbid the donation of their organs, and while they are unlikely to get the law reversed, they have the political clout to slow its implementation.
Only 10 percent of Israeli adults hold donor cards, compared with more than 30 percent in most Western countries. The actual rate of families donating a deceased’s organs is 45 percent, but in other countries it rises to 70 percent, according to Jacob Lavee, director of the heart transplant unit at Israel’s Sheba Medical Center.
The low rate of organ donation is thought to be partly driven by religious considerations. Most rabbis have no problem with transplants to save lives; their objection is to profiting from or needlessly mutilating cadavers. But 99-year-old Rabbi Yosef Sholom Elyashiv takes a different view, and he is one of ultra-Orthodox Jewry’s most influential leaders, claiming 100,000 followers among Israel’s 6 million Jews. Elyashiv forbids organ donation before cardiac death, but allows his followers to receive lifesaving donations.
Lavee, the doctor who helped draft the law, hopes that a broader pool of organs will ultimately benefit everyone, but he acknowledges that one of his primary motivations is “to prevent free riders.”
“This is the first time that a non-medical criterion has been established in organ allocation,” he said. “It will rectify the unfairness of the situation where people who are unwilling to donate wait in the same line as those who are willing.”
The measure opens a new dimension in the worldwide quest to overcome organ shortages. One solution — a legalized organ market — is ethically fraught. Another is called “presumed consent,” where whoever doesn’t opt out is considered a donor.
Spain, France, Austria and Belgium have adopted the latter model and rank among the top European nations in percentage of deceased donations, according to a U.N. study. But experts here say “presumed consent” would have been much trickier to get through the Israeli Parliament.
Writing in the December issue of The Lancet, the British medical journal, Dr. Paolo Bruzzone of Sapienza University in Rome said the Israeli initiative made more sense.
“Certainly, giving holders of donor cards priority in organ allocation sounds more acceptable than the introduction of organ conscription or financial incentives for organ donation,” he wrote.
Luc Noel, coordinator of clinical procedures at the World Health Organization in Geneva, praised the Israeli law for its educational value and for introducing a “community spirit” to the field of organ donations.
“The bottom line here is doing to others as you would like others to do to you and that is where the community has a role,” he told The Associated Press.
Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said the Israeli measure was ethically sound — he called it “reciprocal altruism” that would benefit society as a whole. But he doubted those signing donor cards would gain a significant advantage, because their queue would become much longer.
The only place where a limited version of the Israeli measure has been tested before is in Singapore, whose 1987 law introduced incentives for donors such as waivers for hospital charges and partial coverage of funeral expenses.
Israel’s parliament passed its far more comprehensive legislation in 2008 by a wide margin, including votes from Shas, the mainstream ultra-Orthodox party, and it is to take effect after a huge campaign to explain the new regulations and their complicated point-based system to the public.
But Israel’s unwieldy system of coalition government makes implementation uncertain. One of its members is an ultra-Orthodox party made up of Elyashiv’s followers. Among its lawmakers is Yaakov Litzman, who happens to be the deputy health minister (the top post is vacant).
Another is Moshe Gafni, who said the law is “antidemocratic.”
“If I can’t contribute organs because of my religious beliefs, the state shouldn’t be allowed to harm me,” he told The AP.
The Health Ministry’s legal adviser, Meir Broder, seemed to suggest the final formula was unsettled, saying it was still being fiercely debated among ethicists, lawyers, doctors and religious leaders.
“We are trying to find the point of balance between encouraging people to sign donor cards and not penalize those who don’t,” he said, but didn’t elaborate.
The debate derives from Judaism’s tricky definition of death.
Most leading Orthodox rabbis — as well as Israeli law — agree that a person dies when his brain-stem stops functioning. A minority opinion, endorsed by Elyashiv, holds that as long as a person’s heart beats he or she is alive and therefore the organs cannot be harvested. Donation in Israel after cardiac death is rare and only done in special circumstances.
One prominent ultra-Orthodox Jew who endorses the law is Yehuda Meshi-Zahav, head of Zaka, a widely admired first aid and rescue service. He says everyone should obey his rabbi, but he carries a donor card and says “Preservation of life overrides everything.”
Robby Berman, founder and director of the Halachic Organ Donor Society, a Jewish organization based in New York, said ultra-Orthodox Jews can’t have it both ways.
“My position is if you are not part of the solution, you are part of the problem,” he said. “Every Jew has a right to be against an organ donation, but then you can’t come and say ‘give me an organ.'”
Now let’s see them pass a law that you can only get welfare if you first paid taxes for a few years.
Start an organ gemach.
Every Jew has a right to be against an organ donation, but then you can’t come and say ‘give me an organ.'”
Hate to say it, but I sort of agree with the logic of this law. It is unfair for people who refuse to donate organs to be on equal footing with people who never donate. We have the right to our beliefs and values, but it may be unfair to expect others not to respond in kind.
I dont understand. a person needs hishtadlus and bitachon. hishtadlus here is to get on the organ transplant list and bitachon is to believe in hashem. in yeshiva i learned that it doesnt matter what you do for a living, if hashem wants you to be rich then as long as you create a kayli then hashem can fill it with as much as he wants. thus it shouldn’t matter what number on the transplant list you are?!
Too bad. Don’t expect help from others when you are unwilling to provide that help on a reciprocal basis. The law doesn’t say you cannot get a organ transplant, only that you go to the back of the line which is the ONLY fair way to allocate scarce organs. This is not welfare where you can expect society to subsidize you while you sit at home doing nothing. This is life and death and those who offer life to others should be the first to get help when C’v they are in need.
Don’t we donate kidneys? I’m confused
Hashem will stand by those who keep His Torah. They will never need organ donations.
I think it’s fair to give priority to who has actually donated. Whoever donates blood or a kidney should go on top of the list if they are in need. Of course I won’t exclude others from getting an organ but this gives an incentive and security to who decides to donate.
As usual, the article misstates the situation. Thelarge majority of major rabbis in Israel do not accept brain-stem ‘death’ as equivalent to death.(Brain-stem ‘death’ is not the ‘brain death’ referred to in the responsa of Rabbi Moshe Feinstein; that was based on the notion that the whole brain was completely dead, liquefied, etc, which is not necessarily the case in brain-stem ‘death.’)
It is outright discrimination for the child of a person whose religious beliefs preclude organ donation to be refused a needed organ on that basis. Why should a child’s medical need for a life-saving organ be affected by the beliefs of his parent?
There are tens of thousands of strictly orthodox Jews that are not ‘part of the problem.’ They volunteer for a myriad of organizations. They feed and clothe the poor, they man organizations like Yad Sarah. They are part of the solution. As for those who wish to harm the chidlren of such altruistic people, based solely on their deeply held religious beliefs against the takin of a life even to save a life: remember that the word ‘live,’ spelled backwards, is evil.
This is the ultimate chutzpah. “We won’t sign donor cards but we demand to get the benefits from those who do”. Obviously, these ehrlich yidden are badly in need of brain donors if they seriously think for a moment that anyone will take their complaints about the law seriously.
So those in bad need of an organ, as death approaches fill out a card, their own organs are already of no use, then they get a life saving organ, if they survive they call back their signature, I am sure it is possible & if not..
Don’t vorri der yiddelech vill find a vay round anyting. Vat u sai?
eKidneys are the most needed organ. A kidney from a living person can last many years longer than a kidney from a deceased person. More living kidney donation needs to be encouraged.
There are many articles on the internet about the safety of living kidney donation. Oh, there are risks, as ,every time you go under anesthesia, there is a risk – but kidney donation is lower risk then, for example….
Childbirth is a lot riskier than kidney donation.
Living in certain parts of Israel is a lot riskier than kidney donation.
Driving in a car in Israel, is a lot riskier than kidney donation. (Or here too)
Going into the army in Israel, is a lot riskier than kidney donation.
There are people who have come from Israel to the USA to try to get someone to donate a kidney to them. I have 2 people here now from Israel who are trying to get a kidney. And I know of others who came here from Israel who already got a kidney. And others in Israel who are thinking about coming here. It’s a shame they have to leave the country to get a kidney.
I am in touch with many people who donated a kidney and we are all doing great, Boruch Hashem.
Question – Don’t the organs disintegrate when a person dies?
So, if you sign an organ donor card in Israel, you or your family get moved up. And the people who don’t sign an organ donor card, if in need of a kidney – they should get a family member or friend to donate one, since the kidney usually lasts longer anyhow.
I think that Israel is encouraging more people to sign organ donor cards, so more lives will be saved. And if they are going to say we can’t do this because it would possibly discriminate against the ultra-orthodox who wouldn’t sign organ donor cards, then a lot less lives will be saved, bottom line.
In the USA, those who donate a kidney while alive, if they will ever need one in their lifetime, G-d forbid, they get moved up the list.
No one can have any objections to that.
Its interesting to see how the chilonim and MO’s make a big stink out of the ultra orthodox not contributing.
Did you know that an Israeli in need of a kidney cannot get a kidney from a “non” related donor. Although legal the bureaucratic social workers will disqualify him or her under the disguise of being mentally unstable do donate.
There have been many “frum” kidney donors who have gone so far as to travel to the USA and donate a kidney to save another’s life.
The ultra orthodox may have an issue with cardiac death but in other instances like kidneys, the dog loving and animal protecting lefties object to them.
Many poskin that it is a MITZVA to donate
I have so many people who have contacted me who are in desperate need of a kidney I don’t need the compliments here – thanks anyhow to those who have said nice things. And I appreciate it. But my kidney donation really was no big deal.
But what is really needed here , bottom line is just more people to come forward to donate a kidney so more lives can be saved. And there is nothing halachically wrong with that. Of course not everyone is able to, because of their own health situations and other possible personal issues.
If more people were educated about kidney donation, more people would come forward. Like most people don’t realize you can live just as well with one kidney as with two. When one goes, the other goes at the same time. Look at all these people on dialysis – most have 2 kidneys, but still need a kidney.
So – as I said before,don’t think my kidney donation was a big deal. The hardest part was keeping it from my mother – that was really very tough. I didn’t tell her until after I donated a kidney, and Boruch Hashem she took it well. But until I told her, I had to worry she would find out, because one thing she is afraid of is surgery.
What allows one who holds that an organ taken from a person who’s heart hasn’t stopped is assur (as most harvested organs are) to take an organ in Israel where the Rov are Jews?
I have been in other secular media and I think when Jewish person gets into the secular media about good things they are doing, it is a Kiddush Hashem. Tell me if I am wrong.
Great idea…let’s expand it to EVERY life saving situation. If you don’t support the local fire department, your house goes to the bottom of the list if there is a fire. Same with the hospitals – let’s see how much you donated and then the hospital will decide how long you wait in ER. Ditto with police and all other emergancies, and don’t forget libraries and community centers.
But let’s go even further…Zaka and Hatzalah responding according to your level of donation and/or participation.
On the other hand, just sign the organ card AND RECIND IT! (Everyone can change their mind). That way you have your cake and eat it too!
I don’t see why this is an issue. Obviously if we don’t contribute organs, we should be at the bottom of the list. That is only fair.
Gafni misses a basic point. By not giving him an organ, the state is not “harming” him, it just is not helping him. And why should it help him, if he is not part of the system? There is nothing anti-democratic here. In fact, it is a very democratic law. Only those people who contribute are part of the organ pool. This is the most fair way to distribute organs.
Perhaps a middle ground would be possible. Donating blood, bone marrow, kidneys can all be done safely from a living donor. Someone who is willing to make these donations should be the same as one who signed a donor card.
A few thoughts:
1. Kidney donation is an exception because it can be done from a live person. The organs being discussed here (heart, lungs, liver) can only be removed after death. For it to work medically, you have to define “death” early enough for the organs to still be useful. Unfortunately, most poskim do not accept this definition of death al pi halakha. The article that claims R. Elyashiv’s opinion is the minority one is incorrect — it is the mainstream opinion.
2. If one holds that “brain death” is not death, then in effect you are participating in killing the donors. I don’t see how you can accept organs from someone where the doctors in effect killed him.
3. Can we apply the logic of this law to other areas? How about all the Charedi chessed organizations making a policy that they will not help someone if people in his family have not in some way been involved in chessed — either as a volunteer or as a donor — then he gets no help. Do you think that might not raise an outcry if such a policy were adopted?
Registered organ donors in the United States can get preferred access to donated organs by joining LifeSharers at http://www.lifesharers.org. Membership is free. There is no age limit, and no one is excluded due to any pre-existing medical condition.
I don’t see the problem with the law. At worst it leave chareidim who refuse to donate organs no worse off than they were before. How can you accept what you are not willing to give? Why isn’t that mitzvah habaah be-aveirah.
BTW, I support kidney donation. But this whole discussion is about other organs that cannot come from a live donor.
53. Point 2:
Actually, since they are relying on another Rov’s Psak, even though you do not agree with it, according to halacha it is allowed.
I don’t understand the objection. If taking an organ from someone who is still alive is murder, it should be asur to receive such an organ because you are benefitting from the deliberate muder of another. And this would apply to non-Jews as well as Jews.
If one is not willing to donate an organ, that person should not be allowed to receive an organ. It is only fair. There is a cost to following the Torah. Deal with it.
I’m signed up as a donor on my DMV license. I don’t believe in tribal superstitious interpretation of the Torah that does not follow consistent logic. First it claims that the dead Jews of 3000 years will be raised from the ground some day, but at the same time this logic is against organ donation because the body will be incomplete?
You’re telling me that God will have the power to put together the bones of Moshe Rabeinu, but some how will be out of power to put together a person who donated his heart to save another person instead of letting it rot and feed the worms in the ground?
This law is absolutely fair and logical. The Charedim as usual want to reap the rewards from others in society while not giving back ANYTHING. Don’t pay equal share of taxes because most of them don’t work and on social service programs in Israel, don’t risk their children for national defense like the rest of the Jews and non Jews, don’t produce high skilled workforce that will benefit the society because they don’t educate their children like the rest of the Israelis, don’t contribute to the national organ bank, but are eager to accept another person’s donated heart, liver, lungs, kidney.
Replies to #44 , 48 and 57 etc:
This public forum is not the venue for discussing the intricacies of Jewish law in this regard. Rav Elyashiv shlita has made it clear that in his view even whole brain death (let alone brain-stem ‘death’) is not death according to Jewish law. Hence, as I understand it, he forbids the receipt of vital organs taken from a ‘brain dead’ individual in Israel. Similarly, he has forbade Israelis from going to China to procure vital organs, concerned as he is about the possibility of ‘donors’ actually being killed in order to provide organs (even if the ‘donors’ are condemned criminals, arranging their execution for the day of arrival of the potential recipient is an act of desecration of HaShem’s name, in his view, and strictly forbidden).
I do not advocate ‘my’ position, I only report on the positions taken by the large majority of poskim, lead by virtually every Gadol. I have spent much time meeting with Gedolim and learning these sugyas from them.
[to be continued]
[continuation of prior post]
It is quite obvious that if the decision as to who will be the recipient of a particular organ depends not solely on MEDICAL criteria but rather on whether one’s immediate adult relative signed an organ donor card, that is discrimination–and a breach of the sacrosanct duty of doctors to decide such life-and-death matters based on medical triage, not politics, religious ideology, or other medically irrelevant factors.
The result may very well be that a child who otherwise might have received a vital organ will be denied that organ simply because his father or mother followed the view of any of the myriad of rabbis who forbid signing these organ donor cards. If that is not discrimination, what is?
The secular Israeli doctor who initially chose to advocate this clearly radical approach in the British journal LANCET has made it quite clear that he is aiming at the chareidi community.
Finally, please note that I do not advocate my position. I try to report on the opinions of the many poskim with whom I have learned this sugya, from YU to chareidi orthodox ‘camps,’ including Sefardic poskim and Ashkenazic poskim. Nearly all do not accept ‘brain death.’
For well over 2 years, the Rabbinical Council of America has had a halachic committee working on end-of-life issues including the halachic definition of death. The committee interviewed or sought to interview virtually every posek involved in this issue. Major efforts were extended in this regard.
Regrettably, for unclear reasons, the manuscript has so far not been distributed or published.
If your rav is a member of the RCA, why not ask him when that manuscript might be coming out, and what is the reason for its publication being delayed 🙂
Regrettably, in secular medicine doctors and nurses have gone far beyond the issue of ‘brain death.’ The current fad is ‘withdrawal of care’ (aka pulling the plug) on patients with poor prognoses. This stems from “futile care theory.” Many doctors, once sworn to heal, now advocate hastening a person’s death due to quality of life considerations.
The whole thing is a little baffling, because there is a clause on the back of the card that the carrier can include that states:
“בתנאי שאיש דת לפי בחירת המשפחה יאשר את התרומה לאחר מותי”
“Provided that a cleric chosen by the family will approve the donation after my death.”
So as long as you include this, what’s the big deal to sign it?
86 unfortunately “they” (the ones in charge) are not trusted by the rabbonim. And for good reasons! They may say they will only remove after brain death and even wait for stem cell death or even cardiac death and then by “mistake” they will make an error and take it out prior to the agreed term. That is a major problem with the medical field. They are not trusted.
I am curious as to how the reporter for this Associated Press story (which reaches thousands of newspapers) got the impression that most rabbis favor organ donation after brain death. That is certainly not the case when it comes to poskim. Despite misrepresentations elsewhere, such halachic luminaries who have ruled against accepting even whole brain ‘death’ as halachic death include Rav Waldenberg ztl (the Tzitz Eliezer), Rav Shlomo Zalman Auerbach ztl, Rav Aharon Soloveitchik ztl, Rav Joseph Ber Soloveitchik ztl (according to Rav Aharon ztl, but this is in dispute) and many other late Gedolim as well as yb’mch’lch Rav Elyashiv shlita, Rav Moshe Sternbuch shlita, Rav Neuwirth shlita, Rav Yitzchok Zilberstein shlita, Rav Herschel Schechter ztl (the protege of The Rav), Rav Mordechai Willig shlita, and many more poskim.
The reason I put the term ‘death’ in quotes is that it is accepted by many neuroscientists that when brain ‘death’ is ‘diagnosed,’ that does not necessarily mean that each and every brain cell is dead and the brain is getting completely liquefied (as Rav Moshe Feinstein ztl was told). In fact, parts of the brain may be alive in 10% or more of such cases.
The gemarah holds that brain death is death, not cardiac death. After all, what is the proof in the gemarah for proving that someone is dead? Putting a feather by his nose to see if he’s breathing, that is brain death, not cardiac death.
“The gemarah holds that brain death is death, not cardiac death. After all, what is the proof in the gemarah for proving that someone is dead? Putting a feather by his nose to see if he’s breathing, that is brain death, not cardiac death.”
Wow! Now that post #91 has cleared things up, we can just inform all the Gedolim of his / her conclusion, as they obviously have not learned the Gemara the way this anonymous poster did.
My point, obviously, is that this is a matter of mamash pikuach nefesh–the very definition of life and death–and hence for anyone here to argue one way or the other is hubris in the extreme.
Let’s leave the halachic machlokes to the major poskim–and let’s not countenance outright discrimination against our kinderlach and fellow frum Yidden.
The concern that many have before agreeing to donate and signing donor cards is that hospital staff who know there is a donor card may want to RUSH the death in “brain death cases” so that they can immediately remove the organs — since there is a limited amount of time from death until recipient receives organ. But sometimes the life can still be saved.
That’s something to think about…
Does the govt also hand out money from programs only to people that pay taxes or do they pay public funding only to those that cant afford to pay. Lets pass a new law – You can only receive funding if you pay taxes
I don’t understand!
in israel were the majority is jewish how do you expect to benefit from the fact that most jews are not obsevant.
Almost seven years ago I gave a kidney to a total stranger. It was the most wonderful experience that I have had in a long time. If you are able to donate, then by all means do it. You will never regret it!!
In reply to SD:
Contact me at http://www.linkedin.com/doctorzach or http://www.facebook.com/doctorzach and I can privately address your concerns.
Alternatively, you can attend the yarchei kallah held in Jerusalem every summer and have the opportunity to ask major poskim whatever questions you may wish (www.j-c-r.org).
Notwithstanding what some prefer, not everything is for public consumption on the internet.
I look forward to hearing from you, “SD”.