Judaism values the ability of medicine to extend and improve the quality of human life. But differing interpretations about the role of organ donation in Halachah has meant that Israel has had one of the lowest organ donor rates in the western world. Today, a look at organ donation in Israel and what the country has been doing to increase donations.
Several years ago, Nancy Scheper-Hughes, a medical anthropologist and founder of Organs Watch, called Israel “something of a pariah in the transplant world. Without a strong culture of organ donation and under the pressure of angry transplant candidates, the Ministry of Health has refused to crack down on the country’s multi-million dollar business in transplant tourism that arranges junkets from dialysis clinics in Jerusalem and Tel Aviv to medical centres in Europe and the United States.”
A New York Times article from 2004 was also damning. “To meet Israeli’s growing demand for organs, middlemen calling themselves brokers, from prominent doctors to a former spokesman for a health maintenance organization, have rushed into the market to set prices for a scarce product that can reach $150,000 for a kidney… ‘As of today, there is no law in Israel that forbids trafficking in human organs,’ Meir Broder, a legal adviser to the Health Ministry, explained in an interview in Jerusalem. ‘There is no criminal aspect at all.’”
In 2008, the death of Rabbi Yossi Raichik put Israel’s transplant system into the headlines. Rabbi Raichik was a Chabad rabbi who assisted thousands of Jewish children immigrate to Israel after the Chernobyl nuclear meltdown. He suffered from a prolonged lung illness and required a lung transplant. As his condition deteriorated, his hopes were pinned on a woman who had been declared brain dead following a stroke. A rabbi respected by the woman’s family forbade the transplant. He said Halachah requires that the heart must have stopped before transplantation could be allowed to ensure that the donor had died according to Jewish law. Unfortunately, once the donor heart stops beating, this operation can no longer be done. While other rabbis were being consulted about the permissibility of the procedure, both the woman and Rabbi Raichik passed away.
That same year, the Knesset passed two related laws about organ donations. The Brain-Respiratory Death Law defines the precise circumstances and mechanisms to determine brain death. Death is defined by several criteria including the “cessation of brain activity,” the failure to breathe without need for life support, no response from the pupils and an absence of other reflexes.
The Organ Transplantation Law bans reimbursing transplant tourism involving organ trade and grants donors certain benefits in recognition of their efforts.
• Top priority is granted to candidates whose close relatives donated organs after death or to candidates who have been themselves live kidney or liver-lobe donors.
• Second priority is granted to candidates who have registered as organ donors at least three years prior of being listed.
• And lowest priority to candidates who have not signed the donor card themselves but whose close relatives have registered as organ donors at least three years prior of their listing.
Transplantable organs in Israel are kidneys, lungs, liver (and liver lobes), hearts and pancreas. Transplantable tissues are cornea, bones, tendons, joints, skin and heart valves. Most striking is the rise of kidney transplant operations in Israel (from deceased and live donors), from 152 in 2008 to 246 in 2013.
Both the Israel Ministry of Health and the country’s National Transplant Center operate informative, multilingual websites including an online tissue donation form (Hebrew only).
I particularly like the comprehensive FAQ page which addresses the need for donations, confidentiality, Halachah and…
Q. I am afraid of the evil eye. Is the signature of the card not a reason for worry?
A. Everybody is entitled to his or her own system of beliefs and opinions. However, any insurance (accidents, diseases) should be regarded in the same manner – and yet we all take insurance policies and are aware of their importance. Instead of developing irrational fears, the signature of the card should be considered as a human act, which, if anything, shall protect the signatory.
New laws don’t mean old controversies have ended. “The day after the legislation passed,” reported the Jewish Week, “MK Moshe Gafni from the ultra-Orthodox United Torah Judaism party, said the new law blatantly violates the Torah… Gafni said that ‘from the Torah’s point of view a brain-dead person is still alive.’”
Robby Berman, founder of the Halachic Organ Donor Society in New York was skeptical that the laws would have any significant impact on organ donation in Israel. “The bottleneck to donation is not the law but people’s misunderstanding of the medical and halachic issues surrounding brain-stem death. The solution is education, not legislation.”
Although Israeli donation rates still pale when compared to other countries, the growth since the 2008 legislation is impressive – from 10 to 14% currently, compared to 25% of Ontarians and 45% of Americans.