Friday, November 13, 2009

Israel denies transplants following brain death

Rabbis' dismay as transplant rules change

A lung transplant operation in Jerusalem. Rabbis disagree over what constitutes the moment of death, and when transplants can go ahead

By Anshel Pfeffer, The Jewish Community Online

Deputy Health Minister Yaakov Litzman has dismayed the Israeli medical community and many rabbis by announcing that organ transplants are to be allowed only after the donor’s heart has stopped beating.

His decision contradicted a recent agreement between rabbis and doctors that said that transplants could be carried out following brain death.

Mr Litzman, of the United Torah Judaism party, made his position clear in a letter to a medical conference last week.

In the absence of a health minister in the Israeli cabinet, he is the de-facto head of Israel’s health establishment and has the power to withhold financing from hospitals and medical centers operating against his wishes.

The issue of organ transplants has long been a source of contention between rabbis and doctors. The mainstream medical opinion is that once the brain ceases to function, death can be declared, a position disputed by a number of leading rabbis who view cutting off life-support and removing vital organs while the heart is still beating as murder.

Over two decades of patient negotiations, doctors in Israel managed to win a large number of rabbis over to their position. However, an official rabbinical recognition of brain death as the point at which a transplant can be carried out was denied, since the doctors refused to have rabbis included in the process of pronouncing death before a transplant operation.

Still, many rabbis have privately endorsed transplants and encouraged religious Israelis to carry donor cards. Last year, the Knesset passed the Organ Transplant Law, which necessitates a ruling by two senior doctors who are not involved in transplants on the death of a potential donor. Following the legislation, the council of the Chief Rabbinate voted three months ago that brain death did indeed constitute the moment of death.

Despite the council’s ruling, a number of senior strictly-Orthodox rabbis, including the leading authority Rabbi Yosef Shalom Elyashiv, have remained true to their old position, which was echoed by Mr Litzman in his letter.

The letter caused an uproar in the medical community and calls for Mr Litzman’s resignation soon followed.

But in subsequent interviews, Mr Litzman insisted that he was merely following the transplant law, which also said that transplants should be carried out according to halachah. “All the greatest rabbis had ruled that death is when the heart ceases to beat,” he added.

He would not say whether hospitals and doctors that would decide differently would be reprimanded or have their funding curtailed.

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