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Jews and Organ Transplants – Part 1

An Overview on Organ Transplanation (PDF), by Arye Durst:

Source: ASSIA – Jewish Medical Ethics,
Vol. III, No. 1, January 1997, pp. 7-10

In 1966 the HLA (Human Leukocyte Antigen) system was discovered, assisting in the determination of organ compatibility. In 1980 a new breakthrough was achieved by Borel, a Swiss researcher from the Sandoz company, who developed Cyclosporin A, a new immunosuppressive substance which is still widely used.

Owing to the shortage of organs, organ trade is flourishing, and it is well known that kidneys may be bought from live donors not related to the patient. People from all over the world travel to India to buy kidneys and even undergo the transplants there. Organ trade also exists in Egypt.

There are well-founded rumors from South America con- cerning the kidnapping of children, particularly from the poorer sectors. These children disappear, supposedly taken to resorts for treatment and support, but it is believed that their organs are removed and sold. With evidence of such worldwide trade, we are particularly careful in Israel. However we do treat Israeli patients who have undergone organ transplantation in India, particularly kidney transplants, and who come back to us for continued treatment following the operation.

A review of the results of kidney transplants shows that there is 90% success during the first year for kidneys from live relatives, and 75% success during the first year from dead donors. Currently there are approximately one hundred kidney transplants carried out each year in Israel, with the demand reaching around two hundred and fifty. The organ-demand curve in recent years has been rising exponentially while the supply of organs has remained constant, giving rise to various phenomena which are entirely unethical.

Jews discussing unethical phenomena. How intriguing.

But first, a bit about Human Leukocyte Antigen. HLA is a complicated subject. Essentially it is to organ transplants (AKA grafts) what the ABO antigen system is to blood transfusions. As with the ABO antigens, racial variation is evident in the types and distribution of HLA.

History and naming of human leukocyte antigens, Wikipedia:

Each person has two HLA haplotypes, a cassette of genes passed on from each parent. The haplotype frequencies in Europeans are in strong linkage disequilibrium. This means there are much higher frequencies of certain haplotypes relative to the expectation based on random sorting of gene-alleles. This aided the discovery of HLA antigens, but was unknown to the pioneering researchers.

Human leukocyte antigen, Wikipedia:

These haplotypes can be used to trace migrations in the human population because they are often much like a fingerprint of an event that has occurred in evolution. The Super-B8 haplotype is enriched in the Western Irish, declines along gradients away from that region, and is found only in areas of the world where Western Europeans have migrated. The “A3-B7-DR2-DQ1″ is more widely spread, from Eastern Asia to Iberia.

Back now to the jews. Let’s start with their attitudes.

Organ donation in Jewish law, Wikipedia:

Some ultra-orthodox Jews (haredim) are vehemently opposed to organ donation. Haredim in Israel have recently issued an anti-organ-donor or “life” card which is intended to ensure that organs are not removed from the bearer after brain death or brain stem death. It states: “I do not give my permission to take from me, not in life or in death, any organ or part of my body for any purpose.”

Organ Donation – Death & Mourning, Chabad.org:

Jewish law distinguishes between donating organs during your lifetime and organ donation after death.

It is forbidden to tamper with a corpse in any way unless it is in order to directly save a life. But when you sign a consent form to have your organs removed, not all of those organs will necessarily be used for an immediate transplant. They may be used for research, or stored away, or even discarded if not needed. Jewish law only allows organ donation if it can be ensured that the organs will indeed be used to save lives.

But there is a much more serious concern. To be usable in a transplant, most organs have to be removed while the heart is still beating. But Jewish law maintains that if the heart is still beating, the person is still alive. The moment of death is defined as when the heart stops. So to remove organs from a brain dead patient while the heart is still beating is tantamount to murder.

While the medical and legal world has accepted brain death as a new definition of death, the vast majority of experts in Jewish law have not.

Some countries offer an option to give consent to organs being removed on condition that a rabbi is consulted beforehand, who will ascertain that they will only be removed after absolute death and be used only to save lives. In countries where no such option exists, we don’t consent to the removal of organs after death.

“Jewish law” is a cover, an excuse. Using it, jews discriminate themselves from everyone else, and at the same time rationalize their expectation for special, preferential treatment.

In Israel, a New Approach to Organ Donation, NYTimes.com, by DANIELLE OFRI, M.D., February 16, 2012.

This article informs us that it is a “well-known fact” that jews do not donate organs. Most countries have either one of two legal systems for organ donation: opt-in or opt-out. But of course, Israel is special:

A third way to increase donations is being pioneered in Israel. Until now, Israel ranked at the bottom of Western countries on organ donation. Jewish law proscribes desecration of the dead, which has been interpreted by many to mean that Judaism prohibits organ donation. Additionally, there were rabbinic issues surrounding the concept of brain death, the state in which organs are typically harvested. As a result, many patients died waiting for organs.

So Israel has decided to try a new system that would give transplant priority to patients who have agreed to donate their organs. In doing so, it has become the first country in the world to incorporate “nonmedical” criteria into the priority system, though medical necessity would still be the first priority.

The Israeli program was initiated by Dr. Jacob Lavee, a cardiothoracic surgeon who heads the heart transplant program of Sheba Medical Center in Tel Hashomer. In 2005, he had two ultra-Orthodox, Haredi Jewish patients on his ward who were awaiting heart transplants. The patients confided in him that they would never consider donating organs, in accordance with Haredi Jewish beliefs, but that they had absolutely no qualms about accepting organs from others.

That Haredi Jews would not donate organs was a well-known fact in Israel. But this was the first time anyone had openly admitted the paradox to Dr. Lavee.

The unfairness of a segment of society unwilling to donate organs, but happy to accept them, nagged at Dr. Lavee. After he operated on both patients, giving each a new lease on life, he put together a proposal that would give priority to those patients willing to donate their organs.

Working with rabbis, ethicists, lawyers, academics and members of the public, he and other medical experts worked to create a new law in 2010, which will take full effect this year: if two patients have identical medical needs for an organ transplant, priority will be given to the patient who has signed a donor card, or whose family member has donated an organ in the past.

A critical component of the law’s success was engaging the country’s highly influential religious leadership, which had long been resistant to organ donation. Even among the half of the country that is devoutly secular, when faced with death and whether to donate organs. “Suddenly the families become very religious,” said Dr. Yael Haviv, the medical director of the organ donation program at Sheba. “Suddenly they ask the rabbis.”

The initial claim is that haredi are the ones who don’t donate. Then, at the end, they reveal that even the non-haredi jews use the same “jewish law” excuse.

Jews have organizations dedicated to identifying and advocating for their narrow concerns. For example, HODS – Halachic Organ Donor Society: Mission:

  • To save lives by increasing organ donations from Jews to the general population (Jews and non-Jews alike).

GOALS:

  • To educate Jews about the different halachic and medical issues concerning organ donation.
  • To offer a unique organ donor card that enables Jews to donate organs according to their halachic belief.
  • To provide rabbinic consultation and oversight for cases of organ transplantation.
  • To match altruistic living kidney donors with recipients.

Despite their lame attempt to spin it otherwise, their clear concern is for the jews, and especially what more altruistic donors can do for them. HODS – Halachic Organ Donor Society: Frequently Asked Questions about the Halachic Organ Donor (HOD) Society:

6. Has the HOD Society saved any lives?

Yes. The HOD Society has helped to save more than two hundred people who need a donated organ. Some organ donations were directly enabled by the HOD Society, such as in the pairing of altruistic, live kidney donor Eric Swim of the U.S. with ten year-old recipient Moshiko Sharon of Israel.

Yiddish Phrases:

SHANDA: A shame, a scandal. The expression “a shanda fur die goy” means to do something embarrassing to Jews where non-Jews can observe it.

Debate Over Jewish Guidelines for Organ Donation Crosses the Atlantic, Forward.com, by Michael Goldfarb, January 26, 2011:

London — The controversy over what is dead according to Jewish law is no longer an intramural question among Orthodox rabbis on either side of the Atlantic. In Britain it is now being played out in public. As in the United States, the emotional question of organ donation is the battlefield.

The most recent round of arguments began in early January, when the London Beth Din, the religious court associated with the United Synagogue — Great Britain’s Orthodox umbrella group — and its chief rabbi, Jonathan Sacks, issued guidelines on organ donation. The beit din’s ruling was that brain stem death is not death for the purpose of heart and lung donation; a person is dead under traditional Jewish law, or Halacha, only when there is a cessation of cardio-respiratory function.

The matter might have remained an obscure dispute among Jews. But on January 12, The Guardian, a prominent British daily with national distribution, published an article outlining the beit din’s decision and reported that the chief rabbi had issued an edict ruling that “organ donation and the carrying of donor cards are incompatible with Jewish law.” The paper quoted the British Medical Association asking the chief rabbi to meet with organ donation experts as a matter of “urgency.”

Protect organ donation, JPost, 01/02/2011:

Particularly galling has been the sense that halachic authorities, in America and in Israel, are permitting Jews to receive organs, but not to donate them.

Orthodoxy has been increasingly hijacked by religious fundamentalism

This fanaticism has swept America as well.

Of course, as noted above by the jewish paper of record, the New York Times: most jews go in for this fundamentalist fanaticism excuse when it comes to not donating their organs.

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