The Israel Transplant Center is launching a pilot project in four major hospitals to preserve and “harvest” organs from people whose hearts have stopped and cannot be resuscitated instead of taking organs only from those who suffer lower- brain death.
The center, chaired by Rambam director- general Prof. Rafael Beyar, started to discuss such a pilot four years ago, but decided to go ahead only now as organ-preservation technologies to keep the organs viable improved.
The experimental program, which has worked for several years in Holland, Belgium, France, Spain and other countries, will begin at Hadassah-University Medical Center in Jerusalem’s Ein Kerem, Rabin Medical Center in Petah Tikva, Rambam Medical Center in Haifa and Soroka University Medical Center in Beersheba.
The program has been much easier to implement abroad, in countries where organ harvesting is the default. Where the patient would have to actively opt out of being a donor.
But in Israel, said transplant center director-general Tamar Ashkenazi, unlike in other countries where medical teams may decide to cease life-saving operations and seek out donors, patients are not disconnected from equipment unless their hearts have permanently stopped beating and all attempts at resuscitation have failed – and there is no default for taking organs.
If the patient has suffered a catastrophic heart attack or accident that caused his heart to stop beating and he carries an ADI (organ donor) card, the transplant team would immediately take the body to a surgical theater to insert two large cannulas into the aorta of the heart and introduce preservative liquids. Then the kidneys, lungs, liver or other organs could be preserved for an hour or two until a potential recipient is brought in and the family gives their permission for taking the organs.
If the family members are already present, the transplant coordinator will ask for permission, whether or not the patient was registered as a potential donor.
Although registration as a potential donor is legally considered enough to take organs, Israeli doctors do not do so without the permission of the immediate family.
Families have refused despite the loved one’s having an ADI card only a handful of times among hundreds of organ donations, Beyar told The Jerusalem Post. The situation is touchy, as most families refuse to let anything be done to the deceased before they formally part from him.
The transplant center decided not to use organs from cardiac-dead patients until now because it had been believed that they function in the recipients’ bodies for much less time. But newer research has shown that with better organ-preservation techniques and technologies, they last as long or almost as long as those from brain-dead donors, Beyar said.
He added that if the pilot is successful, it could raise the number of organ transplants by as much as 20 percent, thus saving many more lives.
As most Israeli ultra-Orthodox refuse to donate organs of lower-brain-dead relatives, very few have donated organs up to now. With donation of organs from cardiac- death patients, the community would no longer have a reason, or an excuse, to refuse to give organs. “We can do information campaigns among religious communities and others to try to change their position on organ donation,” Beyar, the Haifa interventional cardiologist, said.
Ashkenazy said that “we have to start carefully and educate families so the cannulas are immediately inserted and the solutions perfused even if the family members have not yet agreed to donate organs.”
Prof. Jonathan Halevy, the modern Orthodox director-general of Jerusalem’s Shaare Zedek Medical Center who until eight years ago was chairman of Israel Transplant, said he was “very much in favor of such a pilot program, as the preservation technology is better, even though the process involves problems.
“Fewer than 10 percent of the population carry donor cards. But if the option is well publicized, it could increase awareness and reduce opposition. Rulings should be solicited on this from leading rabbinical arbiters.”