A voluntary organization of strict modern-Orthodox Israeli Jews is sending
representatives to synagogues, hesder yeshivot and women’s seminaries to
register donors for a Bilvavi organ-donor card – even though it has been called
unnecessary, wasteful and harmful to transplantation by the government’s Israel
Transplant Center and ADI organization.
The campaign has drawn
considerable controversy as Israel Transplant has extended by three months
(until the end of March) an offer of higher priority to ADI donorcard
signatories, instead of waiting a few years to earn such a benefit personally
and for first-degree relatives.
The Health Ministry’s Israel Transplant,
which coordinates and supervises organ donation and transplantation in the
public hospitals, told The Jerusalem Post
, which investigated the matter, that
having a Bilvavi (www.bilvavi.co.il) card does not provide any priority in
obtaining an organ.
The transplant coordinating center also said that
identifying information of registrants is not stored in ADI’s data bank of
nearly 700,000 Israelis.
Prof. Rafael Beyar, a leading interventional
cardiologist, director-general of Haifa’s Rambam Medical Center and chairman of
Israel Transplant, said he welcomed every initiative that will increase the
number of potential Israeli organ donors from every sector that signs ADI cards.
But, he said, Bilvavi is not needed, because those with ADI cards can already
stipulate that the family of a brain-dead patient with the potential to donate
organs may consult with any clergyman before they agree to it, and the
transplant is performed.
Bilvavi, established with funds from the family
of the late Bilha Hirshberg, has trained a cadre of rabbis about what
constitutes lower-brain death, and created a roundthe- clock (including Shabbat
and festivals) phone center that accepts calls and contacts doctors and rabbis
affiliated with the organization. It was initiated by pediatric neurologist
Prof. Avraham Steinberg, an Orthodox rabbi who received the Israel Prize for his
work in Jewish medical ethics, ethicist Rabbi Yigal Shafran and
The option of ADI’s clergyman clause was initiated by Shaare
Zedek Medical Center Director-General Prof.
Jonathan Halevy when he was
chairman of Israel Transplant, before Beyar was appointed by the ministry 18
Halevy, who is modern Orthodox, said that “in principle, I am
for every legitimate initiative that will increase the number of signatories on
donor cards – as long as the initiative is coordinated with Israel Transplant.
If not, and the number of potential donors it adds is minimal, it is not worth
the dissension and division to have another database and card.
unilateral second organization just creates dissension and suspicion. There is
no need for yet another database that is not part of the official national
There are enough physicians around the country who have been
specially trained to declare a patient brain dead, using objective medical
No more are needed, and any family can consult with any
clergyman they trust,” said Beyar.
Most organ transplants cannot be
performed when the person’s heart stops beating; the organs are viable if the
heart continues to beat, but the lower brain is dead.
years ago, Steinberg and colleagues gave support for a Knesset bill written by
Kadima MK Otniel Schneller to regulate the determination of lower-brain death.
Although many physicians argued that it was unnecessarily strict and would
introduce rabbinical interference into medical procedures, for which doctors
were responsible, it was passed.
But even though the rabbis got the law
they wanted, they still want more restrictions, maintained Beyar. The Schneller
law led to the training of dozens of senior physicians in the use of
medicalequipment tests for determining brain death that is available at every
hospital in the country.
Steinberg said there is an “apparently large
population who listen to rabbis who want brain death to be supervised by
‘another pair of eyes,’” – the rabbis trained specially by Bilvavi. He insisted
that none of the 165 volunteer rabbis is paid for their work, even though they
are on call at all times.
The “clergyman consultant” clause that may be
chosen by ADI card-bearers means that the family can choose any rabbi, even one
who has no training in brain-death issues, said Steinberg. If they sign on with
Bilvavi, they have at their disposal dozens of rabbis called areivim
(guarantors) who ensure that no errors occur to give families peace of mind. But
Steinberg, who has his own ADI card, could not point to any errors
patients who were declared brain dead and were found not to be)
since the law went into effect.
The potential “audience” for Bilvavi does
not include secular Jews, and certainly not haredi Jews – who according to the
rulings by centenarian rabbinical arbiter Yosef Shalom Elyashiv, and others, may
not donate their organs.
However, he also ruled that if lifesaving organs
are already available, haredim may take them.
Deputy Health Minister
Ya’acov Litzman (a Gur hassid) has not intervened in the ADI-Bilvavi conflict
because it is not relevant to the haredi community; his director-general, Prof.
Ronni Gamzu, deals with organ-transplant issues.
Asked whether Bilvavi
intended its members to take advantage of the “extra points” to would-be donors
calculated when Israel Transplant decides on organ allocation, Steinberg said it
was not in favor of this and had not demanded it. “We regard it as a violation
of Jewish medical ethics to get priority for signing a card,” he said. “We also
think that ADI’s giving an extra-point system priority for signatories is a
gimmick and not practical. If two potential organ recipients, both ADI members,
meet the same physical criteria, how will having a card benefit when an organ
becomes available?” So far, just 3,000 Bilvavi cards have been
Steinberg said that if 10,000 were signed annually, that would
justify the existence of the organization. But the ADI campaign offering
priority for those who sign now has brought in some 50,000 new signatories in
just a few months, Beyar countered.
Beyar said that the Health Ministry’s
legal department has refused to recognize Bilvavi signatories for the
higher-priority bonus; only ADI members are.
A health system source told
that if Bilvavi had been recognized by the ministry, it would have lead
to a dozen more organizations demanding the right to issue its own cards. It
could be, he said, that they would be signed, but their rabbis would be so
strict about meeting brain-death criteria that no member would actually donate
organs. However, because they signed a card – if it were recognized by the
ministry – he or a family member would be eligible for priority in receiving an
The source said that Bilvavi initially said it wanted priority for
receiving organs, but when it saw the ministry was so adamant against it, the
organization now states that no preferential treatment is received by those who
sign its card – and in fact, nothing about priority is mentioned in its
Prof. Jay Lavee, a leading transplant surgeon and board member
of Israel Transplant, said Bilvavi “raises doubt in the mind of potential donors
that Israel Transplant and ADI are not good enough, that they have made
But this is absolutely untrue. The brain-death law set down
unnecessary procedures; it’s a bad law that serves as a break on organ
transplantation,” he insisted. “There are more potential donors, but fewer cases
of recognized brain death.”
Lavee, who has been negotiating with Bilvavi
initiators for two or three years, said that a medical team that “harvests
organs” has absolutely no vested interest in getting them for desperate
patients. The team that removes organs is completely separate from the team that
performs the transplant, he said.
“And there hasn’t been a single
reported case of errors in the system. If the money for running a second
databank, the Bilvavi phone center and campaigning for signatures were instead
invested in encouraging organ donations, that would be money well
The surgeon said that if religious people signed both ADI cards
and Bilvavi cards, “the ADI card would count and be registered with Israel
Transplant; the other card would not mean anything, as the family could consult
with any rabbi, including those affiliated to Bilvavi, if they
Kyrill Grozovsky, the Israel Transplant Center’s transplant
coordinator at Hadassah University Medical Centers in Jerusalem, explained that
system worked well before the brain-death law was passed, but it since
established uniform criteria for removing all organs.
objective instruments were used only in certain situations. Now, every suspected
brain-death case involves testing by at least one instrument, which ranges from
Doppler ultrasound and angiography to computerized tomograhy and SPECT isotopes
in complicated cases,” Grozovsky said.
But meeting the “unnecessary
criteria set down by Bilvavi only delays the process, and then some organs are
not usable – meaning that there are fewer transplants.
And having more
than one recognized organization causes division among Israelis. Any rabbi
chosen by the family can immediately receive results of tests and give them his
Everything is already in place,” said the Jerusalem transplant
Grozovsky said he suspected that Bilvavi’s motivation is
“There is some hidden interest behind it that the
organizers don’t want to reveal. Having a second or third or fourth donor card
gives the general public an impression that the additional ones are ‘better,’
and that ADI and Israel Transplant have a problem. But there is no such thing.
It all works very professionally.”
Tens of thousands of Israelis joined
ADI in recent months not because they had been against registering as potential
donors, he concluded.
“They were in favor, but they just didn’t get
around to it.
The publicity campaign gave the incentive to do what they
intended to anyway.”
Meanwhile, Israel Transplant announced this week
that in 2011, 89 families donated organs that saved the lives of 261 patients.
Between 49% and 55% consented to give organs.