Deal paves way for bill that would up organ transplants

Chief Rabbinate, Israel Medical Association (IMA) agree on how to determine the moment of death.

rambam hospital good generic pic 248 88 (photo credit: Channel 10)
rambam hospital good generic pic 248 88
(photo credit: Channel 10)
The Chief Rabbinate and the Israel Medical Association (IMA) have finally reached an agreement on how to determine the moment of death, enabling the Knesset Labor, Social Affairs and Health Committee to approve for its second and third readings a bill that will increase the number of available organs for transplant. Committee Chairman MK Yitzhak Galanti said that the bill approved Tuesday was a "revolutionary step that would help reduce the serious shortage of organs for transplant and will save many lives." The vote on the private member's bill of Kadima MK Otniel Schneller passed the committee and will soon go to the plenum for its final readings. Schneller said he was pleased by the vote, because the bill balanced the needs of medical ethics and the demands of Jewish law. The bill declares that lower-brain death and the halt of breathing can be determined solely by a pair of doctors authorized by a steering committee appointed by the director-general of the Health Ministry. The steering committee will be comprised of three physicians recommended by the IMA; three rabbis recommended by the Chief Rabbinate, at least one of whom must be a physician as well; an expert in ethics; an expert in philosophy; and a legal expert recommended by the president of the Supreme Court (one of the last three must be a doctor, while another must be a member of a recognized religion other than Judaism). Steering committee members will be appointed for a five-year term and be eligible for an additional term. The committee will devise ways of training doctors in a short course and approving them for determining the moment of lower-brain death. The training course for the doctors will include the aspects of medicine, law, Halacha and ethics relevant to the subject. When an approved doctor establishes the moment of death - after which the patient can be disconnected from life support devices and organs may be removed for transplant - he must inform the family of the patient's lower-brain-death status. The family is entitled to receive all documentation and to consult with a clergyman before deciding whether to donate organs. If accepting lower-brain death is regarded as forbidden by the patient according to information from the family, the ventilator will not be disconnected - until the patient's heart stops beating. Prof. Jonathan Halevy, director-general of Jerusalem's Shaare Zedek Medical Center (a modern Orthodox Jew who was formerly chairman of Israel Transplant, the national organ transplant coordination center), commented in the past that "Schneller's proposal is an excellent way to reduce public fears and increase trust in doctors who determine the moment of death." Halevy estimated that when the bill became law, the number of ADI registrants as potential organ donors would rise by 10 percent to 20%, and this would be significant. "It would calm potential donors in the entire population, not just the religious, and increase trust in doctors without harming their autonomy," he said. "It is not a magic solution, but it will advance organ donation. It will boost the national consensus." Although many Orthodox and even haredi rabbis in the US, for example, accept lower-brain death as the criterion for "death," most haredi rabbinical arbiters do not accept this definition. In 1984, the Chief Rabbinate accepted brain death as the determining factor if a religiously observant doctor was involved in deciding the moment of death. But this criterion met with opposition from the IMA, which insisted that any licensed physician, whatever his or her beliefs, is qualified to determine death. Surveys conducted by ADI/Israel Transplant to understand why people refused to register as potential organ donors claimed many refused because they feared doctors who determined the moment of death would bend the rules to remove rare organs from still-living patients to save others' lives. Although the state rabbinate has been nearly taken over by haredi rabbis and their halachic arbiters, rather than the more liberal national religious rabbis, the Chief Rabbinate never withdrew its approval for the recognition of brain death. The IMA opposed previous versions of Schneller's bill on the grounds that it would bring about "rabbinical supervision" of the determination of death.