Reluctance to donate organs persists, despite new views

los angeles | By the time the transplant team approached Doris Ullendorf and Ken Gorfinkle, they had already talked about donating the organs of their first-born son.

They knew that Ari, who until 48 hours before had been a perfectly healthy 16-month-old, was brain dead, killed by some mysterious and sudden illness that shut down his metabolic system.

“Part of our reason for doing it was a sense that maybe something good could come out of this horrible thing,” says Ullendorf of those wrenching days 16 years ago. “We also had a feeling that if somebody else had something of his, it was a way of keeping him more alive.”

So they held Ari while he was still on a respirator and said goodbye to him. Then Rabbi Neil Gillman, a family friend, helped the young parents do kriyah, tear their clothing in the Jewish symbol that marks the onset of mourning. He also assured them that donating Ari’s organs was a mitzvah.

“We weren’t sure what the Jewish position was, but our rabbi said if there was anything that could save a life, we should do it,” says Ullendorf, who now has three healthy children.

Like many other Jews, Ullendorf had had a vague preconception that Judaism would not support organ donation. And yet the affirmation she received from her Conservative rabbi is the same answer she might have gotten from any rabbi — Reform, Conservative or Orthodox.

While halachic debate still surrounds the donation of some organs, there is growing consensus that donating organs is not only permissible within Jewish law, but fulfills the positive imperative to save a life.

Several new educational initiatives have emerged in the Jewish community to spread that idea and to counter a very disturbing fact: The Jewish community has one of the lowest rates of organ donation among ethnic groups.

For despite rabbinic decisions, at a grassroots level, there persists in all segments of the Jewish community — traditional and liberal — a reluctance to discuss the topic, and an assumption that Judaism forbids organ donation.

People die every day waiting for an organ. There are currently about 83,640 people on the waiting list of the United Network of Organ Sharing, and that number is not expected to diminish in the next few years, according to the Division of Transplantation of the U.S. Department of Health and Human Services.

The situation has been particularly dire in Israel, where donation was chronically low. Israel was consistently a net drain on the European organ-sharing network, endangering the Jewish state’s status in the network. Israelis have often had to travel abroad to procure organs.

But the situation has taken a turn for the better, as several major rabbis, including the Shas leader Rabbi Ovadia Yosef, declared it not only permissible, but also a mitzvah to make your organs available. Still, Israel has a low rate of organ donation among the developed countries.

Given the high stakes, what is holding the Jewish community back? Partially, the same things that keep the number of organ donors so low in the general population.

“Part of it is people don’t want to contemplate death altogether, and part of it is when they do contemplate death, they have trouble thinking of themselves minus some organs,” says Rabbi Elliot Dorff, a bioethicist who is rector and professor of philosophy at the University of Judaism and co-chair of the bioethics department.

The Conservative rabbi said aside from a general aversion to death, what also comes into play are people’s fears of surgery and notions about resurrection.

According to many doctors and educators who deal with the issue, Jewish audiences — of whatever denomination — consistently bring up the idea that in order to be resurrected, one needs to have all one’s body parts.

Rabbi Eddie Reichman, a physician and professor at Yeshiva University’s Albert Einstein College of Medicine in New York, says the idea stems from some obscure references in midrashic sources. But he points out that if one believes in resurrection, that must come with a belief that God will restore decomposed bodies.

“There is a rabbinic tradition that there is one bone called the luz bone from which resurrection will take place,” he said, “so we will have a connection to the original body in which we lived. Rabbi Aryeh Kaplan has translated this midrash into contemporary understanding, saying one simply needs one strand of DNA.”

But there is also more solid ground for the perception that Judaism would frown upon organ donation: the very real halachic concept of kavod hamet, preserving the dignity of the body that housed the departed soul.

Cadavers are treated with honor, so that modesty is retained even during the ritual washing. The body is never left alone, and it is buried as soon as possible. It is no surprise, then, that harvesting organs would seem to violate these precepts.

But everyone involved in the halachic debate surrounding organ donation agrees that all those laws must be overridden if it is a matter of pikuach nefesh, saving a life — considered one of the greatest mitzvot in Judaism, surpassing most commands.

The real debate revolves, then, around the halachic definition of death. All organs from cadavers are harvested when the donor is brain dead, but machines are keeping the donor’s heart beating and blood flowing, since organs begin to deteriorate as soon as they are deprived of oxygen.

The classic talmudic definition of death is when a feather held below the nose doesn’t move, and when an ear pressed to the chest does not hear a heartbeat. The question then becomes how those criteria work into today’s medical technology.

In 1969, at the early stages of transplantation, the Conservative movement accepted cessation of brainstem activity as meeting the halachic criteria for death.

“The only reason why traditional criteria were the criteria was that was the state of medical science,” says Dorff.

In 1997 the Conservative movement passed a resolution declaring it a positive obligation incumbent upon Jews to sign a donor card and make their wishes known to family members.

The Reform movement likewise encouraged organ donation starting in 1968.

In the Orthodox movement, the question surrounding organ donation remains one of the most heated contemporary halachic debates, involving the top thinkers in the Orthodox world.

In 1991, the Rabbinical Council of America, an Orthodox umbrella group, weighed in, issuing a healthcare proxy form saying that brainstem death met the halachic criteria for death. Therefore, making one’s organs available for donation was permitted and strongly encouraged. The RCA, under the scholarship of bioethicist Rabbi Moshe Tendler, relied on the positions of the late Rabbi Moshe Feinstein and the findings of the Chief Rabbinate in Israel, which in 1989 declared organ donation permissible.

But the Agudath Israel of America, another Orthodox umbrella group, denounced the document, saying there was still too much debate to issue such a definitive answer. An article in the Jewish Observer in response to the RCA proxy cited several noted halachic authorities — including, they say, Feinstein — who have held fast to the idea that a beating heart renders a person living, and thus removing organs from a patient on a respirator constitutes murder.