Articles

Below you will find articles by rabbis, doctors and scholars about the halachic and medical issues surrounding brain-stem death and organ donation. Some articles are pro organ donation and some are con. We believe by showing all positions, we can allow the public to judge for themselves where they stand on these issues.

151. Title: Consideration of a Donation- Powerpoint Presentation
     

     Author: Jellinek, Samuel
     Publication:
     Year:
     Download: English

     HOD Comments:
     This discusses non-economics apsects~~

      

152. Title: Consideration for a Donation: Economic Aspects, Powerpoint Presentation
     

     Author: Jellinek, Samuel
     Publication:
     Year: ~~
     Download: Hebrew

     HOD Comments:

      

153. Title: The Potential Benefits of the Pediatric Nonheartbeating Organ Donor
     

     Author: Koogler, Tracy MD; Andrew T. Costarino Jr. MD, FAAP
     Publication: American Academy of Pediatrics
     Year: 1998
     Download: English

     HOD Comments:
     This study examined the population of a large hospital’s pediatric intensive care unit to determine the potential importance of organ donation from donors without heartbeats. Children in the intensive care unit tend to be sicker than their adult counterparts. They have a higher rate of severe neurological damage and die faster when removed from life support. The study was prompted by the request of two families to donate their children’s organs though no formal program existed at the time of publication. Researchers found that routine use of non-heart-beating donation could increase the donor pool by an estimated 42% at their center. These findings demonstrate that pediatric donors without heartbeats would be ideal candidates for organ donation and call for the establishment of pediatric non-heart-beating criteria.~~

      

154. Title: Consideration for a Donation
     

     Author: Jellinke, Samuel
     Publication:
     Year: ~~
     Download: English

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155. Title: Future Market: The Sale of Human Body Parts
     

     Author: Jellinek, Samuel
     Publication: Greene Study for Equity Studies
     Year: ~~
     Download: English

     HOD Comments:

      

156. Title: Transplantation of Kidneys From Donors Whose Heart Have Stopped Beating
     

     Author: Cho, Yong W. PhD; Paul I. Terasaki PhD; J. Michael Cecka PhD; David W. Gjertson PhD
     Publication: The New England Journal of Medicine
     Year: 1998
     Download: English

     HOD Comments:
     This study assessed the efficacy of transplanting kidneys from donors without heartbeats. Using data from the Kidney Transplant Registry, researchers found that transplantation from non-heart-beating donors were often successful at one year and should be considered a reasonable method to increase overall kidney transplant supply. Kidneys from donors who had undergone a unrecoverable trauma had the highest rate of success (vs. death from other causes). In the early period, these kidneys did not function as well, causing recipients to undergo dialysis in the first week after transplant. By one year, the success rate was comparable to kidneys obtained from brain dead patients. Kidneys from donors without heartbeats could represent a considerable supply for transplantation. Some estimate these kidneys could double the number of kidneys available for transplant and should be used to decrease the waiting list for kidneys.~~

      

157. Title: There is an answer to the shortage of organs donor
     

     Author: Garrison, R. Neal MD; et.al. (See Notes for additional authors)
     Publication: Surgery, Gynecology and Obstetrics
     Year: 1991
     Download: English

     HOD Comments:
     By: R. Neal Garrison MD; Frederick R. Bentley MD; George H. Raque MD; Hiram C. Polk Jr. MD; Linda C. Sladek MSN; Michael J. Evanisko MA; Bruce A. Lucas MD This 1991 study examined the success rates of organ donation requests. The study found that organ donation occurred 22% of the time and that family refusal was the largest reason organs were not donated. In nearly one-fifth of cases, doctors failed to recognize the potential for donation and the family was not approached. The study’s most significant finding was that families who were approached twice, first to discuss the death of their loved one and then later by request for organ donation, had the highest rate of donation. It is thought that separating the discussions allows the family to accept the death.~~

      

158. Title: Organ donors: Your care is critical
     

     Author: Edwards, John, RN, BSN, RRT, CPTC; Richard Hasz BS, MFS, CPTC; Jerome Menendez RN, CPTC
     Publication: RN Journal
     Year: 1997
     Download: English

     HOD Comments:
     This step-by-step guide provides a concise “how to” manual for a nursing care of an organ donor. Nurses can be involved in all stages of organ donor care from identification of a possible donor to organ recovery; they are particularly helpful in the management of a donor. This article explains who can be considered a potential donor, how and when to approach the family about donation, and what to look out for as the patient declines. These techniques guarantee the donor will receive the specialized care needed to ensure the viability of as many organs as possible, thus saving the greatest number of lives.~~

      

159. Title: Observations of withdrawal of life-sustaining treatment from patients who became non-heart-beating organ donors
     

     Author: DeVita, Michael A., MD; James V. Snyder MD, FCCM; Robert M. Arnold MD; Laura A. Siminoff PhD
     Publication: Critical Care Medicine
     Year: 2000
     Download: English

     HOD Comments:
     At the time of non-heart-beating donation’s revival, press reports circulated claiming organ donation was being performed on donors before they had died. This article investigates how to adequately document death and appropriate signs of death before issuing a death certificate. These procedures are especially important in cases of organ donation from non-heart-beating donors where the gap between donor death and organ recovery should be as short as possible. The study found that circulation did not resume after more than one minute of absent circulation, suggesting that two minutes should suffice for certification of death. A few patients had inadequate documentation in their records, which could raise concern for potential abuse. At the time of this article’s 2000 publication, no accepted national standards existed for the certification of death or necessary documentation required for record keeping and oversight existed. These findings demonstrate the need for development of a standardized death certification practice, eliminating any doubt of a patient’s death or the status of a donor at the time of donation.~~

      

160. Title: Non-Heart-Beating donors: One response to the organ shortage
     

     Author: D’Alessandro, Anthony M., MD; Robert M. Hoffmann; Folkert O. Belzer
     Publication: Transplantation Review
     Year: 1995
     Download: English

     HOD Comments:
     Before brain death criteria, there was only non-heart-beating donation (NHBD). NHBD is associated with longer ischemic times, which caused the practice to fall out of favor after brain death criteria were accepted in the 1970s. Ischemia causes damage by limiting or blocking blood flow to an organ. Within NHBD, there are two types: controlled and uncontrolled. In controlled NHBD, time of death is dependent on withdrawal of life support as determined by the family and physician. Controlled NHBD was expected to yield the greatest number of ‘extrarenal organs’ (i.e. not kidneys). In contrast, uncontrolled NHBD is often from patients suffering a sudden death, such as heart attack. Uncontrolled donations are more complicated because the family must have time to hear about donation and come to a conclusion while organs are still viable. Since this process takes time, uncontrolled NHB donors were expected to contribute mostly kidneys, which can withstand more ischemia. These criteria will expand the number of organs available for transplant and should be implemented in conjunction with other expansion efforts.~~

      

161. Title: Non-Heart-Beating Organ Donation: Process and Review
     

     Author: Edwards, John M., RN, BSN, RRT, CPTC; Richard D. Hasz Jr.; Virginia M. Robertson BS
     Publication: AACN Clinical Issues in Critical Care Nursing
     Year: 1999
     Download: English

     HOD Comments:
     Non-heart-beating donation (NHBD), a process by which organs are recovered from patients after pronouncement of death by cardiopulmonary criteria, has mistakenly been label a new donation procedure. This article describes the NHBD donation process, ethical considerations, and the nurse’s role in assisting families with this end-of-life decision. Patients meeting NHBD criteria have sustained life-threatening injuries (including devastating neurological damage though do not fit strict brain death criteria) prompting withdrawal of life-sustaining treatments. These treatments are only withheld if it is believed that the patient’s cardiopulmonary function will stop within one hour of withdrawal. To assess cardiopulmonary function, the patient is removed from the ventilator briefly while the doctor looks for a rapid decrease in heart rate, blood pressure, and oxygen saturation, all telltale signs of impending cardiopulmonary cessation. It is important to note that withdrawal of life support is a common end-of-life practice and that the decision to withdraw should be made before any mention of organ donation. Once the decision to donate has been made, a representative from the transplant team should meet to coordinate timing of withdrawal. The representative should explain that the timing and location of withdrawal can affect which organs are available for donation. For example, should the patient be pronounced dead within one hour of withdrawal, cardiopulmonary criteria would be used and he or she would be rushed to surgery to recover organs available for donation. Organs are best transplanted as soon after death as possible, each with a different timeframe of viability. After all explanations, the family’s wishes should be respected. A helpful case study can be found at the end of the article.~~

      

162. Title: Explaining brain death: a critical feature of the donation process
     

     Author: Franz, Holly G., BSN; William DeJong PhD; Susan M. Wolfe BA; Howard Nathan BS; Denise Payne RN, MPA; William Reitsma BSW; Carol Beasley MPPM
     Publication: Journal of Transplant Coordination
     Year: 1997
     Download: English

     HOD Comments:
     TThis study examined how families’ understanding of brain death affected their decision to donate their loved one’s organs. Little more than half reported receiving an explanation of brain death. Most respondents, even those who had chosen to donate their loved one’s organs, could not demonstrate a clear understanding. Few reported hospital or organ procurement organization staff used visual aids to clarify or reinforce the ideas presented. Before making organ donation requests, a physician should provide a consultation on brain death and the severity of the donor’s injury. Healthcare providers should be familiar with common misconceptions and assess the family’s understanding of brain death. To ensure this communication happens, a clear protocol has been provided at the end of the article.~~

      

163. Title: Sale or Donation of Human Organs
     

     Author: Cohen, Rabbi Alfred
     Publication: The Journal of Halacha
     Year: 2006~~
     Download: English

     HOD Comments:

      

164. Title: Sales of Organs from a Living Donor for Transplant: Motivation and Decision Making
     

     Author: Rappoport, Shabtai
     Publication: Greene Fund for Equity Studies
     Year: ~~
     Download: English

     HOD Comments:

      

165. Title: Interaction of Organ Donor Families and Recipients
     

     Author: Lewino, David, RN, CCRN, CPTC; Lisa Stocks RN, MSN, CPTC; Gail Cole RN, BSN, CCRN, CPTC
     Publication: Journal of Transplant Coordination
     Year: 1996
     Download: English

     HOD Comments:
     The purpose of this study was to determine feelings about direct contact between donor families and recipients. The study found that the majority believed they had a right to meet and were in favor of direct contact. Families wanted to see the benefit of organ donation first-hand and favored prior correspondence. Recipients most often wished to express their gratitude. Both groups believed meetings should be organized by an agency involved in the donation though they did not believe the agency should be responsible for the meeting’s outcome. On the basis of these findings, suggested guidelines were developed to implement meetings. These guidelines can be found at the end of the article.~~