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.

166. Title: Source Sheet on Organ Donation
     

     Author: Navon, Moize
     Publication:
     Year: ~~
     Download: Hebrew

     HOD Comments:

      

167. Title: Post-Mortem Sperm Retrieval
     

     Author: Halperin. Dr. Mordechai
     Publication: Jewish Medical Ethics
     Year: 2001~~
     Download: English

     HOD Comments:

      

168. Title: Visual Impairment and Unintentional Injury Mortality: The National Heath Interview Survey 1986-1994
     

     Author: Lee, David J., PhD; Orlando Gomez-Marin MSc, PhD; Byron L. Lam MD; D. Diane Zheng, MS
     Publication: American Journal of Opthalmology
     Year: 2003
     Download: English

     HOD Comments:
     This paper examines the relationship between reported visual impairment and unintentional injury mortality. Data indicate that severe, bilateral visual impairment is associated with an increased risk of unintentional mortality among adults in the United States. This would seem to support that saving a person from blindness is halachically as if he is being saved from a life-threatening desease (suma kamet). Department of Epidemiology and Public Health, University of Miami School of Medicine, Miami, Florida 33101, USA. dlee@med.miami.edu~~

      

169. Title: Visual Acuity Impairment and Mortality in US Adults
     

     Author: Lee. David J., PhD; Orlando Gomez-Marin PhD; Byron L. Lam MD; D. Diane Zheng, MS
     Publication: Archives of Ophthalmology
     Year: 2002
     Download: English

     HOD Comments:
     The purpose of this study was to examine the association between reported visual impairment and mortality among a nationally representative sample of American adults. The study’s findings show that severe visual impairment and less severe VI, to a lesser extent, are associated with increased risk of all-cause and cardiovascular-related deaths in American women; no link was found for men. These findings, though not fully understood, are similar to other previous studies on cardiovascular disease. For more information regarding the significance of the link between visual impairment and halacha, please see the explanation of Lee et al’s “Visual Impairment and Unintentional Injury Mortality: The National Health Interview Survey 1986–1994.”~~

      

170. Title: The Second Jewish Burial (Hebrew)
     

     Author: Gad, Dr. Dorit
     Publication: www.hofesh.org.il
     Year: 2004~~
     Download: Hebrew

     HOD Comments:

      

171. Title: Payment for donor kidneys: Pros and cons
     

     Author: Friedman, EA and AL Friedman
     Publication: Kidney International
     Year: 2006
     Download: English

     HOD Comments:
     This 2006 article argues for the establishment of a regulated system of kidney sales. This proposal comes in the wake of celebrity endorsements, public relations campaigns, and driver’s license organ donor registration which have failed to meet the increasing demand for organs. As a proponent of organs sales, Friedman argues, “The case for legalizing kidney purchase hinges on the key premise that individuals are entitled to control of their body parts even to the point of inducing risk of life.” This position is in direct opposition to medical association stances worldwide. In reality, black market organs sales are not uncommon in the developing world, allowing marketeers to take advantage of patients desperate for this life-saving procedure and donors living in poverty. To manage these increasing problems, Drs. Friedman propose the establishment of a fair market price, estimated to be about $40,000, to be paid by a federal agency working in collaboration with the United Network for Organ Sharing (UNOS). This agency would be self-sustaining and could reduce the long-term cost of managing end-stage renal disease by eliminating the need for costly and painful dialysis. The paper concludes with an acknowledgment that the development of another government agency, while not ideal, can reasonably deal with the ethical and medical challenges inherent in the present organ crisis.~~

      

172. Title: The Morality of a Free Market for Transplant Organs
     

     Author: Nelson, Mark
     Publication: Public Affairs Quaterly
     Year: 1991~~
     Download: English

     HOD Comments:

      

173. Title: Organs For Change
     

     Author: Siegler, Mark, MD
     Publication: The University of Chicago Magazine
     Year: 2007
     Download: English

     HOD Comments:
     The first of two articles in this file, “Organs for Change,” provides a concise history of organ transplantation, clinical medical ethics, and their intersections. Of transplantation’s ethical issues, Dr. Siegler says, “if you can grasp the ethical issues in transplantation, you grasp the major ethical issues in medicine.” Clinical medical ethics emerged as a field in the 1970s, challenged by the two major principles of organ donation: how to fairly increase supply and methods for equitable distribution. Dr. Siegler and his colleagues developed methods for ethical oversight with surgical innovation and establishing paired kidney exchange (including a Congressional amendment to the 1984 ban on organ sales). Fairly increasing organ supply continues to be a challenge as waiting lists are growing without a commiserate number of donors. Dr. Siegler’s solution includes further amendment of the 1984 ban to allow for a regulated system of organ sales.~~

      

174. Title: Brain Death World Wide: Accepted fact but no global consensus in diagnostic criteria
     

     Author: Wijdicks, Dr. Eelco
     Publication: American Academy of Neurology
     Year: 2002
     Download: English

     HOD Comments:
     While the concept of brain death is widely accepted, no universal criteria exist for its determination. This study compared guidelines from 80 countries finding that all standards specified exclusion of confounders, irreversible coma, absent motor response, and lack of brain-stem reflexes (see Wijdicks, “The Diagnosis of Brain Death” for more information). The majority of countries had medical practice standards (88%), legal standards (69%), utilized some form of apnea testing (59%), and required more than one physician’s declaration (50%). Specifics varied widely on the qualifications of the physician, methods of apnea testing, and observation time before pronouncement of death. Regional differences were also noted, such as mandatory laboratory tests in Europe and Asia. Within the United States, brain death determination has been left to each state to decide (44 states and the District of Columbia have guidelines) whereas most African countries do not. Even if guidelines are not standardized, it is clear there is a universal acceptance of brain death as a concept. Dr. Wijdicks concludes his survey with a call for an international task force on brain death guideline standardization, or, alternatively reexamination and revision of each country’s individual guidelines should cultural and religious beliefs dictate national policy.~~

      

175. Title: Kidney Donors Live Longer
     

     Author: Fehrman-Ekholm, Ingela ; Carl-Gustaf Elinder; Magnus Stenbeck; Gunnar Tydén; Carl-G Groth
     Publication: Journal of Clinical Transplantation
     Year: 19-Jun-05
     Download: English

     HOD Comments:
     One of the big questions surrounding living kidney donation (uninephrectomy) is donor safety. This study looked at the survival rates, causes of death, and kidney function of Swedish kidney donors more than 20 years after donation. The study’s most significant finding was that donor survival rates were considerably higher than in the general population. This result was most likely due to the strict evaluation process (one out of three applicants is chosen), which selects for the healthiest candidates. Renal function and causes of death were similar to the general population. These findings demonstrate no long-term risk associated with uninephrectomy, suggesting the practice is safe.~~

      

176. Title: Renal Transplantation: Living Donors and Markets for Body Parts – Halakha in Concert with Halachic Policy or Public Policy
     

     Author: Warburg, Rabbi Ronnie
     Publication: Tradition 40:2
     Year: 29-Jun-05
     Download: English

     HOD Comments:
     Rabbinical Council of America~~

      

177. Title: The International Organ Traffic
     

     Author: Rothman, David J.
     Publication: 10th Annual Conference on
     Year: 2002~~
     Download: English

     HOD Comments:

      

178. Title: The Economics and Ethics for Human Organs
     

     Author: Hansmann, Henry
     Publication: Journal of Health Politics, Policy and Law
     Year: 1989~~
     Download: English

     HOD Comments:

      

179. Title: Pediatric Liver and Kidney Transplantation with Allografts from DCD Donors
     

     Author: Abt, Peter; Randeep Kashyap; Mark Orloff; Ashok Jain; George Tsoulfas; Adel Bozorgzadeh; Kim Olthoff
     Publication: Transplantation
     Year: 27-Dec-06
     Download: English

     HOD Comments:
     Death after Cardiac Death (DCD) organs, a form of expanded criteria organs, have traditionally been associated with greater complications. Generally, organs are given to pediatric cases preferentially though this has not been the case with expanded criteria organs for fear of increased organ failure. This study examined the outcome of allDCD liver and kidney transplants in pediatric cases over a ten year period and finds the results optimistic . It should be noted that the samples sizes were very small warranting the authors to conclude that “with selective use and in the correct setting, liver and kidney recipients can expect durable results.” As with any small sample size, a larger study would be necessary to obtain valid statistical results.~~

      

180. Title: Short and Long Term Outcomes With the Use of Kidney and Liver Donated After Cardiac Death
     

     Author: Doshi, M.D. and L.G. Hunsicker
     Publication: American Journal of Transplantation
     Year: 29-Jun-05
     Download: English

     HOD Comments:
     This study shows positive results from patients who received deceased after cardiac death (DCD) kidneys and livers. DCD organs are from potential donors who have sustained irreversible neurological injury, but do not meet formal brain death criteria (DBD). Often these patients succumb to their injuries when mechanical support is removed thus DCD organs have sustained some injury. DCD kidney recipients and their kidneys had comparable survival rates to DBD recipients. DCD liver recipients and their livers had slightly decreased three year survival rates. Both options prove to be far better than those patients on the recipient waiting list who did not receive organs. Use of DCD organs in the US is relatively new and thus a very small percentage of the total number of organs donated (3% of kidneys and 1.4% of livers), which could affect these results. Two other liver options, split livers (when one adult liver may be shared approx. 60 – 40% between two recipients) and livers from donors above 60 years of age are compared to DCD livers.~~