Comment #1: Lost in this communal discussion is the context of organ donation. It is part of broader end-of-life medical decisions. Many people gain comfort from the feeling of increased control that comes with thoroughly researching issues that arise. However, this can never take the place of consultation with a medical expert and a spiritual advisor. Ethicists may debate whether a living will or a healthcare proxy is better but finding a trusted advisor to guide you through the complex and emotionally difficult decisions is always important. In other words, the final answer to the issue of brain stem death is: Ask your rabbi.
Comment #2: I have no expertise on the many complex issues involved in brain death. I have invited some lawyers, rabbis, doctors and ethicists to write for this blog. Most have declined due to lack of time. If you fit the bill and can explain some of the issues to readers, please contact me. Also, please see the questions below. Perhaps you can help us better understand the issues by posting in the comments section.
Source #1: Another blog posted an audio clip from a lecture by R. Hershel Schachter (link, beginning at minute 44). The clip is misleading because, while accurate, it lacks the broader context and implies that R. Schachter takes the exact opposite position he really does. If you listen closely, R. Schachter only discusses the strength of various arguments without reaching any conclusion. In a different lecture, in response to a question he also briefly discusses the strength of different views but specifically says what is the commonly accepted ruling: link (beginning at 58 minutes). He also does it here: link (beginning at minute 26). Here is a link to R. Schachter’s Hebrew article on the subject, in which you can see the fuller context: link. As you can see, in the last section he discusses three possible attitudes toward receiving an organ and reaches no conclusion, ending with the the word “ועיין” (there is a floating-word/typo at the end but the next page is the beginning of a new essay). His position on organ donation and receipt has never changed, as can be verified from shul rabbis who have consulted with him on this issue over the past 20+ years. This is a cautionary note about information presented on irresponsible websites. Even when it’s right, it might be wrong.
Source #2: The RCA paper mentions a letter sent by R. Yitzchak (Isadore) Twersky, R. Joseph B. Soloveitchik’s son-in-law, and R. Ahron Soloveitchik, his brother, to R. Marc Angel about R. Soloveitchik’s position on brain stem death. I had not previously heard about the letter and can’t find it on the HODS website. It seems like something that should be publicly available. If you have a copy of it, please send it to me and I will post it.
For the doctors who can explain the facts to us non-medical folks:
Question #1: Some rabbinic authorities differentiate between brain stem death and total brain death. Is there currently a test that can verify total brain death? Twenty years ago there was not but is there today?
Question #2: Does harvesting an organ from a brain-stem-dead patient always mean his situation is made worse? (I know that phrasing is inadequate but I don’t want to say killed or that life-sustaining systems are removed.) For example, if only a single kidney is removed from a brain-stem-dead patient, is his situation changed so that all agree he is now dead? Or is he kept on life support and additional organs can be removed later?
Question #3: A relevant piece of information is whether any specific organ recipient causes a brain-stem-dead patient to be harvested. According to these statistics (link), it seems that donors give on average 3-5 organs. Is this the right data and am I understanding it correctly? Does this mean that most of the time, even if one of the recipients was not a match, the donor would still be harvested for organs? Is there data for number of recipients to number of donors rather than organs per donor?