The Process of Organ Donation
Dr. Kenneth Prager
Dr. Kenneth Prager is Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons and Director of Clinical Ethics and Chairman of the Medical Ethics Committee of Columbia University Medical Center.
In the wake of reignited interest within the halachic community in organ donation, Rabbi Student asked me to describe the process of declaring a patient brain dead and removing organs for donation. I have authorized him to reproduce my answers to his specific questions, which I believe have halachic implications.
When a patient is pronounced brain dead at Columbia University Medical Center the family is informed of this finding and they are explained its significance. It should be noted that the patient is legally dead in the United States if brain death has been determined.
The family is approached by an organ donor network representative asking if they are willing to allow their loved one to be an organ donor. If the family agrees to organ donation the brain-dead patient will be evaluated for suitability to be an organ donor. If he is found to be suitable and if there are appropriate recipients then the organs are removed in the operating room, after which the ventilator is removed and the body becomes available for burial.
If the family refuses to allow organ donation they are told that in view of the fact that their loved one is legally dead that he will be removed from the ventilator. If the family objects, whether for religious or other reasons, reasonable accommodation to the family’s beliefs is made and the patient is not removed from the ventilator. Instead, the patient remains on the ventilator until cardiac arrest occurs of its own, usually in a matter of days. New York and New Jersey are among the states that legally require such accommodation. In 38 years at Columbia, I have never seen a brain dead patient removed from a ventilator against the wishes of the family.
When a brain dead patient/donor is taken to the operating room, his chest is opened and the blood is drained from his body by an incision in a large vein in the chest. A cold saline solution is then circulated throughout the body to preserve the organs. Thus the person is “murdered,” per the terminology of those denying brain death, by the cessation of all circulation even before any organ is removed, by having all the blood drained from the body.
In 10-15% of cases of brain dead organ donors, only a single organ is removed and is selected for use of only one compatible recipient. Thus the Jewish recipient of the single organ donor may be the only reason the donor is taken to the operating room and “murdered” for the removal of the organ. While it is true that the brain dead patient will be removed eventually from the ventilator, the immediate act that is carried out, namely the exanguination of the donor in the operating room and the removal of the vital organ, is done specifically to save the life of the single–sometimes Orthodox Jewish–recipient.
When multiple organs are taken, the heart is generally removed first but the person is already dead even by circulatory criteria at that point. Therefore, when multiple organs are removed, no single recipient causes the “death.” However, about 10-15% of brain dead donors donate only one organ. Thus there is a significant chance that an organ recipient is the proximate cause of the “murder” of the donor who is saving his life.
(Next: Rabbi Moshe D. Tendler)