Author Archives: Aaron Glatt

Symposium on the Ethics of Brain Death and Organ Donation: X

As this symposium closes, I offer the following reflection on what I've learned from both behind the scenes and in front. If the medical facts are sometimes unclear, even less obvious is how different thinkers relate to them. In a subject so widely examined, which countless articles and lectures have discussed, the lack of dialogue between parties is both surprising and confusing. While one may claim that a medical fact disproves another's approach, the other may see the question as so irrelevant as unworthy of discussion. One claims the other mistakes science while the other states that he was simply misunderstood. This symposium was not a dialogue. Such a conversation is extremely desirable. Until that happens, the warnings offered by many participants to proceed with respect and caution are worth heeding. It seems to me that all positions in this discussion have both medicine and halacha on their side, although some more obvious than others. Even if one is ultimately proved right, the other deserves respect and a fair hearing.

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Symposium on the Ethics of Brain Death and Organ Donation: IV

Rabbi Yaakov Weiner / UPDATED A number of great rabbis throughout the ages have accepted breathing and heartbeat as the parameters of death. However, we witness today that a clinically dead person, displaying neither breathing nor heartbeat, may be successfully revived. Does this state of affairs clash with the definition of death of our sages? I submit that the definition of death is primarily a matter of metaphysical, and not physical, change. It is contingent upon the soul leaving the body, as we find in the Mishnah (Ohalot 1:6): “A human [body] does not cause impurity until the soul departs.” No one can perceive the soul as it leaves the body; all that is available are signs of the event. In the time of the Talmudic sages, these signs were the cessation of both breathing and heartbeat. Today, however, via medical technology a clinically dead person can often be resuscitated. Such a case proves, albeit in ex post facto fashion, that the soul has not yet left the body. The definition of death has not changed; the signs have.

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Symposium on the Ethics of Brain Death and Organ Donation: III

Rabbi Moshe D. Tendler / Brainstem death, a.k.a. neurological death: a.k.a. respiratory death, raises the bar above respiratory death by requiring the “total cessation of all brain functions including the brainstem.” This definition is accepted internationally. It conforms fully with the halacha as stated in the Talmud (Yoma 85a) as elucidated by Rashi, “if he appears to have died, no movements are discerned… to ascertain the truth, examine if there is breath in his nostrils. If he does not exhale, he has surely died.” The B.S.D. protocol requires testing to ascertain that the patient does not respond to any stimulus. The neurological exam must affirm: unreactive pupils, no elicited eye movements, no motor response to stimulation, no grimacing, no blink response, no gag reflex, no respiratory movements such as cough, sigh or hiccup. Only after such affirmation the APNEA test is performed to confirm that without the pumping action of the ventilator, there is no autonomous breathing. Confirmatory tests can be performed if required to satisfy those who so demand. These can include a nuclide scan to confirm that no blood is reaching the brain; a test to prove that the brain is not utilizing glucose; as well as others. In truth, the clinical findings of the B.S.D. protocol are definitive such that confirmatory tests are not usually needed.

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Symposium on the Ethics of Brain Death and Organ Donation: II

Dr. Kenneth Prager / 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.

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Symposium on the Ethics of Brain Death and Organ Donation: I

Rabbi Aaron Glatt, MD / There has been a bizarre, unfortunate and hurtful conversation taking place in the public domain (including every imaginable forum) regarding the halachic viewpoint on Brain Death. This has undoubtedly been spurred by a comprehensive halachic work of great effort and significance that was recently published through the Rabbinical Council of America’s Va’ad Halacha. Written by wonderful and accomplished talmidei chachamim, it takes its place in our beautiful “yam shel Torah” with many other fine halachic works, including those that strongly disagree with it. Having cared for patients, been at their bedside as a physician and clergyperson, and sadly at times had to pronounce their death, I think it is very unfortunate that the ensuing debate from this critique has not produced a greater kiddush Hashem. And even more regrettably, it has engendered the opposite.

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