Maran Rav Chaim Kanievsky: Death Determined
With Cessation Of Cardiac Activity Only
January 14, 2010
HaGaon HaRav Chaim
Kanievsky this week met with a senior member of
According to the report, the rav stressed that brain activity is never a determining
factor regarding death and therefore, donor organs from such a person, whose
death was declared based on the lack of brain activity, are forbidden.
The doctor wished to understand, to clarify,
asking how it is possible that it is forbidden to donate an organ while it is
permissible to accept one.
The Rav clarified,
stating that if donor organs are harvested from people declared dead based on
brain death alone, and their hearts are still functioning, their organs are
forbidden [for transplants]. That is to say, they may not be declared ‘dead’.
Therefore, doctors may not view them as viable transplant donors for as long as
their hearts continue functioning. The donor may not give them and recipients
may not receive them, even with the knowledge that a Jewish life will be saved
as a result. The two then discussed a number of other halachic
matters.
It is important that readers are aware this is
not to be viewed as a p’sak halacha and in such matters, one is to consult a posek.
(Yechiel
Spira – YWN
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9 Comments »
1. The Rav clarified, stating that if donor
organs are harvested from people declared dead based on brain death alone, and
their hearts are still functioning, their organs are forbidden [for
transplants]. That is to say, they may not be declared ‘dead’. Therefore,
doctors may not view them as viable transplant donors for as long as their
hearts continue functioning. The donor may not give them and recipients may not
receive them, even with the knowledge that a Jewish life will be saved as a
result.
This paragraph needs additional clarification. Did
R. Kanievsky mean that such organs are forbidden for
transplant even after the fact? IOW, while it may be forbidden for a doctor to
harvest such an organ, what if an organ becomes available from another outside
source. Can the recipient accept the organ? It’s not clear from his statement.
If his p’sak is that such
organs are forbidden even post facto, then I wonder how it is permissible to
accept such organs at all when (IIUC), most (if not all) such organs are
unusable if you have to wait for cardiac activity to stop.
The Wolf
Comment by WolfishMusings — January 14, 2010 @ 10:35 am
2. 1. What if the heart has stopped to function, but the persons brain is
still active, and is perhaps conscious (e.g., if they have an artificial heart
working). Perhaps he requires both brain death and the heart not functioning. I
can’t he imagine he approves of the practice of meachanically
stimulating the heart of a dead person in order to keep the organs “fresh” for
harvesting.
2. If one can’t derive benefit from someone killed
for his organs, that means a hecksher
would be required over the whole transplant process, which may be beyond our
ability to arrange.
Comment by akuperma — January 14, 2010 @ 10:42 am
3. According to this logic, why would a frum
doctor try to resuscitate someone whose heart has stopped? They are halachically dead and nothing can be done for them.
Comment by justajew — January 14, 2010 @ 11:02 am
4. every situation needs a psak.
R’ Chaim may be speaking
for harvesting an prgan only
after cardiac death may be regarding yidden who wan
to donate their organs.
It may be if a Eno yehude wants to donate organs
anyways and will pull the plug anyways wether a yid gets the organ or not is a question to be asked. maybe then the organ is mutar. i dont
know. BUT ASK.
Eash case is diffrent and needs a psak. There
are kidneys and even partial liver which are today harvested from healthy
living people.
Yes The proof that cardiac
should be determining fact for death is clearly a result of the success rates
of organ transplant is extremly higher when a person
is only brain dead and the heart is still functioning.
B”H a realtive had a
liver organ transplant almost 2 years ago and is a total new person.
Comment by savelkwd — January 14, 2010 @ 11:20 am
5. 1. It’s pretty clear that R. Kanievsky meant the irreversible cessation of cardiac
activity. That is why we resuscitate patients, since if they ‘come back’ their
heart was never irreversibly stopped. True, you can only tell this after the fact,
but that is the definition.
2. I don’t think he has ever publicized what he
holds of an artificial heart, but I don’t think he would say that such a
patient is dead. Such a patient has something functioning instead of the heart
that is keeping them alive. While you can replace the heart [and lungs and
kidneys] you can’t replace the brain.
3. According to what he is saying, you may not
receive any organs ‘donated’ by a patient diagnosed as ‘brain dead.’ This is a
big deal and disagrees with what his father in law, R. Elyashiv,
has paskined in the past. However, it is unclear if
R. Elyashiv was aware of the actual procedure since
what he describes is not completely accurate. Vital organs are only removed
when a recipient is available and present. R. Elyashiv
did not address this reality directly.
Comment by jewish guy —
January 14, 2010 @ 11:22 am
6. Cessation of cardiac activity isn’t a good way to tell death. It is
very reversible, that is why defibrillators exist. On the other hand, brain death
is very irreversible.
Comment by jlq3d3 — January 14, 2010 @ 11:58 am
7. A real sit down between the Gedolim and some
top medical experts to finally address this issue would be very helpful to
everyone. I have personally had the z’chus as a Hatzolah member to resuscitate patients who are in cardiac
arrest. A defibrillator uses electricity to kick a heart back into a proper
rhythm. But that heart still has some activity. On the other hand, when the
patient has a TOTAL absence of activity in their heart (which is called asystole) we do CPR and the paramedics give medication to
get the heart pumping again. It is a tremendous z’chus
to be on a call like this and contribute to saving a life. However, with all
due respect to the Rav, we do not stop working on a
patient simply because the heart monitor shows an absence of activity in the
heart. I have B”H been on quite a few calls where a “flatlined”
patient has been rescued and gone on to live many more years. No it’s not
common, but it does happen.
So my issue is, having been
blessed to see this with my own eyes, how can I accept that cessation of
cardiac activity equals death. Hashem has
permitted me to see otherwise.
Comment by NineTwo — January 15, 2010 @ 1:08 am
8. The Rav gets it. He means irreversible
cardiac arrest. That means you tried to resuscitate him. If the patient is is Vfib, then you tried to
defibrillate. If he is asystolic you did CPR, a bunch
of times with proper ACLS protocol.
If the person ‘comes back’ it proves it was not
irreversible. Therefore, anytime a heart stops and we don’t know that it is
irreversible – then we should try to bring the person ‘back.’
The Rav is stating
clearly however, that when the heart is beating, then the person is alive. All
brain dead patients’ hearts are beating and are therefore alive according to
the Rav. Taking out their hearts is retzichah.
Comment by jewish guy —
January 15, 2010 @ 10:00 am
9. The first poster, Wolf, implied that Rabbi Kaniefsky
just meant you can’t harvest organs from those who are brain dead, but once
they are already taken, Jews can use them. The original quotes in the article
clearly imply Rabbi Kaniefsky was saying Jews cannot
benefit in any way from organs taken from brain dead patients.
This is a very honest, courageous and important
statement by Rabbi Kaniefsky. Prior to this, many Haredi Jews had no problem receiving organs for transplant
from a brain dead person, but still refused to donate. This is not only
ethically repugnant but halachically problematic, as
R. Kaniefsky says. When doctors prepare a person who
is brain dead to have his heart or lungs to be donated, it is specifically
designated for a recipient at that time…there is no “bank” of hearts and lungs
that can be utilized by recipients post facto.
It will be interesting to hear the response of
other poskim who in the past have allowed Jews to
receive organs from those who are brain dead.
This is a very complex topic, and people are urged
to speak to their Orthodox rabbis if they have a question about halachic organ donation. For additional information on this
subject (including video testimony from R. Dovid
Feinstein on his father’s position on the subject), please visit http://www.hods.org
Comment by michael g feldstein — January 17, 2010 @ 11:50 am