Bone Marrow: The best kind of gift


In 2002, Los Angeles native Ronnel Conn was an undergraduate at George Washington University in Washington, D.C. When he heard there would be a bone marrow donor drive at the campus Hillel for a D.C. local in need, he showed up and got his cheek swabbed, because, he said, “It seemed like the right thing to do.” 

After graduation, he moved back to Los Angeles to attend graduate school. And then, on a summer day in 2006, he received a phone call from a representative of Gift of Life (giftoflife.org), the Boca Raton, Fla.-based organization that runs the donor drive, and drives like it, all over the country. While there are dozens of worthy organizations that do work similar to that of Gift of Life, the organization is unique in its focus on the Jewish community.

It was a woman on the phone, Conn remembers. “She said, ‘You could be a potential match for somebody.’ I had to first remember that I was in the registry.”

The next step was blood work to determine how good a match he was. “Through the blood work,” Conn explained, “they can determine on a zero to 10 scale what level match you are. I was a 10 out of 10, the highest-level match.” But Conn had his apprehensions.

“I don’t like hospitals,” he said. “I don’t like medical procedures. But I was thinking two things. One, the Jewish tradition teaches us if you can save one life, you can save the whole world. That really resonated with me. Two, whatever fear I am feeling, it is nothing compared to the person on the other end. So I went forward with it.”

Going forward meant daily injections by a nurse of a drug to increase blood-forming stem cells several days in advance of the nonsurgical procedure. Next, he spent a few hours at City of Hope in Duarte, having his blood drawn from one arm, cycled through a machine, and then returned to his body through the other arm, all the while accompanied by someone from Gift of Life’s donor services department. (In about 20 percent of cases, the donor goes through a more invasive procedure where bone marrow is aspirated from the pelvic bone using a needle and syringe, but there is no cutting or stitching and rarely is an overnight hospital stay required.)

All that Conn knew about the intended recipient was that he was a 28-year-old male. Conn, who is now the assistant executive director of the Westside Jewish Community Center, was just a few years younger. It could have been one of his buddies.

One year later, Conn was contacted by Gift of Life to find out if he was interested in meeting his recipient. His answer was unequivocal: Yes. If the other party also said yes, a meeting would be arranged. Not long thereafter, Gift of Life flew Conn to New York to meet the recipient at one of the organization’s board meetings. After the emotional meeting, the two men spent several hours at a nearby bar, getting to know each other. Conn learned that the man was a physician. He had been a medical resident, treating first responders following the Sept. 11 terror attacks, when another resident mentioned he didn’t look so well and should get checked out. He did, and learned he had leukemia. 

“We have become great friends,” Conn said. “I went to his wedding. He now has a kid. I’ll always remember when I met his mom … at his wedding. She gave me the biggest hug. She said, ‘Thank you for giving my son back.’ I learned after the fact how dire his situation was.”

Currently, Gift of Life counts some 235,000 donors in its database, the majority Jewish, though they welcome and encourage anyone and everyone to register, especially healthy adults ages 18 to 44, who are most likely to yield a match.

These numbers represent tremendous progress since 1991. That was when Gift of Life co-founder Jay Feinberg was diagnosed with leukemia, at the age of 23, and was told by his doctor in no uncertain terms that he would not find a match because of the low number of Jews in existing databases and the fact that so many blood lines were severed in the Holocaust. (Donation of blood stem cells, unlike regular blood donations, has a genetic element.)

Within days of that conversation, Feinberg and his mother, Arlene, founded Gift of Life.

“One of the most powerful things I have witnessed in the world is the power of a Jewish mother,” said Feinberg, now 46. “She, like any parent would, said, ‘I’m not going to let my son or daughter die.’ It’s certainly what she did. We started Gift of Life around my parents’ dining room table. Before we knew it, we got donated office space.” 

Today, Gift of Life has 45 full-time employees nationwide, runs about 1,000 donor drives a year throughout the United States, primarily on college campuses, and has facilitated transplants in more than 2,700 patients all over the world. It took four years for a match to be found for Feinberg himself. But in that time, matches were found for many other patients.

Feinberg is now chief executive of Gift of Life. His mom died earlier this year. In her honor, the organization recently launched the “Arlene’s Vision” fundraising campaign with a goal of raising $4 million and signing up 70,000 new donors. 

Some two dozen foundations and hundreds of individuals support Gift of Life, which brought in and spent approximately $8 million in 2012 (the latest year for which this data is available). Like other tissue banks, the organization also is reimbursed every time a transplant takes place. This covers all of its associated medical expenses. 

Beverly Hills resident Yvonne Hatherill, 53, received a transplant thanks to Gift of Life. 

“Basically, they saved me,” she said. “But they also saved my family.” Hatherill’s twin girls were 2 1/2 when she was diagnosed with T-cell acute lymphoblastic leukemia in 2004. At the time, Hatherill figured she was tired simply because of the demands of being a mom.

Needless to say, Hatherill is a huge advocate of joining the donor database. (You can even request a kit on Gift of Life’s website if you can’t make it to a drive.) 

“I can’t express how important it is,” she said. “The fact that people still think it is going to require this painful surgery, it’s an outdated belief. That’s rarely what happens.

“You do have to go through a medical exam. And they will give you a couple of injections to boost stem cells so when they draw them you have more than normal. But for very little effort on your part, you can save a life. It is that simple.” 

Awaiting transplant, family rallies with hope


Michael Goldberg’s heart is working just fine.

The University of Washington professor teaches a class on romantic comedies. From “Annie Hall” to “Pretty Woman,” he leads his students on a tour of film’s fondest genre.

What Goldberg needs, however, is a new kidney, and it’s not the first time. His lone kidney is a failing transplant from nearly two decades ago.

It all started when he was a 15-year-old living in Los Angeles. He was diagnosed with Type 1 diabetes, a disorder in which the pancreas stops producing insulin, a hormone that converts sugar into energy. Blood sugar levels rise, causing excessive thirst and urination, as well as potential organ damage down the line. 

Looking back, he wishes he’d taken better care of his body after the diagnosis. 

“I was probably not in good control for three or four years,” Goldberg said. “It was a combination of I was a semi-alienated 15-year-old, and I had ADD.”

A 2.0 senior year GPA didn’t stop him from enrolling at the University of California, Santa Cruz, where he found a good doctor and started to regulate his condition. But in 1986, while earning his doctorate at Yale, he was diagnosed with kidney disease. 

He got married and took a professor position in the Seattle area in 1993. Soon after, his failing kidneys finally gave out.

“I had to go on dialysis suddenly,” he said. “There were a lot of complications, and
it was tough.”

He began going to the Northwest Kidney Centers three days a week for the blood-cleansing treatment, which involves a machine artificially filling the role of the kidneys. Blood is drawn from the body, typically through a vein in the arm, then cleaned and streamed back in. 

In addition to needing a new kidney, doctors told Goldberg he needed a new pancreas. This promised to cure his diabetes, a pancreas-based disease, but ruled out the prospect of a living donor. He was put on the waiting list for a pancreas-kidney transplant in 1995. Just nine months later, he received the organs from a cadaver donor — a recently deceased teenager whose parents wanted their son’s organs to live on.

Goldberg in his office on the Bothell campus of the University of Washington, where he teaches history and film.

The new kidney fit right in for 17 years, which is outstanding for a cadaver donation. But the powerful medication that organ recipients must take can eventually be toxic to the new organs.

“Most kidneys fail not because your body rejects them,” Goldberg said. “It’s because you’ve been scarring the kidney through the immunosuppressant drug.”

In fall 2011, the lab results came in: The pancreas was in good shape, but Goldberg needed another kidney.

He went back to the Northwest Kidney Centers, but this time for training rather than treatment. He and his wife, Elizabeth de Forest, learned how to do home dialysis and set up shop in their bedroom in August 2012.

Home dialysis is done five nights a week and takes about five hours a night. De Forest throws on a lab coat and latex gloves and inserts a needle into her husband’s fistula, a surgically created passage where a vein has been connected directly to an artery. The vein is about as thick as a piece of licorice — strong enough to be drawn from night after night.

A preschool teacher by trade, De Forest took the year off to be by her husband’s side. “I’m pretty much on call if anything happens,” she said.

Studies have shown that home dialysis can reduce stress on the heart and improve survival rates. Still, 90 percent of dialysis patients prefer to go to a center. Many cite a feeling of safety that comes with having the process done by professionals.

But, for Goldberg, there’s no place like home. He loves having his wife and two sons, Asher and Jonah, around to support him. There’s a flat-screen TV in the bedroom, with boxes of DVDs on one side and boxes of syringes on the other.

“It can be stressful at times but, you know, usually we’re used to it,” said Asher, 14.

“It’s not just him on the machine,” said 12-year-old Jonah. “It’s sort of like all of us.”

Michael Goldberg and his wife, Elizabeth de Forest, setting up the home dialysis process.

Goldberg attends the Reform Temple B’nai Torah in Bellevue, Wash., where he has relied on the clergy as a source of support since learning that the transplant was giving out.

“Even though I was really sick, I was trying to make it for Saturday services,” he said. “My blood pressure was going up and down — people were always looking out for me. But just to be there was so important. I really feel my faith helps me get through this stuff.”

An especially tough stretch came around the time his son Asher was turning 13. On the Friday night of the bar mitzvah, Goldberg was in such terrible shape that he had to leave and lie down. At the following day’s ceremony, though, he got up and danced.

“The bar mitzvah became this remarkable moment,” he said. “It really felt like a blessing.”

Goldberg’s parents, Irving and Esther Goldberg, live in Encino. His father was so touched by his son receiving the first kidney that he started a nonprofit called Transplant for Life.

“I felt I had an obligation to return my expertise in a way that would help increase organ donation,” the elder Goldberg said. “Transplant for Life was based on the mission of increasing donor awareness among the interfaith religious communities in our nation.”

They provided speakers for synagogues, churches and mosques and distributed kits that included sample sermons and prayers. For years they participated in the annual National Donor Sabbath, a three-day observance that encourages a nationwide dialogue about organ donation. This year’s Sabbath ran from Nov. 15-17.

While the transfer of organs can be contentious in Jewish culture, Transplant for Life found wide support.

“We researched all denominations of the Jewish community: Reform, [Conservative], Orthodox, ultra-Orthodox,” Irving Goldberg said. “We had close to an 80 percent positive response.”

The only real resistance came from the ultra-Orthodox, but even there, some approved of the process so long as specific criteria were met.

Transplant for Life was eventually absorbed by the Transplant Recipients International Organization.

The organ waitlist looks a lot different now than it did in 1995. There are more than 120,000 people who need an organ, and about 18 of them die each day. What once took six to nine months can now take up to five years, depending on blood type. For Goldberg, whose blood type is A, it’s two to three years, but he doesn’t even know where he’s at on the list.

The alternative to the waitlist is finding a living donor. Often family members or loved ones volunteer to help out. Goldberg found out the first time around that his close family members have positive cross-matches, meaning his antibodies will reject their blood cells. 

He had a donor lined up last spring, a friend whose kids attend school with his, but doctors discovered a rare condition in her kidney that meant she wasn’t a candidate. 

Donating a kidney traditionally required the removal of a rib. Now there’s a less invasive laparoscopic procedure with improved success rates and recovery time. Research shows giving a kidney doesn’t affect long-term health or lifespan. 

“You never know, there are people now donating kidneys who don’t know anyone,” Goldberg said, referring to so-called altruistic donations. “They just say, ‘I want to donate a kidney,’ and get connected.”

For now, it’s five nights a week on the machine. 

“It can be a challenge,” Goldberg said. “It’s emotional. I think we deal with it really well. You’re dealing with your body — you’re dealing with needles and blood and those sorts of things.”

But like any good professor, Goldberg tries to keep things in perspective.

“I was talking to the cantor a couple days ago. He was saying that for people who have a larger spiritual outlook — whether religious or just based on concern for a larger purpose in the world — it’s easier to fight off the feeling of self-involvement about your condition. Mine is bad, but there are worse things. Look outward. Ask yourself not just why you want to live, but what do you want to do that day in the world? Look beyond yourself.”


For more about Goldberg’s story, visit http://www.caringbridge.org/visit/michaelgoldberg

A Kidney for Chana


 

Chana Bogatz is 5 years old, and she loves cutting and pasting paper, playing with her brothers and sisters and having “Happy Birthday” sung to her.

In those ways she is a normal child, in other ways, she is not. She has never eaten food through her mouth — only through a feeding tube inserted in her nose. Her hair is long but patchy, and her face is bloated. She is the size of a 3-year-old. She speaks in half-words, not sentences, because she has never been to school, so her vocabulary is underdeveloped. She has spent most of her short life in hospitals. And if she doesn’t find a kidney, she could die.

This month, Chana’s parents, Yehudis and Moredechai Bogatz, launched a citywide appeal to find someone who could donate a kidney to their daughter. Neither of them have the blood type necessary (type O) to make them potential donors, but they are hoping that someone will respond to the “Save Chana” flyers they have hung in shop windows all over the Jewish areas of Los Angeles or the savechana.org Web site they have set up, and be inspired enough to help Chana.

“If she gets a kidney, she is going to have a normal life,” said Yehudis Bogatz, who moved to the United States from Israel four years ago. “She is a very smart kid even though she has had a lot of complications, [but once she has had the transplant] she will be able to go to school and learn and do things.”

Chana is one of the estimated 60,000 people in the United States waiting for a kidney transplant, and one of 14,313 in the Western states. The need for kidneys has doubled in the past 10 years, according to Dr. Robert Metzger, president of the Organ Procurement and Transplantation Network. Statistically speaking, two-thirds of those in need will be on the waiting list for two to five years before a matching kidney becomes available on one of the national organ donor databases, like the United Network for Organ Sharing (UNOS). The kidneys registered on these databases generally come from cadavers.

But those wanting to bypass UNOS can attempt to find a living donor. Since a donor’s remaining kidney will perform all kidney functions, there is little risk involved for the donor. There is also a greater chance that the recipient’s body will accept the kidney, because there can be a better tissue match between the living donor and the recipient than there could be between a cadaver and the recipient.

The Bogatzes’ attempt to find Chana a kidney is the latest chapter in her long and difficult medical history. Three weeks after she was born, she was diagnosed with a sole, malfunctioning kidney. She began dialysis when she was 3 months old, but at 10 months, the veins used for dialysis were exhausted and could no longer sustain the treatment. At that point, the Israeli hospitals could do no more for her and, on one day’s notice, the Bogatzes moved with their six children — a seventh has been born since — to Palo Alto, Calif., so that Chana could receive treatment at Stanford Medical Center.

In 2001, she received an infant cadaver donor kidney, which was meant to be a “bridge” until a regular kidney became available. For a short while, the kidney worked, but after a year, it failed and she needed to continue dialysis once again. She was in dialysis for 20 hours a day. But eventually she lost the ability to respond to the dialysis. Last year, the Bogatzes moved to Los Angeles so that Chana could receive treatment at UCLA Medical Center.

Although her life is spent in and out of hospitals, Chana does as best she can. While on dialysis, she takes her scissors and paper and sits quietly amusing herself by cutting. She always pulls up her sleeve to show her doctors her one remaining “good” vein so they can poke it with their needles. She was — and still is — conscious and proud of the feeding tube in her nose, and will run to get either parent to put a new bandage on it if it starts to become loose. She also learned how to adjust the various tubes and catheters going in and out of her body, often surpassing her mother’s knowledge of how to work them.

For the Bogatzes, coping with their daughter’s illness has meant many changes to their lifestyle. In Israel, both Moredechai and Yehudis Bogatz worked as high school teachers. In addition, Yehudis wrote and produced plays for the school she taught at, and wrote a book titled “No Different Than You” (Feldheim) about Yehudis’ sister, Shevi, who died of kidney failure one year before Chana was born.

Both parents have yet to secure gainful employment — Moredechai Bogatz can’t speak English, and even though Yehudis Bogatz did start working as a teacher, the demands on her time ferrying Chana to and from the hospital made regular employment impossible. They live in a two-bedroom house in the Fairfax neighborhood, and rely on the support of organizations like Chai Lifeline and Tomchei Shabbos to meet their needs.

Now the Bogatzes main focus is making a happy home for their children, have them love each other and be proud of Chana. They see the illness as a blessing, and they try to focus and draw strength from positive things.

“When I first heard I had a sick baby, I was crying and crying, but my goal was that my family shouldn’t fall apart,” Yehudis Bogatz said. “So things don’t have to be perfect by me — I don’t care if the house is messy — as long as the kids are happy and Chana is happy, and that we are all together.”

For more information on Chana Bogatz, visit www.savechana.org, or call (800) 728-3254. Suitable donors must be between 18 to 45 years old, have type O blood and be in good health. There is no cost to be screened and donor’s medical expenses will be fully covered.

 

World Briefs


LAX Shooter Had Terror Ties?

The man who killed two people in the July 4 attack at Los Angeles International Airport told U.S. officials in the mid-1990s that Egyptian officials had accused him of being affiliated with terrorists. As a result of the disclosure made this week by U.S. officials regarding Hesham Mohamed Hadayet, Attorney General John Ashcroft ordered the agency to investigate any ties between asylum seekers and terrorist groups. Meanwhile, Egyptian police and Hadayet’s wife denied that Hadayet had been investigated for terrorist links. After killing the two and injuring several more people at the airport’s El Al ticket counter, Hadayet was killed by an El Al security guard.

Choreographer Wins

A choreographer who has created dance prayer rituals for the Reconstructionist movement won a MacArthur “genius” award. Liz Lerman was one of 24 MacArthur Fellows named Tuesday for their excellence in intellectual, cultural and scientific endeavors. Like the other winners, Lerman, 54, who lives in suburban Washington, D.C., will receive $500,000 over five years.

House Passes Palestinian Sanctions

The U.S. House of Representatives passed a bill instructing the president to issue sanctions if the Palestinian Authority violates its peace commitments. The State Department Authorization Act, passed Wednesday by a voice vote, includes language originally contained in the Middle East Peace Commitments Act. The bill calls on the president to report every six months whether Palestinian leaders have complied with agreements they signed with the United States and Israel and, if not, to impose sanctions on them. However, the president can choose to waive the sanctions for national security reasons. The authorization act also would require the American Consulate in Jerusalem to be placed under the supervision of the U.S. Embassy in Tel Aviv and would recognize Jerusalem as the capital of Israel and Jerusalem residents as Israelis. The bill awaits Senate approval.

Terror Victim Saves Palestinian
Girl

A Palestinian girl was recovering after she received a kidney from a Jewish victim of a Palestinian suicide bombing. Seven-year-old Yasmin Abu Ramila, a resident of Jerusalem, had been undergoing kidney dialysis for nearly two years while waiting for a transplant. The family of Jonathan Jesner, a 19-year-old yeshiva student from Scotland, volunteered to donate his organs after he died last Friday, a day after a suicide bombing aboard a Tel Aviv bus.

Briefs courtesy Jewish Telegraphic Agency.

Just the Right Size


This is a heartwarming story about a kidney.

The kidney in question belongs to Mike Jones. It used to belong to Patricia Abdullah.

Jones and Abdullah have very little, apparently, in common. Jones is an African American man. Abdullah is a female descendant of the Hawaiian royal family. Jones is Christian. Abdullah is Muslim. Jones lives in the city. Abdullah lives in the Valley.

They’re a perfect match. Sometimes you just have to stay positive. O-positive.

Jones and Abdullah met during a success seminar. When Jones announced he would have to be late to one session because of his ongoing need for dialysis, Abdullah and other classmates got involved. After five years of dialysis, Jones was desperately in need of a transplant.

For one assignment in their seminar, Jones and Abdullah learned how to successfully make what are considered “unreasonable requests.” During the in-class exercise, Abdullah shocked her partner: She said “I’m O-positive, Mike. Make an unreasonable request of me.” Jones, also O-positive, took a moment to realize what she had said, then put the seminar lessons to work and made an unreasonable request: “Will you give me one of your kidneys?” So she did.

Still, all did not run smoothly. But a fellow classmate, an administrator at Cedars-Sinai Medical Center, helped work out insurance problems. Cedars-Sinai’s Dr. Gerhard Fuchs alleviated Abdullah’s concerns about missing weeks of work at her new job by removing the organ laparoscopically, requiring only small incisions. Dr. J. Louis Cohen transplanted the healthy new kidney into Jones.

And so a Muslim’s kidney is transplanted into a Christian’s body in a Jewish hospital. Both patients were recovered and healthy within three days, so the kidney doesn’t seem to mind. And according to Abdullah, “Both of our families are going to get together for a group photo. And that’s going to be our Christmas card.”

History in the Making


By the time the transplant team approached Doris Ullendorf and Ken Gorfinkle, they had already talked about donating the organs of their first-born son.

They knew that Ari, who until 48 hours before had been a perfectly healthy 16-month-old, was brain dead, killed by some mysterious and sudden illness that shut down his metabolic system.

“Part of our reason for doing it was a sense that maybe something good could come out of this horrible thing,” says Ullendorf of those wrenching days 12 years ago. “We also had a feeling that if somebody else had something of his, it was a way of keeping him more alive.”

So they held Ari while he was still on a respirator and said goodbye to him. Then Rabbi Neil Gillman, a family friend, helped the young parents do kriyah, tear their clothing in the Jewish symbol that marks the onset of mourning.

He also assured them that donating Ari’s organs was a mitzvah.

“We weren’t sure what the Jewish position was, but our rabbi said if there was anything that could save a life, we should do it,” says Ullendorf, who now has three healthy children.

Like many other Jews, Ullendorf had had a vague preconception that Judaism would not support organ donation. And yet the affirmation she received from her Conservative rabbi is the same answer she might have gotten from any rabbi — Reform, Conservative or Orthodox.

While halachic debate still surrounds the donation of some organs, there is growing consensus that donating organs is not only permissible within Jewish law, but fulfills the positive imperative to save a life.

Several new educational initiatives have emerged in the Jewish community to spread that idea and to counter a very disturbing fact: The Jewish community has one of the lowest rates of organ donation among ethnic groups.

For despite rabbinic decisions, at a grassroots level, there persists in all segments of the Jewish community — traditional and liberal — a reluctance to discuss the topic, and an assumption that Judaism forbids organ donation.

An Urgent Need

Twelve people die every day waiting for an organ. There are currently about 68,500 people on the waiting list of the United Network of Organ Sharing, and that number is expected to quadruple in the next few years, according the Division of Transplantation of the federal government’s Department of Health and Human Services, which sponsors National Organ and Tissue Donation Awareness Week the third week in April.

In 1998, about 5,800 people who died donated organs and tissue — about a third of the number of potential donors. An additional 4,300 people were living donors, mostly of kidneys. One cadaver can supply a heart, kidneys, pancreas, lungs, liver, intestines, cornea, skin, bone marrow and connective tissue. Some of those on the waiting list can survive for several years without a transplant. Many will die waiting.

The situation has been particularly dire in Israel, where donation was chronically low, and Israel was consistently a net drain on the European organ sharing network, endangering the Jewish state’s status in the network. Israelis have often had to travel abroad to procure organs.

The situation has recently taken a turn for the better, as several major rabbis, most recently Shas leader Rabbi Ovadia Yosef, declared it not only permissible but a mitzvah to make your organs available. Still, Israel’s remains among the lowest rates of organ donation in developed countries.

Dignity of the Dead vs.

Saving a Life

Given the high stakes, what is holding the Jewish community back?

Partially, the same things that keep the number of organ donors so low in the general population.

“Part of it is people don’t want to contemplate death altogether, and part of it is when they do contemplate death, they have trouble thinking of themselves minus some organs,” says Rabbi Elliot Dorff, a bioethicist who is rector and professor of philosophy at the University of Judaism and chair of the Committee on Jewish law and Standards of the Conservative movement.

About five years ago, Dorff participated in an interreligious project that looked at the psychological, folklorist and literary issues that prevent people from making their organs available.

He said aside from a general aversion to death, what also came into play were people’s fears of surgery and notions about resurrection.

According to many doctors and educators who deal with the issue, Jewish audiences — of whatever denomination — consistently bring up the idea that in order to be resurrected, one needs to have all her body parts.

Rabbi Eddie Reichman, a physician and professor at Yeshiva University’s Albert Einstein College of Medicine in New York, says the idea stems from some obscure references in midrashic sources. But he points out that if one believes in resurrection, that must come with a belief that God will restore decomposed bodies.

At a panel on end-of-life issues at B’nai David-Judea Congregation a few months ago, Reichman countered with another midrashic idea.

“There is a rabbinic tradition that there is one bone called the luz bone from which resurrection will take place,” he said, “so we will have a connection to the original body in which we lived. Rabbi Aryeh Kaplan has translated this midrash into contemporary understanding, saying one simply needs one strand of DNA.”

But there is also more solid ground for the perception that Judaism would frown upon organ donation: the very real halachic concept of kavod hamet, preserving the dignity of the body that housed the departed soul.

Cadavers are treated with honor, so that modesty is retained even during the ritual washing. The body is never left alone, and it is buried as soon as possible. Every effort is usually made to bury a person with all her body parts, even amputated limbs or spilled blood.

It is no surprise, then, that harvesting organs would seem to violate these precepts.

But everyone involved in the halachic debate surrounding organ donation agrees that all those laws must be overridden if it is a matter of pikuach nefesh, saving a life — considered one of the greatest mitzvot in Judaism, surpassing most commands.

Defining Death

The real debate revolves, then, around the halachic definition of death. All organs from cadavers are harvested when the donor is brain dead, but machines are keeping the donor’s heart beating and blood flowing, since organs begin to deteriorate as soon as they are deprived of oxygen.

The classic Talmudic definition of death is when a feather held below the nose doesn’t move, and when an ear pressed to the chest does not hear a heartbeat. The question then becomes how those criteria work into today’s medical technology.

In 1969, at the early stages of transplantation, the Conservative movement accepted cessation of brainstem activity as meeting the halachic criteria for death.

“The only reason why traditional criteria were the criteria was that was the state of medical science,” says Dorff, who discusses the topic in his book, “Matters of Life and Death: A Jewish Approach to Modern Medical Ethics” (Jewish Publication Society 1998).

In 1997 the Conservative movement passed a resolution declaring it a positive obligation incumbent upon Jews to sign a donor card and make their wishes known to family members.

The Reform movement likewise encouraged organ donation starting in 1968, and has made available extensive educational and programming material (see sidebar page 16).

In the Orthodox movement, the questions surrounding organ donation remains one of the most heated contemporary halachic debates, involving the top thinkers in the Orthodox world.

In 1991, the Rabbinical Council of America, an Orthodox umbrella group, weighed in, issuing a healthcare proxy form saying that brainstem death met the halachic criteria for death, and therefore making one’s organs available for donation was permitted and strongly encouraged. The RCA, under the scholarship of bioethicist Rabbi Moshe
Tendler, relied on the positions of the late Rabbi Moshe Feinstein and the findings of the chief rabbinate in Israel, which in 1989 declared organ donation permissible.

But the Agudath Israel of America, another Orthodox umbrella group, denounced the document, saying there were still too much debate to issue such a definitive answer. An article in the Jewish Observer in response to the RCA proxy cited several noted halachic authorities — including, they say, the late Rabbi Moshe Feinstein — who have held fast to the idea that a beating heart renders a person living, and thus removing organs from a patient on a respirator constitutes murder.

Agudath issued its own proxy that designates the patient’s personal rabbi to make the decisions, and it makes no declaration about organ donation.

There is more rabbinic consensus on live donation of kidneys, where halacha — much as secular bioethics — requires that the donor not be putting herself into mortal danger. Discussion still surrounds live donation of lobes of the lung or parts of the liver, which are newer to the medical field and have higher mortality rates than live kidney donations.

Taking Action

But most people who assume that organ donation is not within Jewish practice aren’t referring to the halachic debate, but rather to the deep-seated, very personal qualms inherent in the issue.

That is where several new educational initiatives are taking aim, trying to dispel superstitions, to move people toward dealing with an issue that can save lives.

Alan Septimus, a securities analyst in New York whose life was changed by a kidney transplant five years ago, founded Operation Pikuach Nefesh in 1997 to make organ donation a topic discussed in Jewish institutions.

He says he hasn’t run into anyone who is unwilling to host a speaker or run a program, but “it only becomes a priority if I find an institution that has been personally touched by the issue.”

Irving Goldberg founded Transplant for Life, an educational group that operates out of Temple Kol Tikvah in Woodland Hills, after his son underwent a successful pancreas and kidney transplant four years ago. Its primary mission is to encourage Jewish participation in the Department of Health and Human Resource’s National Donor Sabbath, a Friday, Saturday and Sunday set aside in November for organ and tissue donation awareness in churches, synagogues and other religious communities.

With Goldberg’s help, participation went from 14 Los Angeles area shuls a few years ago to 85 in 1999. Goldberg, who gets calls from all over the country, supplies written materials for Jewish program-ming for Donor Sabbath — or any other day — and a five-step process to ensure that organiza-tions and individuals can get involved (see sidebar below).

The topic is also gaining some high-profile support in Los Angeles, with the help of some Wexner Heritage Foundation alumni, a class of 20 leaders in the Jewish community, including several entertainment industry machers, who spent two years together studying Jewish history and culture. As a class project, the group is developing a discussion guide for the hundreds of powerful members of the Wexner network nationwide.

“Our hope is if we keep talking about it people will be challenged in an intellectual and personal way,” says Beth Comsky Raanan, a member of the class.

Discussion materials will also be available through Pikuach Nefesh, a new program Hadassah will launch at its international conference in Los Angeles in July.

“We will address the specific need for people to have a discussion with their families, so that everyone is on board,” says Nancy Falchuk, co-chair of Hadassah’s convention.

While the law does not require doctors to consult family members if a donor card is signed, most do, out of respect for survivors. But since so many people don’t discuss the issue with loved ones, in almost half the cases the family refuses to let the procedure go through.

Temple Beth Am, which has been touched personally by a member who donated a kidney to his wife, will hold a half-day seminar on the topic Sunday, June 11, starting at 9 a.m. (for information call 310-652-7353, ext. 223).

Septimus says the initiative for changing these facts must come from within the religious community, because that is where people turn for end-of-life issues.

For Septimus, who for years before his transplant was tethered to a dialysis machine 12 hours a day, transplantation is very much a religious issue, where the physical and the spiritual merge.

“Many of the prayers we say daily take on tremendous new meaning,” says Septimus. He quotes the part of the “Amidah” that praises God as a “supporter of the fallen, healer of the sick, liberator of the imprisoned.”

“I never thought of myself as a shackled slave, yet I had to be hooked up to a machine and have a needle in my arm to draw out my blood and have it cleaned. Our lives are very fragile,” Septimus says.

“Whether you believe God is Mechayeh HaMetim (Resurrecter of the Dead) or Mechayeh Hakol (Who Gives Life to All), whether you take it literally or figurative-ly,” Septimus adds, “certainly there is a greater understanding of what those prayers mean after we’ve seen ourselves become so vulnerable, and because of this phenomenal late 20th century innovation, restored back to a semblance of health.”


While organ donation remains a topic of sensitivity, all denominations agree that it is a mitzvah incumbent on healthy Jews to donate blood on a regular basis and to enter their names into a bone marrow registry. With American blood banks experiencing dangerous shortages, the mitzvah becomes even more urgent.

To make an appointment to donate blood, call the Red Cross at (800) GIVE-LIFE.

To enter a bone marrow registry, (800) MARROW-2, www.giftoflife.com.


A Godly Act

By Michael Gotlieb

Shortly after I graduated rabbinical school, I received a phone call. At the other end of the line was the voice of a woman wanting to donate an organ. Feverishly, my thoughts turned inward as I began rehashing the material taught to me in my biomedical ethics courses: when life stops, what Jewish law says, how to comfort the bereaved… “Rabbi,” she went on, ” would you send someone over from your congregation right away to pick it up?” That’s when I realized she had been referring not to her kidneys or corneas, but to her somewhat neglected, 30-year-old Wurlitzer.

As happy as I was to receive a Wurlitzer — and that the women was in fine health — I do wish more congregants would call me to discuss donating the other kinds of organs. It is, to be blunt, nothing short of a godly act.

Inexcusably, most people do not donate their organs once they pass away. Some refuse to donate out of the fear their body will be disfigured when the organs are harvested. But according to the U.S. Department of Health & Human Services, the procedure takes place in an operating room, guided by the hand of a skilled surgeon. When completed, it leaves the deceased donor neither disfigured nor altered in appearance.

Others, who wish to donate their vital organs after they die, often fail to properly inform their family and physician of their final request, thereby invalidating a potentially life saving contribution. Meanwhile, 64,000 Americans are included on an organ recipient waiting list; a list which grows larger every year. One-third of those listed will die before they receive a heart or liver.

If everybody eligible would routinely and clearly stipulate that his or her vital organs may be donated upon death, the waiting list for those in critical need would diminish significantly. Unless medically ill-advised, everyone has a moral obligation to be an organ donor.

Giving of one’s vital organs upon one’s death is an unsurpassed expression of love, precisely because the donor will never know the recipient. Furthermore, organ donation has the power to transcend ethnic and racial boundaries. The recipient is not concerned about whethe
r the compatible donor lived life as a Jew, Christian, Muslim, or secularist; whether he or she was rich or poor; black or white.

Ever since the courts ruled on Roe vs. Wade, our nation has debated the important moral question of when life begins. But in order to help save the lives of those who are in precious need of an organ transplant, it is also in our nation’s moral interest to address the question, “When does life end?”

Most major religious groups approve and support the principles and practices of organ donation based on the definition of brain death. Such a definition is an accepted medical, ethical, and legal principle. It is the standard by which our own Jewish religion determines life’s cessation; one that crosses most Jewish denominational boundaries.

According to a recent Gallup poll, fewer than 10 percent of Americans are aware of their own religion’s doctrines regarding organ and tissue donation. If that survey is correct, places of worship throughout the land must better inform their congregants of their religious duty to donate their organs. Though religions may differ on many issues, most agree: Organ donation is one of the highest forms of preserving and caring for one’s fellow human being.

While the Bible makes no specific mention of organ transplants, its timeless content alludes to it in principle. The story of creation portrays God taking a rib from Adam, and thereby creating Eve. No doubt, the story is allegorical and not intended for a literal interpretation. Nonetheless, it suggests that God both gives and enhances life, in essence, by transplanting one part of a human being into another. As God does, so ought we.

In the final analysis, the good that comes from organ donation is that which it teaches humanity the world over: All of us are made of one flesh, all of us are truly children of God.


Michael Gotleib is senior rabbi at Kehillat Maarav in Santa Monica