An Issue That Can Try Body and Soul
For Los Angeles screenwriter Robert Avrech, it was a wrenching choice between two of his greatest loves: his Orthodox Jewish faith and the life of his only son.
His son, Ariel, is in critical need of a lung transplant. Avrech knew of a man who had just collapsed on a softball field and was in a coma. But Avrech, guided by his religious and moral compass, would not approach the family about a possible organ donation.
It seemed “ghoulish,” he said. He saw a slippery slope that would turn the desire for healing and life into a morbid wish for death to harvest organs. Wouldn’t that make him no better than a Nazi?
Even after the man eventually died, Avrech still declined to approach the family, for he says his Jewish values, particularly the need to show reverence to the body and respect for mourning, overrode even his own desperate desire to save his son’s life.
“It’s a difficult situation for me, because I want to save Ariel’s life,” Avrech said slowly, his voice weighted with emotion he does not try to hide. “But there are worse things than death, like leading an immoral life.”
Avrech’s case underscores the sometimes wrenching dilemmas--and vast divergence of belief--that occur in the religious world over the issue of organ donations.
All religions cherish the value of saving lives, but questions of when death begins and when donated organs may be used have raised a thicket of moral issues.
In Japan, for instance, an ancient religious belief that cutting a corpse defiles the individual’s spirit has severely hampered organ donations. Not until 1997 did the nation recognize brain death as legal death, becoming the last advanced industrial nation to move away from the idea that death occurs only when the heart and lungs cease working. In part, the hesitation stemmed from beliefs among some Buddhist schools of thought that transplants from the brain-dead would deprive a soul of reincarnation.
The Roman Catholic Church, by contrast, has an “upbeat, positive attitude” toward organ donation, said James Walter, the O’Malley professor of bioethics at Loyola Marymount University in Los Angeles. At St. Francis Medical Center in Lynwood, he said, a pastoral care team broaches the subject of donations with families as early as the onset of brain death. As a result, the Roman Catholic hospital is one of the largest sources of organ donations in Los Angeles County, he said.
The positive Catholic tradition stems from the 1940s, when theologians began promoting organ donations as an act of charity, “the willingness to sacrifice for the sake of other people,” Walter said.
Officials turned to the concept of charity to legitimize donations, because the church until then had frowned on mutilating the body except for the purpose of benefiting the greater whole--amputating a gangrenous limb, for instance. That “principle of totality,” sacrificing a part for the whole, could not be used to justify donations lest it open the door for totalitarian societies, for instance, to claim ownership of people’s organs. So a new principle--personal acts of voluntary charity--had to be established, Walter said.
Within Islam, organ donations are encouraged under the Koranic exhortation that “whoever gives life, it is like giving life to all human beings,” said Maher Hathout, a retired Muslim physician and member of the Kuwait-based Islamic Medical Conference. The group affirmed organ donations as an act of charity several years ago, he said, stipulating that organs were not to be bought and sold and that living donors could not endanger themselves in offering organs. He added that Muslim scholars have also affirmed the use of organs from pigs--a growing supply source--despite prohibitions against eating pork.
In the Jewish world, debate rages between religious movements and even within them.
“To many people the issue of organ donations is very emotion-laden,” said Rabbi Yitzchok Adlerstein, a professor of Jewish law at Loyola Law School in Los Angeles. “Unless you have a very, very definite cause, and usually an immediate need, Judaism attaches a high value on keeping the body intact.”
Adlerstein said that entrenched value explains why crews in Israel can be seen gathering up the body pieces of a victim killed in terrorist blasts, for instance, to ensure a proper burial. There is also a folkloric belief that the body should be intact for resurrection after death, he and others say.
Those attitudes, however, appear to be changing in at least some sectors of Judaism. In 1995, legal scholars from the Conservative movement, the Jewish grouping with the highest number of U.S. synagogue members, approved a rabbinical ruling that not only declared organ donations permissible but said they were an obligation under Jewish law.
“Saving a life takes precedence over the general principle that honor is due to the dead body,” said Rabbi Elliot Dorff, an expert in bioethics at the University of Judaism in Los Angeles and author of “Matter of Life and Death: A Jewish Approach to Modern Medical Ethics.” He added that organ donations in fact constitute honor to the dead body and give meaning to the death of loved ones for grieving families.
Since the 1995 decision to deem organ donations a religious obligation, many Conservative temples have promoted them through sermons, fliers and distribution of donor cards, said Rabbi Bradley Shavit Artson, dean of the Zeigler School of Rabbinic Studies at the University of Judaism.
The issue, however, remains highly controversial within Orthodox Judaism. Rabbis from opposing camps continue to vociferously debate when death begins-- at the cessation of neurological functions, known as brain death, or when the heart and respiratory systems fail. The definition is key to organ donations, because doctors using heart-lung machines can keep those systems working a long time. Rabbis also disagree about whether there is consensus on the issue within Orthodoxy and about the scope of a late 1980s decision by the Chief Rabbinate of Israel that accepted brain death as the standard and paved the way for heart and liver transplants.
Rabbi David Bleich, a professor of the Talmud at Yeshiva University in New York, said the vast majority of Orthodox scholars reject the brain-death standard. Traditional Jews cannot be party to pulling the plug on a patient before the heart and respiratory functions stop, he said. He added, however, that Orthodox Jews could receive organs extracted from brain-dead patients as long as they had nothing to do with obtaining them. Bleich also criticized the Chief Rabbinate’s decision, saying it relied on “erroneous information” in making its ruling.
That position provokes a withering rebuttal from Rabbi Moshe David Tendler, a professor of medical ethics and chairman of the biology department at the same Yeshiva University. He said Jews who reject brain death should not then be able to harvest organs from brain-dead patients, or they would be akin to “hit men” waiting for others to kill someone so they benefit. Tendler accepts brain death as the standard and maintains that organ donations are required by Judaism. He said that only “inconsequential scholars” disagree with him.
As the debate rages, Ariel Avrech needs new lungs. At minimum, he needs donations of two lung lobes, which can be extracted in what medical experts regard as a relatively safe procedure.
The 21-year-old rabbinical student suffers from pulmonary fibrosis, a severe scarring of the lungs caused by massive chemotherapy he has undergone since being diagnosed with a brain tumor at age 14. In May, his breathing functions deteriorated so rapidly that he was forced to return to Los Angeles from his rabbinical studies in Baltimore.
Most of the time, Avrech is attached to an oxygen machine. He tires easily, and can no longer devote his customary nine hours a day to his beloved Talmud study--managing only an hour at most these days. The soft-spoken, self-contained student, who wears a black velvet yarmulke and white tassels as a reminder of the commandments, spends most of his time now in prayer, with doctors or receiving a stream of phone calls and visits from well-wishers.
Homebound, Avrech also serves as a culinary guinea pig for his father, who has learned to cook for his son--aspiring to move from George Foreman grill items to fancy concoctions like Portobello Napoleon. They spend hours watching DVDs together--most recently, howling over a documentary on a Thai Elvis impersonator. Avrech says his son, who has endured his illnesses without complaint, has become his hero.
“I don’t know if this is God’s intention, but Ariel and I know each other better and love each other more than ever before,” said the elder Avrech, his eyes filling with tears, “I wish Ariel weren’t ill, but I’m going to take advantage of it.”
The family’s Orthodox community has rallied around them. Members of Avrech’s synagogue, Young Israel of Century City, have brought food, gifts and even daily services to his home during the High Holy Days. The Jewish Healthcare Foundation has distributed an e-mail on Avrech’s plight throughout the Americas, Europe, Brazil and Israel. The appeal, a “Life-Saving Search for a Living Lobar Lung Transplant Donor,” says the suitable donor would be an adult male, age 18-50, 5-foot-8 or taller, blood type A or O, a nonsmoker and non-asthmatic in good health.
So far, more than 20 potential donors have stepped forth. But few, if any, appear to meet the qualifications--including a New York man, 75, who had donated a kidney before and was now eager to offer Avrech a lung lobe. As time ticks by, the family is reaching out to the broader community.
For his part, Ariel Avrech says his ordeal simply represents the unique challenges God presents everyone, challenges that have helped him grow. He focuses not on his pain but the beauty and godliness his illness has elicited.
“People have displayed tremendous courage, bravery and generosity, and they wouldn’t do this if I weren’t sick,” he said. “I see all of the beautiful things coming out in this world because of me.”
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Those wishing to help can contact the Jewish Healthcare Foundation (Bikur Cholim) at (323) 852-1900.
