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Published by: outdash2 on Oct 20, 2013
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RABBI DAVID SHABAI, MD
 Donation After Cardiac Death: Halakhic Perspectives
Virtually all halakhic decisors agree that donating liesaving organs ater death is certainly permissible; most view itas appropriate and commendable. While the orah proscribesdesecrating a corpse, this prohibition, like almost all others, isset aside in the context o lie saving. aking a lie-sustaining organ rom a living person, however, would kill the donor, andeven though done or the noble purpose o 
 pikuah neesh
, mur-der is an exception to the general rule. Murder is never permit-ted, regardless o the reasoning or rationale. We are thus let with harvesting lie-sustaining organs only rom the dead.Most transplanted organs are harvested rom braindead patients, with the assumption being that a brain dead pa-tient is dead. While accepted by US law, the halakhic status o brain death is debated.
1
Since vital organs are in high demandbut short supply, eorts are also being made to harvest trans-plantable organs rom patients declared dead by the traditionalcardiopulmonary criteria (when the heartbeat and respirationsirreversibly cease). Tese eorts have spawned various dona-
1 Te interested reader is directed to this author’s
Defning the Moment:Understanding Brain Death in Halakhah
(New York: Shoresh Press, 2012)or a more in depth discussion.
Rabbi David Shabtai, MD is a ellow o the Wexner Kollel Elyon andteaches medical halakhah at the Rabbi Isaac Elchanan TeologicalSeminary. He is the author o 
Defning the Moment: Understanding Brain Death in Halakhah
.
 
Verapo Yerape 
272
tion ater cardiac death (DCD) protocols, which try to balancea proper moral and ethical determination o death with thetransplant viability o harvested organs. Te scientifc, ethical,and legal rameworks or DCD protocols, in both controlled(cDCD) and uncontrolled (uDCD) settings, were examinedby R. Bardos. Tis article will analyze some o the halakhicaspects and questions involved in donating organs ater cardiacdeath.
Reversibility
Almost all halakhic decisors incorporate irreversibility in their criteria or determining death.
2
A person cannot bedeclared dead by virtue o his heart stopping and cessation o breathing when these unctions can return. Death is defnition-ally fnal and can only be determined when respiration and car-diac unction irreversibly cease. Tis is not a modern notion.Rambam already notes that beore starting burial preparations,one must “wait a short while (
 yishheh me’at 
) or ear that theperson has merely ainted.”
3
 
Hatam Soer 
explains that Ram-bam was concerned that while a person may appear to current-ly not be breathing, this does not necessarily mean that respira-tions have irreversibly ceased. It is very possible that they mightreturn, and a defnitive determination o death must wait untilsu cient time has passed to rule out that possibility.
4
Determining what “irreversibility” means may enor-mously inuence the practical determination o death. Whatmust not be reversed and in what timerame? Must irrevers-ibility be practical or merely theoretical? Tese questions play a major role in analyzing the halakhic parameters o donationater cardiac death protocols. 
2 C.
Teshuvot Ateret Paz 
(1 vol. 3,
EH 
9), however, who discusses the poten-tial ramifcations o viewing resuscitation as revival rom the dead.3
Hilkhot Avel 
4:5.4
Teshuvot Hatam Soer 
,
YD 
338.
 
273
Donation Ater Cardiac Death: Halakhic Perspectives 
Uncontrolled Donation After Cardiac Death
Uncontrolled donation ater cardiac death (uDCD)protocols apply to a person who has just suered a cardiacarrest and or whom emergency medical technicians (EMs)have attempted resuscitative measures but were unortunately unsuccessul. Ater CPR has stopped and death is declared, theuDCD protocol may come into eect. EMs can contact anorgan preservation unit, whose purpose is to try to maintainthe transplant viability o the organs o the recently deceasedpatient. Te mechanisms o preserving the organs include or-cing blood to continue to circulate within the dead body by attaching a “thumper” to the person’s chest, which mechani-cally and repeatedly presses on the chest, orcing blood outo the heart throughout the circulatory system. Oxygenationis also provided artifcially through a bag valve mask (Ambubag) or a mechanical ventilator in order to allow the bloodow to contain necessary oxygen. R. Bardos discussed some o the ethical issues involved in stopping CPR, obtaining consent,and initiating the organ preservation methods. Te ollowing analysis will relate specifcally to some o the halakhic aspectso determining this patient’s death and preserving his organs;the halakhic analysis o these other issues is beyond the scopeo this paper.
 A. Death by Irreversibility ried and Failed Resuscitation
In uDCD, the question o whether or not the patient isdead is not overly complicated. Once resuscitative eorts havebeen deemed to have ailed, the patient’s heartbeat and respira-tion can certainly be described as having irreversibly stopped;there is no chance that this patient will ever breathe again onhis own or that his heart will ever beat again. I that possibility existed, we can assume that they would have already returned with proper resuscitative measures. Since they have not recov-ered, it is clear that they have both irreversibly ailed. Only aterthis determination do the EMs initiate the organ preserving 

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