Organ and Tissue Donation - HealthCare Chaplaincy Donation-All... · with the ruling of Rabbi Moshe...
Transcript of Organ and Tissue Donation - HealthCare Chaplaincy Donation-All... · with the ruling of Rabbi Moshe...
© HealthCare Chaplaincy1#
Organ and Tissue Donation:
Medical Facts,
Ethical Challenges, and
Religious Perspectives
Rabbi Charles Sheer
Director, Department of Studies in Jewish Pastoral Care College of Pastoral Care
HealthCare Chaplaincy
© HealthCare Chaplaincy2#
What we’ll cover in this
presentation:
The NEED for organs and tissue donations
The PROCESS of organ procurement
The CHALLENGES that inhibit donation
The PERSPECTIVES of religious communities
on organ donation
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Acknowledgement
I wish to thank
The New York Organ Donor Network for
assisting in the development of the format
and content of this presentation.
The Organ Procurement and Transplantation
Network for data and statistics.
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The Essential IssueNeed for Organ Donation in U.S.
5,824 5,985 6,080 6,190 6,457 7,150 7,593 8,025 8,090 7,990*
69,55076,005 79,226 80,666
84,333 88,149 91,53294,276 97,782
100,811
17,008 17,332 17,635 18,65518,290 20,04422,20521,211 22,049 21,768*
0
20,000
40,000
60,000
80,000
100,000
120,000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Deceased Donors Waiting List Transplants Performed (Dec'd Donors)
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The waiting list…as of 1:05 PM
on May 5, 2009
Total candidates: 101,988
Liver 15,825
Kidney 79,683
Total: 95,508
Source for all data: Organ Procurement and Transplantation Network (OPTN)
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Transplants performed in 2009,
January and February
Transplants performed
Total: 4,519 Deceased donor: 3,515
Living donor: 1,004
Donors
Total: 2,301 Deceased donor: 1,298
Living Donor: 1,003
QUESTION: How could there be more transplants than donors?
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Organs & Tissues
That Can Be
Transplanted
Intestines
Corneas
Liver
Bone
Skin
Tendons
Heart & Heart Valves Lungs
Femoral Veins
Saphenous Veins
Pancreas
Kidneys
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One Year, Five Year
Graft Survival
0
10
20
30
40
50
60
70
80
90
100
1 YEAR 5 YEAR
Kidney C
Kidney L
K-P (P)
Liver C
Heart
Lung
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NATIONAL ORGAN TRANSPLANT
ACT of 1984 (NOTA)
Single nationwide network (OPTN)
Private & non-profit under Federal Contract
(UNOS)
Transplant Centers and OPO’S must be members
of OPTN to receive Medicare reimbursement
OPO’S required to be non-profit
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What Are the Responsibilities of an
Organ Procurement Organization?
Handle all organ & tissue donor referrals
Donor evaluation, donor management
Family counseling, consent process
Surgical recovery of organs & tissues
Matching of organs to recipients
Transportation of organs to transplant centers
Hospital development & professional education
Public education
Donor family aftercare
Public policy
Data entry, management, & dissemination
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Finding a Needle in a Haystack: In the best of circumstances, very few
organs are acceptable for
transplantation
Organs Tissues
Hospital Deaths 56,000 56,000
Screened-in 1,200 5,300
Medically Suitable for Donation
607 3,473
Donors (year 2008)
251 699
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HOW LONG CAN AN ORGAN
REMAIN VIABLE ONCE
RECOVERED?
Heart 4 hours
Liver 12 - 18 hours
Lungs 4 hours
Pancreas 8 - 12 hours
Kidneys 24 - 48 hours
Intestines 8 hours
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ORGAN MATCHING CRITERIA
Medical urgency
Tissue match
Blood type
Waiting time on list (for kidneys)
Organ size
Immune status
Geographic distance
Done by national computer list at UNOS
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THE MAIN OBSTACLE TO ORGAN
TRANSPLANTATION IS, of course,
The insufficient number of organs
donated for transplantation.
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One Year, Five Year
Graft Survival
0
10
20
30
40
50
60
70
80
90
100
1 YEAR 5 YEAR
Kidney C
Kidney L
K-P (P)
Liver C
Heart
Lung
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AFTER DONATION:
Studies Show That…
„ 85 ‟ 98% of families who consented to donation felt it had a positive impact during their time of grief
„ All respondents had no regrets regarding their decision to donate
Batten HL, Prottas JM. Kind strangers: The families of organ donors. Health Aff 1987: 37: 35-47.
Bartucci MR. Organ Donation: A study of the donor family perspective.
J Neurosci Nurs 1987: 19(6): 305-309.
Savaria DT, Rovelli MA, Schweizer RT. Donor family surveys provide useful information for
organ procurement. Transplant Proc 1990: 22(2): 316-317.
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Annual Consent Rates ‟ NY
Metro 2003 - 2008
57%58%56%
48%47%41%
0%
10%
20%
30%
40%
50%
60%
70%
80%
2003 2004 2005 2006 2007 2008
GOAL = 75% CONSENT RATE
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But in actual practice, only 8%
of New Yorkers are on the State
Donor Registry, compared to…
70% in Utah
69% in Oklahoma
68% in Indiana
67% in Arkansas
66% in Minnesota
65% in Virginia
65% in New Mexico
61% in Georgia
61% in N. Dakota
60% in Ohio
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Potential Donor Profile Has
Changed
IN THE GREATER NY METROPOLITAN REGION:
Trauma patients are only 22% of organ donors
(39% nationally)
54% of donors are over 50 (35% nationally)
21% of donors are over 65 (10% nationally)
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Religious faiths ‟
their perspectives on
organ donation and transplantation.
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The Catholic position
Address of John Paul II
to the 18th International Congress
of the Transplantation Society
29 August 2000
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Cardio-respiratory vs.
neurological death
…once death occurs certain biological signs inevitably follow, which medicine has learnt to
recognize with increasing precision.
…for some time certain scientific approaches to
ascertaining death have shifted the emphasis from
the traditional cardio-respiratory signs to the so-
called "neurological" criterion.
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Catholic definition of death
…the death of the person is a single event,
consisting in the total disintegration of that unitary
and integrated whole that is the personal self. It
results from the separation of the life-principle (or
soul) from the corporal reality of the person….
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Science and religion
…the Church does not make technical
decisions…. the criterion adopted in more recent
times for ascertaining the fact of death, namely the
complete and irreversible cessation of all brain
activity, if rigorously applied, does not seem to
conflict with the essential elements of a sound
anthropology.
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Full Catholic support for organ
transplantation
Transplants are a great step forward in science's
service of man, and not a few people today owe
their lives to an organ transplant. Increasingly, the
technique of transplants has proven to be a valid
means of attaining the primary goal of all medicine
- the service of human life.
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The Position of Islam
Holy Qur'an 5:32:
'That if anyone kill a person, unless it be for murder
or for spreading mischief in the land, it would be as
if he killed the whole people; and if anyone save a
life, it would be as if he saved the life of the whole
people.'
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An Imam’s Perspective
Sheikh Omar S. Abu-NamousImam, Islamic Cultural Center of New York
New York City
“An organ donated is an ongoing charity”
From “On the Beat,” NYODN, Fall 2003
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Imam Abu-Namous
Islamic juristic academies and fatwa (juristic
opinion) bodies in the Muslim world, including the
Islamic Organization for Medical Sciences based in
Kuwait, are agreed on the permissibility and
lawfulness of donating organs to patients whose
survival or cure vitally depends on them
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The Imam’s teaching:
An organ donated is an ongoing charity that will
continue to be rewarded as long as the donated
organs live.
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Jewish attitudes towards death ‟
how that impacts on organ donation
Judaism requires that the entire body be buried, and that a funeral take place as soon as possible after one’s demise.
Judaism prohibits deriving material benefit from a corpse or doing anything to it that might be considered a desecration.
On the other hand,
“Pikuah Nefesh” ‟the saving of a life ‟ trumps all other
considerations…
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Some Jews hold that only total and irreversible
cardio-respiratory failure is death.
The question for Jewish law: if neurological death
(“brain death”) is NOT considered death in Jewish
law, then Judaism would prohibit the removal of an
organ from a “brain dead” person.
“Pikuah nefesh” does not trump murder.
Except for three things: sexual
immorality, idolatry and murder.
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Rabbinical Council of America
(Orthodox)
In the United States, the RCA in 1991 issued a statement as
follows:
“The saving of a life takes precedence over all but three
imperatives.... Accordingly, no barriers exist to donation of
the organs of the deceased….after the patient has been
declared dead by a competent neurologist…. In accord
with the ruling of Rabbi Moshe Feinstein and of the chief
rabbinate of Israel, brain stem death, together with other
accepted neurological criteria, fully meets the standards of
halacha for determining death. Since organs that can be
life saving may be donated, the family is urged to do so.
When human life can be saved, it must be saved.
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Conservative Judaism on
Organ Donation
The Rabbinical Assembly Committee on Jewish
Law and Standards has ruled that one is obligated
to permit post-mortem transplantation of his or her
organs in life-saving medical procedures and that
withholding consent for such organ donation is
contrary to Jewish law.
(From the Rabbinical Assembly Committee on Jewish Law and
Standards, 1990 responsum by Rabbis E. Dorff and A. Reisner,
published in “Conservative Judaism,” spring 1991.)
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Reform Judaism
A responsum was adopted in 1968 affirming the
legitimacy of organ transplantation as an act of
holiness and “pikuah nefesh” (the saving of a life)
Reform synagogues annually mark Donor Sabbath
and active campaigns encourage members to
register as organ donors
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The Chief Rabbinate of Israel
and recent RCA review
The Israeli Chief Rabbinate has repeatedly ruled
that neurological death is death.
However, some rabbis in Israel and in the U.S. only
consider cardio-pulmonary death as death.
The RCA is currently reviewing its position on brain
death given the varying opinions which have been
issued by rabbinic decisors. A new statement may
be issued reflecting the differing positions with
Orthodoxy.
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A Protestant perspective:
Rev. Dr. James A. Forbes, Jr.Former Senior Minister
The Riverside Church of New York City
A Gift that Models Divine Compassion
…with only a few exceptions, all of the major religions affirm
and celebrate the godliness of organ and tissue
transplantation. Words like caring, sharing, compassion, and
sacrifice are at the heart of true religion.
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His theological imaging of
organ donation
The cross, a central Christian symbol, is about
Jesus giving himself for the salvation of the
world…. With this understanding, becoming a
donor takes on sacramental meaning. Organ and
tissue donation is considered to be the ultimate
humanitarian act of benevolence.
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The Golden Rule and
Organ Donation
The opportunity to donate organs and tissues may
be one of the most effective ways to counteract
the pervasive selfishness of these modern times.
The golden rule urges us to think and act from the
perspective of what we would desire of others if
we were similarly situated.
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For more information about
religious communities and organ
donation
The New York Organ Donor Network website has
statements from over thirty religious communities
regarding their position on organ donation
(www.donatelifeny.org)
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For further information about
organ/tissue donation
New York Organ Donor Network
www.donatelifeny.org
Organ Procurement and Transplantation Network
www.optn.org